Laser-Assisted Frenectomies
Dispelling misconceptions and embracing the evidence-based benefits
Cherish K. Leung, DMD, MHA, MPH
Frenectomies, which are commonly performed to correct tongue-ties in newborns, play a pivotal role in ensuring that infants can latch and swallow to breastfeed effectively. However, discussions surrounding frenectomies, particularly those conducted with laser technology,1 have recently ignited a debate among parents that is fueled by misinformation. This is concerning because it may dissuade parents from considering this evidence-based procedure as a solution for their newborns' feeding difficulties. As dental professionals, it is imperative that we understand and communicate that the available data unequivocally supports the safety and efficacy of frenectomies performed with lasers, especially considering the vulnerable state that many parents find themselves in when seeking care for their children.
The lingual frenectomy, which is among the most prevalent of the frenectomies that are performed, entails the delicate removal of the lingual frenulum situated beneath the tongue. This procedure is frequently used to alleviate cases of tongue-tie where the lingual frenulum is abnormally short or taut and impeding the tongue's mobility. Although the direct cause of tongue-tie has not yet been confirmed by medical professionals, some research suggests that the condition may arise from excessive folic acid intake during early organ development.2 This research notes that such excessive intake could potentially lead to heightened structural tension in the body's central region and foster the formation of excess connective tissue, including the lingual frenulum.2
Contrary to some misconceptions, laser frenectomies are effective. Expert consensus, including endorsement by the American Academy of Pediatric Dentistry,3 underscores the benefits of laser frenectomies when compared with traditional ones, including shorter operative times, improved hemostasis, reduced pain, and fewer complications. In recent years, there has been a notable uptick in the amount of frenectomies being performed, particularly in the realm of breastfeeding support. In part, this increase can be attributed to technological advancements and dental education. Improvements in laser technology have made the procedure even more effective and less invasive, enabling it to benefit a broader range of cases while facilitating more timely interventions. Furthermore, the rise in frenectomies could also be linked to an uptick in the amount of mothers choosing to breastfeed their babies. Historically, breastfeeding initiation rates saw a significant rise from 33.4% in 1975 to 59.7% in 1984, with a subsequent dip in the late 1980s. However, by the mid-1990s, the rates rebounded and stabilized around 60% for initiation and approximately 20% at 6 months.4 Recent statistics reveal that 83.2% of infants begin breastfeeding and that 24.9% are exclusively breastfeeding at 6 months.5
Substantial peer-reviewed research has validated the efficacy of laser frenectomies. Studies published in esteemed journals, such as Breastfeeding Review, The Laryngoscope,6 the International Journal of Dental Research and Oral Health, and the International Journal of Clinical Pediatric Dentistry, consistently demonstrate the positive outcomes of laser-assisted frenectomies. These studies highlight immediate improvements in feeding, reduced pain, shorter procedures, minimized scarring, and more.
Consider the case of 6-year-old Jacob, who had experienced numerous issues since his infancy, including difficulty eating, snoring, and night terrors. To address the concerns, I performed a laser frenectomy using a dental laser that combines laser energy with water and air for safe use on tissues in the mouth. Following the laser frenectomy and a period of myofunctional therapy, Jacob exhibited remarkable improvement, including clearer speech, reduced snoring, and improved sleep quality. Another one of our patients, a baby who had struggled with significant breastfeeding issues and reflux, demonstrated similarly remarkable improvement following laser frenectomy. After the treatment, her symptoms resolved, and she was able to thrive and enjoy various foods without issues.
The portrayal of frenectomies, particularly those performed with laser technology, as risky procedures lacks substantiation. When indicated, frenectomy is a safe and effective solution to address feeding difficulties in infants. Parents should be making informed decisions based on accurate information and expert guidance. As dental professionals, we are responsible for educating and supporting parents to ensure that they can access the best possible care for their children.
The references for this column are available online with the digital version of the article at: insidedentistry.net/go/04-24-perspective
About the Author
Cherish K. Leung, DMD, MHA, MPH, is a board-certified pediatric dentist with private practices in Claremont and Cypress, California.
References
1. Murzyn-Dantzer L. Infant laser-assisted lingual frenotomy: a case study. BIOLASE website. https://www.biolase.com/media/16-0695_DrMurzyn-Dantzer.pdf. Published 2016. Accessed February 22, 2024.
2. Rubin G, Stewart C, McGowan L, et al. Maternal folic acid supplementation and the risk of ankyloglossia (tongue-tie) in infants; a systematic review. PLoS One. 2023;18(11):e0294042.
3. American Academy of Pediatric Dentistry. Policy on the use of lasers for pediatric dental patients. In: The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry; 2023:133-136.
4. Wright AL, Schanler RJ. The resurgence of breastfeeding at the end of the second millennium. J Nutr. 2001;131(2):421S-5S.
5. A closer look at the 2022 CDC breastfeeding report card. U.S. Breastfeeding Committee website. https://www.usbreastfeeding.org/usbc-news--blogs/a-closer-look-at-the-2022-cdc-breastfeeding-report-card. Published October 24, 2022. Accessed February 22, 2024.
6. Ghaheri BA, Cole M, Fausel SC, et al. Breastfeeding improvement following tongue-tie and lip-tie release: a prospective cohort study. Laryngoscope. 2017;127(5):1217-1223.
