Most adults do not notice a crucial part of their mouth’s anatomy: the part that allows us to speak without impediment and nurse or take a bottle as infants. This usually continues until we become parents and experience issues with our own baby’s feeding. A low frenum is easy to see but often overlooked in infants.

What is a frenal attachment?

The frenal attachment is the ligament that connects the upper lip to the upper gums. This simple ligament provides stability to the lips and gums. It also allows babies to properly latch onto a bottle or a nipple, and it assists in the development of speech.

Although its importance is becoming more apparent to dentists, many pediatricians give the frenal attachment nothing more than a cursory glance until problems arise.

What are the different frenum attachment classifications?

There are essentially two different frenum attachment classifications (other than no classification at all).

  1. High frenum (or a high frenulum)
  2. Low frenum (also called a low frenulum or a tight frenulum)

High frenum

High frenum occurs when there is little frenal attachment of the gum and upper lip. The ligament may be non-existent, or what is there does not function as a proper attachment to the gum.

Low frenum

This occurs when the frenal attachment reaches closer to the teeth, often even between the two front teeth. The ligament may insert itself between erupting front teeth.

What are the risks of a low frenum attachment?

Many parents only become aware of an issue when their new baby has difficulty feeding. Some of the risks of low frenulum attachment in babies include:

  • Difficulty latching on: While most babies and mothers struggle with this at first, babies with low frenum may never quite get it right
  • Cracked, bleeding, or sore nipples: Babies will suck harder to try to get more milk, resulting in soreness
  • Excessive gas: The baby is sucking more air than milk as they nurse
  • Poor weight gain: Not enough milk means not enough weight gain (and sometimes a failure to thrive diagnosis)
  • Fussiness: All babies fuss, but babies who are hungry for lack of adequate nutrition and excessive gas may be even fussier
  • Poor milk supply: Milk supply depends on demand, so if the baby is not able to drain the breast at a feeding, supply may drop

As children age, the risks of an untreated low frenum continue. When the frenal attachment reaches between the front two teeth, a diastema can form. This gap continues to grow as a child ages, pushing other teeth out of alignment.

Additionally, low frenulum attachment can lead to plaque formation in small children. The attachment many not allow for proper tooth brushing, or brushing teeth properly may be painful.

Finally, a low frenum may make it difficult for children to breathe with their mouths closed. As dry mouth can lead to tooth decay and other dental issues, this can cause problems as children grow. It can also interfere with speech patterns.

When should I get help for a low frenum attachment?

If your child is having trouble feeding from a bottle or a breast, it is important to visit your doctor or dentist to take a closer look at their mouth.

While the idea of surgery on their baby is frightening to every parent, if left untreated, a low frenum can cause many other issues, including:

  • Orthodontic procedures as the low frenum pushes the front teeth apart (even after braces)
  • Difficulty chewing and swallowing solid food, which can lead to digestion issues
  • Development of speech impediment or difficulty speaking
  • Difficulty smiling

If caught early, problems with gapped teeth and additional orthodontia may be prevented.

Frenectomy and laser frenectomy

The most common treatment option for a low frenum is a frenectomy. Traditionally, a frenectomy was performed with a scalpel, but these days lasers are the surgical instrument of choice.

Traditional surgery has a higher risk of infection and significant pain. Psychologically, many parents would avoid the procedure or put it off rather than see their child undergo this type of procedure.

A more gentle option is a laser frenectomy. This procedure uses a laser to sever the tie while simultaneously healing the wound to minimize the time in surgery and the chance of infection.

To minimize pain, your dentist may apply a few drops of local anesthetic before sweeping the laser across the frenum to gently sever the tie. The entire procedure usually takes less than five minutes.


When performed on an infant, a low frenum attachment can be