Frenectomy
Frenae (plural of frenum) are generally minor strands of muscle attaching the lips, cheeks, and tongue to the bone in the mouth. Because no significant functional problems are encountered when a frenectomy is performed, there is a minimal role in the function of the tongue or muscles of facial expression. There are specific indications for performing a frenectomy procedure. For the upper front frenum, a frenectomy is often postponed until the permanent lateral incisors and permanent canines erupt (permanent canines usually erupt about 11-13 years old). This recommendation is based on the fact that when the laterals and canines erupt, they will generally close the early diastema (space) between the permanent central incisors. If a frenum is large it may be done sooner and as early as 7 or 8 years old. If the diastema is not closed by normal eruption of the upper anterior permanent teeth, a frenectomy may be helpful, although orthodontics may also be necessary. Exceptions to postponing the frenectomy would be evidence on a radiograph of a notching in the bone between the central incisors or evidence of recession on the adjacent teeth. Many times an untreated frenum pull will cause gum recession to occur. If recession has already occurred a gum graft may also be necessary. See gum grafting procedures and read about recession.
An upper frenum problem does not seem to affect speech patterns. On the other hand, the frenum, which attaches the tongue to the lower arch, may interfere with speech. Generally, this will become apparent as the child begins to form words and phrases. If a notching of the tongue is noted when the tongue is protruded, it is generally recommended to have the frenum excised when the child starts developing speech patterns. Speech therapy may also be required.