Significance of the tethered maxillary frenulum: A questionnaire-based observational cohort study

Sody A. Naimer*, Ariel Israel, Aviezer Gabbay

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The clinical significance of lip-tie, or a tethered maxillary frenulum, remains under debate. Clinicians and parents are often perplexed when deciding whether procedures available to relieve a seemingly tight or severemaxillary frenulum are needed. Purpose: No previous studies have assessed the consequences of not subjecting a tethered maxillary frenulum in newborns to surgical intervention. This study aimed to contribute the first prospective trial on this topic with a relatively extended follow-up of these newborn infants. Methods: This prospective observational questionnaire-based cohort trial was performed in a community setting and aimed to determine whether lip-tie is associated with an increased likeli-hood of eventual feeding or oral disorders. Results: The convenience sample comprised of 61 consecu-tively arriving infants with concomitant tethered frenula who were treated at the clinic for various reasons. This cohort was compared with a random sample of 66 age-matched children for a mean follow-up period of 6.42 years. Infants undergoing oropharyngeal procedures were excluded. Awareness of a deviation in oral structures was reported by 18% of the study group versus 0% of the controls. Mothers participating in the study group (24.6%) less frequently recalled painful nipples or discomfort during breastfeeding than those in the control group (47.0%) (P<0.01). There were no intergroup differences in other types of feeding difficulty, dental hygiene, pronunciation, or speech development. Conclusion: Our findings suggest that a tethered labial frenulum is not associated with an increase in breastfeeding disturbances or oral disorders. These data encourage clinicians to question the need to intervene in cases of tethered maxillary frenula.

Original languageEnglish
Pages (from-to)130-135
Number of pages6
JournalClinical and Experimental Pediatrics
Issue number3
StatePublished - 2021
Externally publishedYes


  • Breastfeeding
  • Frenulum
  • Infant welfare
  • Oral pathology
  • Tethered maxillary frenulum


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