Guidelines of management regarding frenula in pedodontic patients

Introduction
In the oral cavity, there are three types of frenula, or folds of the mucous membrane, whose primary function is to provide stability to the lips and tongue. Abnormalities of the labial and lingual frenula can cause many developmental disorders in children. Recent years have seen an increased number of diagnosed cases and an increase in surgical interventions to correct their attachment.

Aim
The aim of this paper is to review the current literature on the guidelines of management regarding frenula in pedodontic patients and to present diagnostic and therapeutic criteria.

Material and methods
The current literature on oral frenulum disorders was reviewed, and the search of the PubMed/ MEDLINE database for the past five years was conducted. The paper was supplemented by a discussion of the latest guidelines of the American Association of Pediatric Dentistry (AAPD).

Results
Treatment of congenital frenulum defects must be individualised in terms of the type, nature, and timing of intervention. Function limitation is the basis to determine further management. Each case should be reviewed on an interdisciplinary basis. Treatment should include both surgical intervention and exercises to maintain long-term effects. The positive effect of surgical correction of ankyloglossia in terms of breastfeeding was demonstrated. Studies on the effects of frenulum defects on speech defects and the impact on the development of orthodontic defects that have been performed so far provide inconclusive results. Research is primarily hampered by the subjective nature of this condition.

Conclusions
The latest guidelines proposed by the American Academy of Pediatric Dentistry may be helpful to clinicians. However, further studies are recommended to determine causal relationships between breastfeeding difficulties, pronunciation problems and abnormal frenal attachment.