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Frenectomy
Information

At JFPM, we use a diode laser for in-office treatmetn of lip & tongue ties, avoiding general anesthesia to reduce complications. Comfort is ensured with appropriate numbing methods. The diode laser aids healing and minimizes bleeding, with trained physicians providing local outpatient aftercare  for better outcomes.

What Is A Frenectomy:
A frenectomy is a minor surgical procedure that removes or alters the tissue (frenulum) connecting the lips or tongue to the gums. While everyone has these connections, their tightness can vary, with labial (lip) and lingual (tongue) ties being the most common needing revision. At JPFM, we use a Diode Laser for frenectomies instead of scalpels or scissors.

Common Types of Oral Ties:

 

Labial (Lip) Tie: a too short or stiff maxillary labial frenulum can restrict the upper lip's movement. and cause a gap between the two front teeth in older patients.

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Lingual (Tongue) Tie: an unusually short or thick lingual frenulum, a membrane that connects the tongue to the floor of the mouth.

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  • Anterior tongue tie: Near the tip, easily diagnosed, with lower risk of reattachment and need for revision.

  • Posterior tongue tie: Located in the middle or back, often hidden and harder to diagnose, may require multiple procedures. A laser frenectomy can reduce reattachment risk, but children may still need a second revision around ages 2 or 3 if speech issues arise.

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Benefits of Laser Frenectomies:A diode laser targets specific tissue, preserving healthy areas and minimizing complications. It causes minimal bleeding compared to scissors, enhancing visibility for a more complete frenectomy and reduces reattachment risk. The laser also cauterizes tissue to lower infection risk and can be adjusted quickly to suit the patient's anatomy.

Symptoms (Infants):

Oral ties in infants can cause nursing or bottle-feeding difficulties, often resulting in "failure to thrive." Lip ties often affect latching, while tongue ties complicate swallowing, leading to reflux and poor weight gain.


A consultation is always advised if these symptoms arise:

    • Painful latch

    • Nipple or bottle refusal

    • Clicking sound during feeding

    • Clamping or biting

    • Frequent or prolonged feeds leading to dissatisfaction

    • Nipple pain or trauma (flattened, blistered, or cracked nipples)

    • Poor weight gain

    • Colic or reflux

    • Inability to take a pacifier

    • Leaking milk or dribbling during feeding

    • Frequent plugged ducts

 

Symptoms (Toddlers, Children, and Adults):​

Lip and Tongue ties can cause painful brushing and increase cavity risk and may lead to speech issues and decay. In older children and adults, lip ties can create gaps between teeth, needing correction before orthodontics, ​

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Tongue-tie can cause several issues, including:

  • Speech problems (difficulty with sounds like "t," "d," "z," "s," "th," "n," and "l," speech delays, and lisping)

  • Oral health issues (difficulty removing food, leading to tooth decay and bad breath)

  • Challenges with oral activities (eating certain foods, playing instruments)

  • Neck and shoulder tension

  • Increased headaches or migraines

  • Sleep problems (snoring, teeth grinding, sleep apnea)

  • Swallowing difficulties (pills and food)

  • Mouth breathing (poor sleep quality and dry mouth)

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Why choose us:​

At JFPM, we perform in-office procedures using a diode laser and numbing agents, avoiding general anesthesia to reduce complications. Numbing cream or an injection of anesthetic depending on the age of the patient is used to ensure comfort. The diode laser promotes efficient healing and minimizes bleeding. Local, outpatient treatment by trained physicians has been shown to improve patient outcomes. Dr. Giridhar Veerula has surgically treated tongue-ties since 1992 and specializes in laser treatment since 2016, while staying updated on research. His son, Dr. Vijay Veerula, has also been performing frenectomies since 2021, incorporating a holistic approach to treatment and follow-up care. Dr. Vijay Veerula recommends OMT and cranial sacral therapy as part of the frenectomy aftercare that helps alleviate any remaining oral tie symptoms.

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For moderate to severe oral ties, surgery is often necessary, but Osteopathic Manipulative Treatment (OMT) can alleviate mild symptoms like headaches and jaw tension if surgery is declined. It's advised to seek Osteopathic care before and after surgery for better recovery. Trained Osteopaths assess tongue function, release tight muscles, and help identify the need for surgery. Post-surgery, addressing underlying issues can effectively relieve symptoms and improve overall well-being. At JPFM, Dr. Giridhar Veerula and Dr. Vijay Veerula collaborate on oral tie cases, ensuring patients receive the most comprehensive and effective aftercare!

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What to Expect:

  • Before the procedure, we will have a consultation to evaluate the severity of the oral ties, discuss options, and prepare you with a personalized aftercare plan.

  • ​For newborns with feeding or nursing issues, our physicians recommend performing the procedure the same day as the consultation to benefit both the newborn and mother. Especially if the symptoms indicate the need for immediate action: nipple or bottle refusal, low weight gain, or painful latch.

  • Delaying the procedure when symptoms indicate its necessity can only cause more stress and harm to newborns or the breastfeeding relationship.

  • The procedure is quick, lasting under a minute, and is generally well-tolerated by infants and children. Numbing cream or anesthetics are used to minimize pain and stress, with oral anxiety medication available for older children and adults upon request.​

  • Parents and guardians must wait outside for safety during the procedure.

  • Your child will be away for 5-10 minutes; safety protocols for laser use necessitate this. We understand this can be difficult for both you and your child and will do everything to ease the uncertainty and separation anxiety.

  • Crying is very typical but usually due to separation anxiety or the unfamiliarity of the procedure not than pain.

  • The procedure itself is painless and quick; less than a minute of laser use.

  • Staff will bring you back immediately to offer comfort measures. Nursing or bottle-feeding can be tried immediately. Some mothers find instant results! Others may need the support of a lactation consultant.

  • At JPFM, we ask our patients to diligently follow their personalized aftercare procedures which includes stretching exercises, lactation consults, OMT , cranial sacral therapy, and speech therapy if applicable. This provides improved patient outcomes, less risk of reattachment, and a more thorough elimination of symptoms.

  • If a patient is hesitant about a frenectomy, we can consider alternatives like OMT and cranial-sacral therapy sessions to alleviate some of the symptoms while you decide. However, it's important to note that severe oral ties may cause recurring symptoms if not fully addressed through surgery.

Preparation for the Procedure:
We recommend having the necessary medications ready for post-procedure care and to have your lactation consultant on-call the day of the procedure for troubleshooting and feeding issues.

 

For Tylenol, administer every 6-8 hours post-procedure at 160mg/5mL concentration, using the following dosages:
6-11 pounds: 125mL
12-17 pounds: 2.5mL
18-23 pounds: 3.75mL
24-35 pounds: 5mL

For children 6 months and older, ibuprofen can be used as directed. Homeopathic remedies or no medications are also options, and we can discuss your specific needs at your first appointment!
 

Familiarize your child with aftercare stretches before their frenectomy appointment. Starting these tolerance exercises early helps them adapt to the sensation and supports recovery.


To increase oral tolerance, we suggest:

  • Gently Rubbing the lower and upper gumline side to side.

  • Let your child suck your finger while playing tug-of-war.

  • Apply gentle pressure to the palate while they suck your finger.

  • Massage the cheeks to reduce tension.

  • and incorporate playing together with a teething toy or baby safe teething brush into your daily routine. (using teething brush on your baby's gums daily is great practice for future toothbrushing tolerance)

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Performing these activities multiple times daily will enhance tolerance and make aftercare easier..

Post-Procedure:

The anesthetic will wear off in 1-4 hours; monitor your child to prevent self-biting. Afterward, they may experience some soreness. It's common for children to be fussy post-procedure. For younger children, nursing or offering a bottle can be comforting, while cold teething toys may help. Older children should start with a cold, soft diet, gradually adding solids and avoiding spicy or acidic foods. Administer Tylenol and Motrin as prescribed and remind them to keep hands away from their mouth. Although the infection risk post-laser frenectomy is low, maintain clean hands during stretching exercises and contact us with any concerns.


You can begin the prescribed stretches at home, ideally 4-5 times daily for 4-6 weeks to reduce reattachment risk. Parents are encouraged to reach out if their child struggles with the aftercare. OMT, Cranial-Sacral therapy and Consultations with a lactation consultant or speech therapist are strongly recommended. Follow-up appointments for a frenectomy (tongue tie) can be scheduled anytime; just inform the front desk to ensure proper booking with Dr. Veerula.

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We recognize that this procedure may appear daunting; however, we are committed to providing you with support every step of the way!

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