Frenectomy, explained.

The lingual frenum connects the tongue to the floor of the mouth. When it is too tight, the result is what is usually called a tongue tie.

The labial frenum connects the lip to the gum. When that one is too tight, it is called a lip tie.

A short or tight frenum of either kind can also make oral hygiene difficult to practise, or cause pain and discomfort in its own right.

A frenectomy of a tongue tie may be needed where there is difficulty with breastfeeding, with feeding generally, or with speech development.

A frenectomy of a lip tie may be needed where there is limited lip movement, gum recession being pulled by the frenum, or a gap between the front teeth that the frenum is holding open.

At the consultation we work through each of these deliberately: limited lip or tongue movement, breastfeeding difficulty, speech problems, gum recession, and a midline gap. Where breastfeeding is the concern, a lactation consultant is involved alongside us — the assessment is not ours alone to make. Where a midline gap is the concern, the timing is set by your orthodontist or dentist, who will have referred you at the right point in treatment.

Once you have decided to go ahead, you do not need to fast or change your diet the day before or the day of. You simply arrive.

The exception is sedation. If sedation is planned, stop eating and drinking at least six to eight hours beforehand, and arrange a lift both ways — the medication for pain and discomfort makes driving unsafe.

Discuss your chronic medication and any supplements with us beforehand, particularly omega 3 and omega 6, so we can rule out an excessive bleeding risk.

Once the area is numb, the frenum is carefully cut or modified — using a scalpel, surgical scissors, a laser or electrosurgery, depending on the case. In some cases stitches are needed to close the wound.

It is usually short, around thirty minutes, though that depends on how many frena need releasing and how large the attachment is.

You are numb during the procedure, so you feel nothing at the time. Afterwards, expect mild soreness, some swelling and possibly minor bleeding. The area generally starts healing within a day or two, and we review the site at about two weeks.

A yellow-white membrane will appear over the area while it heals. That is normal and not a sign of infection — it catches people out, so it is worth knowing in advance.

The full post-operative instructions for a frenectomy set out the first day, the first week and the second week, and we give you the same sheet before you leave.