Short answer: The lip tie (frenulum) is a thin fold of tissue that connects the inner surface of the upper or lower lip to the gum, and everyone has one. When it is thick or extends down between the two front teeth, it can contribute to gaps between teeth, gum recession or difficulty cleaning. In this case the frenulum is released or removed with a short procedure called a frenectomy. The timing is usually planned together with orthodontic treatment; not every prominent lip frenulum needs to be cut.
When you lift your upper lip in the mirror, you will see a thin fold of tissue running from the middle of the lip to the gum. This structure is the lip frenulum, and everyone has one. For most people it causes no problems; however, in some cases it may be associated with problems such as a gap between the front teeth, gum recession or the gap reopening after orthodontic treatment. In this article we look at what the lip frenulum is, how it relates to gaps between teeth, when and how it is treated, and how treatment is planned together with orthodontics.
What is the lip frenulum?
The lip frenulum is a thin fold made of connective tissue and mucosa that attaches the mucosa on the inside of the lip to the gum and the bone beneath it; its medical name is frenulum or frenum. There are three main frenula in the mouth: the upper lip frenulum, the lower lip frenulum and the tongue frenulum under the tongue. This article focuses on the upper lip frenulum in particular.
The thickness and length of the lip frenulum and the point where it attaches to the gum vary from person to person. In babies, the upper lip frenulum is usually thick and attached low; it may even extend between the two front teeth to the palate. As the child grows, the teeth erupt and the jawbone develops vertically, the attachment point of the frenulum often moves upward and the frenulum becomes thinner. For this reason, a lip frenulum that looks thick in young children does not always mean there is a problem.
When does it cause problems?
- If the frenulum extends between the two upper front teeth and prevents the teeth from moving closer together
- If it pulls on the gum when the lip moves and causes gum recession
- If it makes it difficult to clean the gum line of the front teeth
- If it contributes to a gap that has been closed orthodontically reopening
- Rarely, if it noticeably restricts lip movement and smiling
How is the lip frenulum related to a gap between the teeth (diastema)?
A thick, low-attached lip frenulum can be one of the causes of a gap between the two upper front teeth (diastema); however, not every gap between teeth is caused by the lip frenulum. A mismatch between tooth and jaw size, small or missing lateral incisors, a tongue-thrusting habit and an extra unerupted tooth in the front region can also cause a similar gap.
To find out whether the lip frenulum plays a role in the gap, the dentist does a simple examination: if the gum between the two front teeth, or even on the palate side, blanches when the upper lip is gently pulled up and out, the frenulum is thought to extend into this area. A typical cleft appearance in the bone between the two front teeth on an X-ray can also support this link.
If you would like to know how gaps between teeth are treated depending on their cause, you can find detailed information on our treating gaps between teeth with clear aligners page.
When is the lip frenulum cut?
Cutting the lip frenulum is recommended only when the frenulum is causing, or is expected to cause, a clear problem, and the timing is determined by the type of problem. The general approaches can be summarized as follows:
- Wait-and-see approach in young children: Gaps seen in the baby-teeth stage and when the permanent front teeth have just erupted can narrow on their own as the lateral incisors and canines erupt. In this period, early cutting is generally not done; the situation is monitored.
- Together with orthodontic treatment: If the lip frenulum is thought to contribute to the gap, in most cases the gap is first closed orthodontically, and then the frenulum procedure is done. This order aims to prevent the healing tissue formed after the procedure from making it harder for the teeth to move together, and to reduce the risk of the gap reopening.
- If the frenulum physically blocks tooth movement: In selected cases, the procedure may be planned before orthodontic closure.
- If there is gum recession: Especially if the lower lip frenulum is pulling on the gum and causing recession, the procedure may be considered without waiting for a particular age, to prevent the recession from progressing.
The issue of the upper lip tie being linked to breastfeeding difficulties in babies is controversial. In this case, the decision should be made together with the pediatrician and a breastfeeding consultant, after other possible causes of the feeding problem have also been assessed.
How is lip frenulum surgery done?
Lip frenulum surgery (frenectomy or frenotomy) is a procedure done under local anesthesia that usually takes a short time and is performed on an outpatient basis.
- Anesthesia: The area is numbed with local anesthesia; the aim is for no pain to be felt during the procedure.
- Releasing or removing the frenulum: In a frenotomy, the frenulum is only released; in a frenectomy, the frenulum tissue is removed together with the fibers attaching it to the gum and bone.
- Method: The procedure can be done with a scalpel or a laser. With laser procedures, there may be less bleeding and stitches are often not needed. With the conventional method, a few fine stitches are placed.
- Duration: The procedure usually takes less than half an hour.
For a few days after the procedure there may be mild tenderness and swelling in the area. Eating soft, lukewarm foods, not poking the area with your teeth or tongue and following the oral care your dentist recommends make healing easier. The wound surface usually heals within one to two weeks. In some cases, your dentist may recommend gentle lip-stretching exercises to prevent the tissue from reattaching.
How is lip frenulum treatment planned together with orthodontics?
When the lip frenulum and a gap between the teeth are assessed together, the healthiest outcome is usually achieved through joint planning by the orthodontist and the clinician performing the procedure. A typical plan may include the following steps:
- Comprehensive examination: The causes of the gap (lip frenulum, tooth size, habits) are assessed together; an X-ray is used to check whether there is an unerupted tooth in the front region.
- Orthodontic closure: The gap is closed with clear aligners or braces.
- Lip frenulum procedure: A frenectomy is done once closure is complete or nearly complete.
- Retention: The gap is kept from reopening with a fixed retainer wire bonded to the back of the front teeth and/or a clear retainer worn at night.
Because gaps in the midline tend to relapse, the retention phase should not be neglected even if a frenulum procedure has been done. A frenulum procedure alone does not close a wide gap; orthodontic treatment is needed to move the teeth.
The order is similar for patients treated with clear aligners. While the aligners gradually close the gap, the frenulum procedure is usually left until the final stage of treatment; aligner wear can usually continue during the healing period after the procedure. Whether the edge of the aligner is pressing on the healing area is checked at a follow-up appointment, and a small adjustment is made if needed. This approach helps achieve both esthetic and stability goals, usually without disrupting the flow of treatment.
When should you have your lip frenulum assessed in Ankara?
If the gap between your child's permanent front teeth does not close even after the side teeth have erupted, if a gap reopens after orthodontic treatment, or if you notice that the lip frenulum is pulling on the gum, an assessment is worthwhile. At our clinic in Park Oran Ofis on Kudüs Caddesi, our orthodontist examines the role of the lip frenulum in the gap and, if needed, plans the order of the procedure and orthodontic treatment together with you.
Frequently asked questions
Does a gap between the teeth close on its own once the lip frenulum is cut?
Usually not. A frenulum procedure can help prevent the gap from reopening, but in most cases orthodontic treatment is needed to move the teeth together. In some children, small gaps may narrow on their own in the early period.
At what age is lip frenulum surgery done?
There is no specific age limit; the timing is determined by the type of problem. If there is a gap between the teeth, the eruption of the permanent canines and orthodontic closure are usually awaited. Earlier intervention may be needed for frenula that cause gum recession.
Should a lip frenulum procedure be done with a laser?
Procedures done with either a laser or a scalpel are effective. In some cases, a laser can mean less bleeding and healing without stitches. The choice of method depends on the structure of the frenulum and your dentist's assessment.
Does lip frenulum surgery leave a scar?
Because the procedure is done on the inner surface of the lip, there is no visible scar on the outside. The wound inside the mouth usually heals within one to two weeks and blends in with the surrounding tissue.
