Gum and bear it?

February 7, 2007 3:30 PM

My tooth doc suddenly urges me to get a frenectomy. Cause for suspicion? I like my dentist, who's skillful and friendly, but sometimes I get the feeling he's a bit too enamored of getting the latest gizmos and practicing trendy procedures.

A little background: I've always had lots of plaque in my lower middle teeth, but not much gum damage. Now the dentist wants to sever and reattach the frenum there to reduce the pull on my gums, and urges me to have this done within two months. He never mentioned this concern before. He's quoted me a fee of about $250 (US), and says it's a quick, relatively painless procedure.

I don't know much about frenectomies. Googling has revealed little apart from dental q+a sites, so I'm asking in the green. Should I get a second opinion? Anybody care to comment, either about my dentist or the op itself?

posted by rob511 to health & fitness (14 answers total)

My daughter had a frenectomy after her braces came off in order to prevent her two front teeth from separating. She was apparently born with a very large frenum. It was done at the same time as getting out her wisdom teeth. Of the two, she suffered more from the frenectomy than the wisdom teeth removal. The area was sore and uncomfortable for quite a few days after.

I'm not a dentist, and don't understand how your frenum could be damaging your gums. In any case, if you're unsure, it's probably a good idea to get a second opinion.
posted by Flakypastry at 3:45 PM on February 7, 2007

Interesting, I've never heard of this, and have no opinion on it, but I can tell you what some quick google scholaring turned up.

Specifically in:
Valerie Clerehugh, Aradhna Tugnait (2001)
Diagnosis and management of periodontal diseases in children and adolescents
Periodontology 2000 26 (1), 146–168.

the money quote is

There is evidence to support undertaking a frenectomy to remove a high frenal attachment that is impeding effective plaque control

which cites
Wennström JL. Mucogingival therapy.Ann Periodontol1996: 1: 671–701 which unfortunately is not published online as an e-journal.

Whether this means you should do it or not I have no idea, But Periodontology is the journal of the American Academy of Periodontology which seems to be the premier institution of Periodontologists.

Long story short, it's seems like it's not a quack idea, but I have no clue how prevalent or good of an idea the surgery is.
posted by jourman2 at 4:12 PM on February 7, 2007

* premiere
posted by jourman2 at 4:14 PM on February 7, 2007

jourman2, you were right the first time.
posted by Faint of Butt at 4:19 PM on February 7, 2007

damn you internets, damn you all to hell.
posted by jourman2 at 4:22 PM on February 7, 2007

My brother has been told all his life that he desperately needs a frenectomy, he's never done it, he's 25 and still ticking with no noticeable health problems, except that he can't stick his tongue out as far as most people. You're really not likely to have any issues if you just say no.
posted by croutonsupafreak at 4:53 PM on February 7, 2007

buccal frenectomy isn't a new procedure but your dentist may have been to one too many conferences. you never can tell.

your dentist will have a rationale. ask. have your dentist show you the tissue... have him explain the relationship between the current pull between cheek and gums and your unremitting plaque in that area. ask for full information.

once you can identify your buccal frena ask friends and family for a quick look at theirs. compare.

while you're at it ask how many times he has performed the procedure. if he says "none, you'll be my first" i'd be thinking uh-oh. else i'd want to compare his frequency with other dentists. why would your dentist not refer you to periodontist? ask.

armed with your dentist's rationale and performance stats seek a 2nd, maybe a 3rd opinion. just consultations. ask the dentists how many they do... is buccal frenectomy a common procedure? would they recommend it in your case?

if you decide to go ahead you've probably doubled your cost, but heck: cheap at half the price.
posted by de at 5:01 PM on February 7, 2007

I had a frenectomy just after having my braces removed back in high school. As I was told by my orthodontist, without the removal of upper frenulum, my teeth would shift back apart & I'd end up with my "David Letterman Gap" back in a few years. However, my primary dentist was against the procedure - he had a particularly large upper frenulum and had never had any problems with it (other than a pronounced gap between his front 2 teeth).

For the procedure proper, I had it done by a periodontist, under twilight sleep, and it took several hours. The stitches were painful, and the 'cast' put in over my gums was irritating. However, my teeth have not shifted back, so he was right at that point. I don't know if you consider being under for several hours a quick procedure or not, but I wouldn't say that recovery was painless.
posted by librarianamy at 5:43 PM on February 7, 2007

The surgeons I work with do them all the time, but this is on babies whose tongue is sufficiently tethered to cause speech or feeding problems. It is a 5 minute procedure and done with minimal anesthesia and often no need for an IV. I don't see any of the dentists I work with doing them however, which makes me wonder. It sounds like a second opinion would be good. We aren't doing any dental cases today or else I would ask our dentists what they think of it.
posted by TedW at 6:44 AM on February 8, 2007

I had one when I was 14. Had it done for the gap tooth thing. Didn't hurt too bad, just a couple of stitches and a day or two of soreness.
posted by electroboy at 9:38 AM on February 8, 2007

Thanks, all. I'm not sure I'm much more enlightened (considering the varied responses), but I sure will get a second opinion.
posted by rob511 at 2:03 PM on February 8, 2007

I know you already have a gazillion best answers, but I just wanted to pipe in and let you know that i'm having a frenectomy in two weeks - I'm getting invisalign and they need to do it to remove the gap between my teeth. My dentist recommended it, but she referred me to an oral surgeon who presumably does this stuff on a regular basis. You might want to consider going that route if you're worried about the experience level, intent, etc.
posted by echo0720 at 6:57 PM on February 8, 2007

I work for a periodontal office. I had both a lingual and labial frenectomy last month. The lingual frenectomy (under the tongue) was the most painful procedure that I have ever had in my life, but fortunately for you, that's not the kind of frenectomy that was recommended for you.

If the labial frenulum is attached too high, it will pull on your gums and cause recession. If your gums are still healthy enough that you can have a frenectomy without a gingival graft, I would definitely recommend getting it done sooner rather than later. Labial frenectomies are easy- after a shot of lidocaine, you can't feel a thing during the procedure, and the healing is quick and not at all painful. If you hold off, and then need a graft, it's not only going to be more expensive, but you're going to have a more painful recovery.
posted by Ruki at 1:24 PM on February 9, 2007

Ding, ding, ding!!! Thanks, Ruki -- that's exactly what I needed to know!
posted by rob511 at 11:43 PM on February 9, 2007