Hi Dr. Walker

Your question on short frenums was a good one - and this old dog is willing
to try to teach another old dog new tricks.

I am a general dentist who has been looking in mouths for close to 30 years.
 For over 20 years I have been researching the reasons for the collapse of
the oral cavity and the airway.  Over those years I have been documenting the
devastation that tight frenums do cause - and will be sharing some of this
information during a presentation at the ILCA conference this July in Kansas
City.

It sounds like you have a sharp consultant on staff. The key point that she
noticed was the tongue being "heart-shaped".  In nearly all cases a
heart-shaped tongue means that the frenum is too tight and does not allow the
tongue to perform a correct swallow.  I would like to refer you to two
excellent articles on swallowing:

Ros Escot - "Positioning, Attachment and Milk Transfer", Breastfeeding
Review, 1989, p31-37.

Michael Woolridge - "The 'anatomy' of infant sucking", Midwifery, p 164-171.
1986?

More information can be obtained from the excellent bibliographies in these
articles.

IF the swallowing action as described in those articles CANNOT take place
because of the restriction placed on it by a tight frenum OR is blocked by
the insertion of an artificial nipple OR pacifier - then the oral cavity
cannot develop properly!

An example I see in dentistry on a regular basis is that of a person who has
had orthodontics and still has a tight frenum (ankyloglossia).  NEARLY ALL
these case fail and relapse to a mal-occlusion due to the abnormal swallowing
pattern of the tongue.  Muscle always wins out in a battle with bone - and
the tongue - being a muscle - pushes the teeth to a point where IT WANTS to
push the them - not to where man places them with wires.  At the end of
active orthodontic treatment both the patient and the orthodontist are
usually pleased with the results - but I see them several years later and the
results are not as good.  Since the orthodontist has NOT FOLLOWED UP over the
years - he/she thinks the results are still good.  WRONG!!!  If the patient
goes back because the results obtained did not hold - it is usually blamed on
the fact the patient did not wear the retainer FOREVER!

What I am trying to say is - there are NO GOOD BENEFITS of a tight frenum.
 Similar to the above situation with orthodontists - the baby may leave the
hospital and everyone thinks everything is okay - but the mother soon gets
sore nipples she goes to formula - and without good follow up, nobody has
questioned the reason why.

A tight frenum restricts the positioning of the tongue and it cannot extend
over the lower ridge as explained in the above articles.  This restriction
does not allow the baby to get a good latch on to the areolar tissue and
subsequently slips back only on the nipple.  The hard lower jaw - uncovered
and unprotected by the tongue digs into the nipple and causes it to get sore.

Tight labial frenums can also cause poor latch on because they can prevent
the upper and over lip from extending to the proper position.  These frenums
are the main cause of the "gaps" or diastema seen between front teeth - here
again the muscle is stronger and the teeth will not go through the muscle to
get where they should be.

I am NOT an advocate of cutting all frenums - just the tight ones - and if
you can see a "heart-shaped" posturing of the tongue, it is probably too
tight.  A frenotomy is a simple procedure and the benefits are tremendous -
from improved breastfeeding to better oral development!

An excellent video on frenotomies and how the procedure helps improve
breastfeeding can be obtained from Dr. Jain who is also on Lactnet now.  She
can be contacted at: [log in to unmask]

If you have any more questions I would be happy to correspond with you
through email also.  Thanks for your question and willing to learn new
tricks!  From another old dog!

Brian Palmer D.D.S.
eMail - [log in to unmask]