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Are Frenectomies Over Prescribed?

Dr. John T. Hansford Jr. is a double-board certified specialist in pediatric dentistry and dental anesthesiology. Opinions expressed are those of the writer.

  1. A 2023 New York Times article suggests that some infants and children may be undergoing unnecessary surgery to address tongue ties. The article states, “Tongue releases done in hospitals grew more than 800% nationally between 1997 and 2012. Ear, nose and throat specialists in 25 states said they had seen sharp increases in requests for tongue-tie consultations, sometimes overwhelming their schedules. And searches for “tongue tie” on Google reached a record in June. Many families swear by the procedures. But the tongue-tie boom has unnerved pediatricians across the country.”

As it is a fairly common condition, patients must be informed about the procedures aimed at treating tongue ties.

Here are some signs and symptoms caregivers may notice that identify a tongue tie: Upside down heart-shaped tongue when trying to stick the tongue out, breastfeeding or speech difficulties with related low-self esteem and bullying. Once a tongue tie has been identified, there are several options:

No treatment/Monitor:

If asymptomatic, there is usually no need for an operation. If symptoms arise, then it could be prudent to get several opinions. If a few professionals from  various specialties recommend a procedure, then the indication for surgery is significant. The benefit of monitoring is no risk of surgical complications and, depending upon age and ability to cooperate for surgery, no anesthesia risks. The risks of such an approach would include worsening of symptoms, and an increased chance of needing sedation. 

          2. Scalpel or Scissor Frenectomy: 

The pros of using a blade to release a tongue tie include no risk of airway fire. Some cons include stitches and bleeding. This can increase the surgery time, and affect a young or anxious patient’s ability to cooperate. The sight or taste may be alarming to patients and/or families. It is a normal occurrence, but may affect the patient experience. Often the tongue must be numbed and suture placed in the tip of the tongue for movement control. This is quick and painless, once the additional local anesthesia shots are given.

Laser Frenectomy:

According to The Journal of Applied Oral Science, the pros of laser frenectomy include: “shorter operative working time, tissue cauterization and sterilization, hemostasis, less local anesthesia requirement, and fewer postoperative complications 15. Additionally, the need for suture is eliminated and a uniform depth in the surgical site is maintained, reducing unnecessary damage to tongue muscle1,15,29. For all these features, lasers are well tolerated by children.” The risks of laser surgery are increased risk of airway fire. 

Anesthesia may be a necessary component of frenum surgery. For an infant, many frenectomies are done without local anesthesia or any type of sedation. As patients age and have the capacity for memory, autonomy, and cooperation, health care professionals providing frenectomies may be able to elicit cooperation through behavior management or they may need to recruit the services of an anesthesia provider.. Lasers present the risk of airway fire as the laser is an “ignition source”. If your child is receiving laughing gas, supplement oxygen, or any type of sedation, discuss the plan for airway fire prevention and management. The Anesthesia Patient Safety  Foundation’s Airway Fire Prevention Algorithm, The Academy of Laser Dentistry, and the American Society of Anesthesiologists’ Operating Room (OR) Fire Prevention and Management Algorithm are excellent resources when talking with your doctor.

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