In this past week I have had over a half dozen patients call to tell me that the ENT, their MD, or their pediatrician said the frenums- see pictures below- do not require ‘trimming’.

Sleep TMJ treatment maxillary frenum frenulum tongue views

If you look at the picture on the left, that little bit of tissue just above the two front teeth is called a maxillary frenum, or frenulum (I’ve heard it both ways). The pulling of that tissue is what is keeping the front two teeth apart, but even more onerous is the fact that this tissue is holding back the entire upper jaw from proper ‘face forward’ growth. So if a person is only six years old or so, and this is when their body and face are really trying to grow, this frenum might be preventing proper development. Now imagine how this can affect the airway. Since the upper jaw is not able to drive forward which would open the airway, this little guy will be more likely to end up with sleep apnea when he is older since that jaw is being held back and not allowed to grow forward to full potential which would open the back of his throat and airway more.

Similarly, on the right side photo, the tongue is being held down by that frenum. It simply cannot reach the roof of the mouth and get a good seal up there. This means more mouth breathing will have to occur and since that tongue is held down, there is less chance for good nasal breathing so nitric oxide is less likely to be formed. (You all remember my blog on nitric oxide, don’t you?)  I have found that due to a lack of education in this area, many doctors do not ‘get it’ that these frenum restrictions will hold back a child’s jaw growth during their important years of development!

In a recent article written by an MD (a REAL doctor in other words), it was stated that there is a current trend toward frenum trimming/cutting/reductions/etc because of monetary reasons. To me this is just insulting because I do not ever receive a kickback of any kind for sending a child to the ENT surgeon for this procedure. I make no money at all by providing such a referral. In fact, I actually lose money in some cases because the cost of doing the procedure sometimes means that the parents cannot afford my services until they save up after the cost of the frenectomy procedure! So whoever wrote that article probably needs to re-think their thoughts!

I truly wish that I had the resources to do a proper study on how children develop with or without the frenum trimming procedure. However, that would be malpractice on my part, wouldn’t it? Since I already know that these children will have more face forward growth if the frenums are reduced, why in the world would I want to compare to children who maintain restrictive frenums? Why would I want to see another child suffer from breathing and developmental problems when I already know the better path for them to take?  So as a parent, please take the time to look at this aspect of your child’s growth and help them to grow better!