How to Treat and Prevent Conditions of the Lingual Frenulum

The lingual frenulum normally extends from the bottom of your mouth to the midline of your tongue. However, in some cases, it may be abnormally attached.

An abnormally attached lingual frenulum can affect both nutritional and developmental milestones in babies. Because of this, it’s something that’s routinely checked for at birth.

Tongue tie, also referred to as ankyloglossia, is caused by a short lingual frenulum. In this attachment, the tongue is more closely tethered to the bottom of the mouth.

This shorter length inhibits the movement of the tongue. Children with tongue-tie may experience:

• trouble breastfeeding, leading to poor weight gain
• speech issues, particularly with articulating the sounds for l, r, t, d, n, z, and th
• difficulties eating certain foods, such as licking an ice cream cone
• problems with underbite, due to pressure on the jaw from the tongue being situated at a lower level
• obstructive sleep apnea, possibly due to changes in facial development as well as increased mouth breathing

Treating a short lingual frenulum

Treatment of a short lingual frenulum can be controversial. If no feeding or developmental difficulties are seen, your doctor may prefer a watchful waiting approach. This is because the lingual frenulum may naturally lengthen with age.

If treatment is necessary, there are two possible approaches:

• Frenotomy. This approach is typically used in infants and involves quickly cutting or clipping the lingual frenulum with sterile scissors.
• Frenuloplasty. This more involved procedure helps to release the lingual frenulum and is performed under general anesthesia.

Sometimes you may notice that the area around your lingual frenulum feels sore or tender. This may be due to something visible like an ulcer or an injury. However, in some cases the cause may not be as obvious.

The following things may cause you to experience pain at or around your lingual frenulum:

• an injury to your mouth
• vitamin deficiencies like those of B12, folate, and iron which can lead to pain in the tongue
• certain mouthwashes, which can lead to tongue irritation
• some medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and beta-blockers, which can cause ulcers
• Behcet’s disease, a rare condition in which inflamed blood vessels can lead to the development of sores

Preventing and treating a sore lingual frenulum

You can do the following things to help manage and prevent soreness at or around your lingual frenulum:

• Practice good oral hygiene.
• Avoid using products or medications that you’ve noticed lead to pain or irritation.
• While you’re healing, try not to eat foods that may further irritate your tongue. Examples include spicy or acidic foods.
• Suck on ice cubes to help numb pain.
• Make sure you’re getting enough vitamins to prevent deficiencies. Take vitamin supplements if you need to.
• Use over-the-counter (OTC) topical products, such as those containing benzocaine and hydrogen peroxide, to help relieve pain associated with sores.
• If you play sports, wear a mouth guard to help prevent injury to your mouth.

Canker sores are lesions that can develop in your mouth or on your gums. They can sometimes occur under your tongue, close to the lingual frenulum. Canker sores are typically round or oval-shaped with a red edge and can be painful.

The cause of canker sores is unclear, but there are a variety of things that appear to trigger them, including but not limited to stress, injury, and food sensitivities.

Preventing and treating canker sores

Although canker sores often go away in a week or two, there are several steps that you can take in order to help treat canker sores and prevent new ones from occurring:

• Use OTC topical products to help ease pain and promote faster healing. Look for products that contain hydrogen peroxide, benzocaine, or fluocinonide.
• Try rinsing your mouth with saltwater or sucking on ice cubes to help relieve pain.
• Follow good oral hygiene habits.
• Stay away from foods that you may be sensitive to or have caused canker sores in the past. Avoid potentially irritating foods, such as spicy foods, while canker sores are healing.
• Make sure that you’re eating a well-balanced diet in order to prevent nutritional deficiencies. Use vitamin supplements if you need to.
• Find ways to relieve stress.
• See your doctor if canker sores don’t respond to at-home care. They may be able to prescribe medications that can help with healing.

Have you noticed something that looks like a bump or skin tag close to your lingual frenulum and wondered what it could be? While skin tags, don’t occur on the tongue, there are a few possible causes of bumps or lumps:

Plica fimbriata

Plica fimbriata are small fringes that are made up of mucous membrane. They may be found running parallel to either side of the lingual frenulum.

These fringes may have delicate extensions that grow out of them. These extensions can look like skin tags, but are completely normal and are harmless.

Lymphoepithelial cysts (LECs)

LECs are a rare type of cyst that can occur on different parts of your body, including on or below your tongue. They’re noncancerous growths that are firm and yellow or creamy in color.

LECs are typically painless, although in some cases swelling or drainage can occur. They can be removed surgically, and recurrence of the cysts is rare.

Oral human papilloma virus (HPV)

HPV is a viral infection that can be transmitted to the mouth by oral sex. Many times it’s asymptomatic, but in some cases it can cause warts to occur.

HPV is also associated with cancers. In fact, it’s believed to cause 70 percent of mouth and throat cancers in the United States.

Although the types of HPV that cause warts aren’t the same as those that cause cancer, it’s still a good bet to check in with your doctor if you think you have an oral HPV infection. They can advise you on how the growths can be removed.

You can prevent getting HPV in your mouth by using a condom or dental dam during oral sex. Although it hasn’t been tested for oral HPV, getting the HPV vaccine may also help.

In some cases, your lingual frenulum may tear or rip. This most often occurs due to injury or trauma to the mouth or face, such as an object being placed into the mouth too forcefully.

Tearing of the lingual frenulum or other oral injuries may be a sign of abuse. In fact, injury to the face or mouth has been reported in up to 49 percent of infants and 38 percent of toddlers who’ve been physically abused.

Treating a torn lingual frenulum

Small tears to the lingual frenulum often heal on their own. However, since the area around the lingual frenulum contains a lot of blood vessels, bleeding may be a problem. Because of this, larger tears may require stitches.

Various oral piercings have become increasingly popular — including those in the lingual frenulum. To do this, the lingual frenulum is pierced horizontally. Jewelry such as a bar or ring can then be placed through the piercing.

Like any piercing, you’ll experience pain with a lingual frenulum piercing. However, the level of pain can vary by individual. Similarly, the healing time can also differ from person to person. It usually ranges between 3 to 6 weeks.

There are a variety of complications associated with healing tongue piercings, one of which is infection. The moist, warm environment of the mouth is an ideal place for bacteria to grow and thrive.

Preventing and treating infection

You can help to prevent infection during healing by doing the following:

• Continue to practice good oral hygiene. This includes brushing, flossing, and using alcohol-free mouthwash.
• Avoid playing with or touching your piercing. If you must touch it, make sure your hands are clean.
• Delay sexual contact, including French kissing and oral sex, until after healing is completed.
• Avoid submerging yourself in water where microbes may be present, such as lakes or swimming pools

If you notice signs of infection such as abnormal pain or swelling, bleeding, or discharge of pus, you should be sure to see your doctor. You may need antibiotics to treat the infection.

There are a few situations involving your lingual frenulum for which you should see a doctor. They include the following:

• noticing that your child is having difficulty breastfeeding
• having trouble with tasks like speech or eating that may be attributed to tongue-tie
• experiencing persistent pain around the lingual frenulum that has no clear cause
• developing sores that are large, recurring, or persistent
• having an unexplained bump or lump that doesn’t go away
• getting a large tear in your lingual frenulum or a tear that bleeds profusely
• having a piercing in your lingual frenulum that may be infected

The lingual frenulum is a fold of tissue that helps to anchor and stabilize your tongue. It’s important for many things, including speech and eating.

There are a variety of conditions that can affect the lingual frenulum. These can include things like an abnormal attachments, cold sores, or tears.

If you’re experiencing symptoms at or around your lingual frenulum that are persistent, recurring, or cause concern, make an appointment with your doctor. They can help you determine what may be causing your symptoms.