Frenectomy
What is a Frenectomy?
A frenectomy is a procedure that consists of releasing the frenum, a band of fibrous tissue, under the tongue or upper lip to allow for better range of motion. Children may be born with a combination of conditions called a tongue-tie (ankyloglossia) and/or a lip-tie causing restrictions in movement that can cause difficulty with breastfeeding, and in some instances, other problems like dental decay or spacing, speech and airway difficulties, and digestive issues. These issues can generally be corrected by a simple procedure done with our soft tissue laser.
Laser Frenectomy – How Does It Work?
A soft tissue laser does NOT cut; it is more a “vaporization” of tissue that occurs with light energy. There is very little discomfort with the laser. There is almost no bleeding from the laser procedure. Lasers sterilize at touch and therefore have less risk of infection. The healing is very quick; a laser stimulates bio-regeneration and healing.
Tongue-Tie – What Does It Really Mean?
Ankyloglossia, or tongue-tie, is the restriction of tongue movement as a result of fusion or adherence of the tongue to the floor of the mouth. A tongue-tie is therefore caused by a frenum that is abnormally short or attached too close to the tip of the tongue.
Normal tongue function is important for multiple reasons. Among the many benefits, normal tongue function will allow a baby to latch adequately and breastfeed efficiently, promote normal speech development, make it possible for a child to self-cleanse the mouth during eating, allow adequate swallowing patterns, and allow for proper growth and development. Challenges that can occur with a tongue-tie:
- Inability to latch
- Inability to open mouth widely and therefore affecting speech and eating habits
- Inability to speak clearly when talking fast/loud/soft
- Clicking jaws
- Pain in jaws
- Protrusion of the lower jaws, inferior prognathism
How Can A Lip-Tie Affect My Child?
A lip-tie occurs when the upper lip remains attached to the upper gum. Challenges that can occur in children and infants with moderate to severe lip-ties:
- Spacing between the maxillary central incisors; a large gap can form called a diastema
- Difficulties with brushing and flossing
- Increased risk of dental decay
- Repeated trauma to the maxillary frenum because it is so low and prominent
- Pain with breastfeeding
- Inability to adequately move the maxillary lip upward during breastfeeding, affecting an infant’s latch and ability to create a good seal.
Why Have the Tongue-Tie and / or Lip-Ties Released for My Baby?
- To help make breastfeeding more successful
- To help relieve the pain of breastfeeding and regain healthy nipples and breasts
- To stimulate milk production by adequate stimulation
- To help achieve satisfactory bonding between a mother and her baby
- To ensure adequate feeding and growth of the baby
- To avoid serious long-term issues with palatal development, teeth spacing, dental caries, speech impairments and social stigma
What Can I Expect After the Laser Frenectomy Is Done?
Breastfeeding immediately after the procedure is encouraged as breast milk contains amazing healing properties and the simple act of breastfeeding will reassure and soothe the baby. Oftentimes there is an immediate improvement. It is possible that latching may be a struggle at first since we are using a small amount of anesthetic to complete the procedure. The numbness will wear off about 30-45 minutes after the procedure. Do not be alarmed if latching is difficult at first. We recommend to be thorough with the prescribed post treatment exercises and to work with the lactation consultant and possibly a bodyworker (cranial sacral therapist, pediatric chiropractor, etc.) to increase the chances of success.
Typically, no pain control is necessary but you may use Tylenol, Ibuprofen (if 6 months of age or older) to help with discomfort. Starting a few days after the procedure, the wound(s) will look gooey white and/or yellow in appearance. This is a completely normal way the mouth heals.
Frequently Asked Questions
Q: Are the doctors in the office trained for this procedure?
A: Yes. Rest assured that during their pediatric dental residencies our pediatric dentists have been trained how to do these procedures quickly and expertly with the use of laser technology.
Q: Do I need a referral from another doctor?
A: No. However, we recommend that you have an evaluation with a lactation specialist, IBCLC, prior to making an appointment for your baby. In addition, if you do have additional diagnostic information from another provider, we encourage you to share that with the doctor during the exam visit.
Q: How young is too young to have my baby evaluated for a lip or tongue tie?
A: It is never too young to have your baby evaluated. We examine newborns all the time. Sometimes babies are only a day old. It is best to have a frenectomy, if it is indicated, at a younger age rather than waiting since your baby can form habits and compensations which may require your baby to have additional therapy. In some cases, additional therapy is needed to fully rehabilitate the oral-facial structures regardless of the age.
Q: Will the first visit be considered a consultation or an exam visit?
A: It will be an exam visit since it does include a physical examination of the oral cavity, which is needed for full diagnosis and treatment plan recommendations.
Q: Will just having the surgical procedure conducted on my baby help correct my breastfeeding issues?
A: Caring for you and your baby is truly a team effort and we highly recommend that you continue to work with your lactation consultant (IBCLC). For some babies, if there are no other problems with the cranium, head, neck, or back, and if your baby is a newborn at the time of the frenectomy, the likelihood of additional nonsurgical therapy is low. However, if there are other problems contributing to an improper latch, changing the anatomy of the frenum (lip tie or tongue tie) by surgical removal alone will not fully alleviate all the symptoms. Some babies require additional therapy, i.e speech language pathology therapy for suck, swallow, range of motion, lateralization of tongue, strengthening training, craniosacral therapy to release tensions deep in the body to relieve pain and dysfunction, chiropractic treatment for possible nerve interference and to correct subluxation/misalignment that may exist.
Q: Will any pain medication be given to my baby before conducting the procedure?
A: In most cases, yes. Our doctors will address this question in a more individualized way once we have examined your baby. For older children, and adolescents topical and local anesthetic are used for comfort during the procedure.
Q: Can I breastfeed my baby prior to the procedure?
A: Yes, you can, however if you are planning on having the surgery done in the same visit, we recommend you wait until after the procedure is completed to prevent regurgitation and possible aspiration of the milk by your baby.
Q: How long does the appointment usually last?
A: Allow about 30 minutes for the examination, giving you all the information about the procedure, and answering questions you may have. Usually the more informed you are prior to visiting our office, the shorter the appointment is but we encourage questions even if you think you know everything about tongue-tie and lip-tie laser revision. The frenectomy itself will take no more than a couple of minutes.
Q: Am I allowed to stay in the room with my baby while the procedure is being conducted?
A: For safety reasons, we will ask that you wait in our reception area during the procedure. In addition, our doctors prefer to focus fully on your baby so that we may finish the procedure quickly. We invite you to trust us and know we will take care of your baby. An assistant and doctor will be present in the room with your baby at all times. Because this is a surgical procedure involving a laser, protective eyewear is required. Your child’s eyes will be covered with a towel during the procedure. Immediately after the procedure a member of our staff will escort you to the room where the procedure was performed and we will have you comfort your baby and have you try to nurse or feed your baby with a bottle. Most times mothers see an immediate improvement in feeding.
Q: Will my baby bleed extensively on the area being revised?
A: Usually not. Since the laser cauterizes blood vessels of the area being revised there usually is minimal or no bleeding observed. If there is, it is minimal and by the time your baby is in your arms there is typically no longer any bleeding visible.
Q: Is my baby going to be in pain after the procedure? What can I use for pain management?
A: On the day of the procedure babies don’t usually experience discomfort. The discomfort usually sets in on day two and can last up to day five post-revision. However, every baby is unique and therefore every baby experiences the healing process and the level of discomfort differently. We recommend skin to skin contact with your baby, allow your baby to latch on you as much as possible whether for feeding or just for soothing/comfort. You can freeze some breast milk and place small shavings of it in your baby’s mouth and allow it to melt. In addition, based on your baby’s weight, you will have a calculated dose of infant’s Tylenol in your post-op instructions should your baby develop a mild fever or need it for pain management.
What else can I expect post-revision?
A: Some babies may sleep more in the days following the revision and breastfeed less often, we suspect this is their way of dealing with the healing process. Some babies may have shorter and more frequent breastfeeding episodes. You may notice a great latch on the day of the revision and then not as great during the days following the revision due to soreness setting in and new oral musculature starting to be used post-revision when the tongue has more freedom to move. Many times, the tongue needs time to adjust or even needs re-training if it has been compensating for a while. Remember, sucking begins in-utero so even though your baby may be a newborn, he/she may still need time to adjust or he/she may need to have therapy to strengthen the oral musculature.
In addition, your baby may also cry during the stretching exercises and this is normal considering you are stretching tissue in an open wound. You may see minimal bleeding during the exercises but this is usually not a concern since it stops quickly, very few parents have reported bleeding. Increased drooling has been observed as a side effect of the surgery but it returns to normal as the wounds heal.
Q: Does my dental insurance cover the procedure?
A: We have found that there are a lot of inconsistencies around insurance companies and coverage for frenectomies. Because of this, the fees for the procedure are due in full at the time of the appointment. We will still submit to your dental insurance and if any payment is made, it will go directly to you as the subscriber. We highly recommend you contact your insurance plan and ask about coverage for the procedure. When contacting your insurance plan, have them look at dental coverage. Please understand that we file dental claims as a courtesy. We are not responsible for how your insurance plan handles its claims or for what benefits they pay on a claim.
Q: Can you bill my medical insurance?
A: Our office will not be able to bill to your medical insurance. We are not contracted with, nor do we file claims to any medical plans. You may be able to bill your medical insurance on your own. If your insurance approves and reimburses for all or part of the procedure, they will reimburse you directly.
Here is some information that you may need while seeking coverage information:
Dental Insurance Codes for Reimbursement: ADA Code
D 0140 – Limited Oral Evaluation – Problem Focused
D 7960 – Frenulectomy (also known as frenectomy or frenotomy)
(The code for the frenulectomy is the same for the Upper Maxillary Labial Frenulum (UL) and the Lower Mandibular Lingual Frenulum (LL). Depending on your dental insurance carrier they may require certain descriptive words to differentiate between the arches, either upper (UL or UA) or lower (LL or LA).
Medical Insurance Codes for Reimbursement: ICD 10 and CPT Codes
ICD 10 Code: Diagnosis of Ankyloglossia (Tongue tie) Q38.1
ICD 10 Code: Diagnosis of Restricted Labial Frenulum (Lip Tie) Q38.0
Procedure CPT Code: Labial or Upper Lip Frenulum / Frenotomy: 40806 or 40819
Procedure CPT Code: Lingual or Lower Tongue Frenulum / Frenotomy: 41010