Fraenula are little strings of tissue found underneath the tongue, inside the cheeks near the back molars, and under the top lip. While an embryo is developing in the womb, these strings guide the growth of various mouth structures. Once we are born, the fraenula are largely redundant, although they seem to help in positioning the baby teeth.
The fraenum (or fraenulum) that attaches the top lip to the upper portion of the gum is called the maxillary labial fraenum. An abnormally low maxillary labial fraenum is the most common cause of gapped front teeth in the upper jaw. This gap is called maxillary diastema. The abnormal fraenum is attached so low on the gum-line that it props apart the two front teeth. Whether or not an abnormal fraenum should be surgically removed is controversial.
Symptoms
The symptoms of an abnormal maxillary labial fraenum can include:
- The fraenum extends down between the front teeth
- The front teeth in the upper jaw are gapped.
Other causes of gapped front teeth
Apart from an abnormal maxillary labial fraenum, other causes of gapped front teeth can include:
- Natural development – teeth are usually gapped when they first come through. The emergence of the canine (or eye) teeth often closes any gaps.
- Missing teeth – some children are born lacking one or two teeth in their jawbones. A missed tooth can cause gapping.
- Small teeth – some children may have small teeth that allow for gaps.
- Large jaws – some children’s jaws are relatively large compared to their tooth size.
- Lingual fraenum – this is the fraenum that attaches the tongue to the floor of the mouth. In some cases of severe tongue-tie (a condition caused by a restrictive fraenum that stops the tongue from poking out past the lips), the fraenum may cause a gap in the front teeth of the lower jaw.
- Extra teeth – sometimes extra teeth are present in the bone between erupted teeth and are unable to erupt.
The gap may close by itself
Gapped front teeth in the upper jaw close by themselves in many cases. Generally, a baby’s teeth start to erupt between six and nine months. At this early age, the front teeth could be gapped and the maxillary labial fraenum attached low to the gum. By the time the child reaches its first birthday, the fraenum has probably shortened, and the eruption of more teeth has closed any gaps. If the second (adult) front teeth are gapped, the eruption of molars (flat, grinding teeth located further back in the jaw) helps to ‘crowd’ the front teeth together. About one in 10 children have gapped adult front teeth that don’t close by themselves.
Complications of gapped front teeth
Complications of gapped front teeth can include:
- Self-consciousness – some people may feel embarrassed, and reluctant to smile with parted lips.
- Tooth misalignment – a large gap between the front teeth could leave insufficient room for the lateral teeth (the ones next to the front teeth). This may cause tooth displacement and problems with the bite.
Treatment options
Your orthodontist should be able to advise you on whether treatment is needed when your child is about 10 or 11 years old. Options may include:
- Bonding – if the gap is small, veneers that are slightly wider than the teeth are bonded to the tooth surfaces. (Big gaps aren’t treated with veneers, because the resulting front teeth would look abnormally wide.)
- Removable appliance – such as a plate.
- Fixed appliance – such as braces. Brackets are fixed to the front teeth and rubber bands used to pull the teeth together.
- Frenectomy – surgery to remove the fraenum, usually done after the gap is closed by orthodontic treatment.
Surgery is controversial
Gaps occasionally reopen after the treatment appliance is removed. In some cases, the abnormal fraenum is thought to be responsible; without the pressure of braces, the fraenum simply pushes the teeth apart again.
An operation to remove the fraenum is called a fraenectomy (or fraenulectomy). This is a controversial procedure because sometimes it doesn’t work, and the front teeth remain stubbornly gapped. Risks of frenectomy include damage to the gum between the front teeth, reaction to the anaesthetic, haemorrhage and bleeding. A frenectomy may include:
- The operation is performed using general or local anaesthetic.
- A laser or scalpel is used to remove the excess tissue.
- The wound is then stitched.
- It may take a few weeks for the mouth to heal.
- Self-care suggestions include gargling with salt water and taking anti-inflammatory drugs such as aspirin or ibuprofen.
Where to get help
- Your dental professional
- Your doctor
- Orthodontist
- Dental Health Services Victoria Tel. 1300 360 054
Things to remember
- The fraenum (or fraenulum) that attaches the top lip to the upper portion of the gum is called the maxillary labial fraenum.
- Your orthodontist should be able to advise you on whether treatment is needed when your child is about 10 or 11 years old.
You might also be interested in:
Teeth - cosmetic dentistry explained.
Teeth - orthodontic treatments.
Teeth - orthodontics.
Teeth care.
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