All of us have an upper lip frenulum. It helps attach the lip to the gums and provides normal anchoring for bone growth and development of the face and nose. Lip (labial) frenulums come in all shapes and sizes: short, long, thick, stretchy, tight. In many babies, it extends around the gum line. When it’s extremely tight it may cause a notch in the bone. Typically, as baby grows, the gums grow longer but the frenulum remains the same length, so the gums end up extending beyond it and it sits up above the teeth. With time, the rest of the teeth coming in help push the top two front teeth closer together, narrowing the gap or eliminating it all together. Occasionally, depending on how thick, long or tight that upper lip frenulum is, it may remain visible between the teeth and causes a gap, known as a diastema. Diastemas are not always harmful, and in some places is considered aesthetically pleasing. The diastema hit the modeling world by storm a few years ago and many models were volitionally shaving the space between their top teeth to accentuate it. We unfortunately do not appreciate its appearance in the US. When older kids start to have orthodontic work and dental crowding is noted, the frenulum can be clipped to help close the diastema which helps the rest of the teeth shift and align. There is currently no evidence based research that gives defined criteria to distinguish between a normal frenulum and one that is tied.
For breast fed babies it is essential to look at the function of the lip over it’s appearance. Can the baby open the mouth wide, round and spread the lips without tension? Are they using the lips to compensate for a weak or inefficient tongue? Is the bone of the upper gum notched from the tension of the frenulum? Can the upper lip flip up without the lip dimpling or the frenulum blanching? Do the gums turn white where the frenulum attaches when the lip is flipped? Are there white or red creases on baby face from the corner of the nose down to the corner of baby’s mouth while baby feeds or after feeding? When the range of motion is impacted and is causing problems, the upper lip tie can be clipped or released.
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