Frenulum Tear

Get CMETorn FrenulumHave you ever been told that something “isn’t a big deal” only to later find out that it was? Of course, any one who is in a significant relationship with another person has experienced this phenomenon. I, myself, may be at fault (once in a blue moon). Often, when I evaluate intra-oral injuries I will tell families that the mouth heals very well and seldom requires primary repair (ex, Tongue Lacerations). Naturally, there are other intra-oral injuries that do warrant more contemplation and concern (ex, Tonsillar Injuries). A lip frenulum tear, however, is “no big deal.” Right? Well… let us just remain vigilant.

 

Frenulum Tear

  • The upper lip has the Superior Labial Frenulum and lower lip has the Inferior Labial Frenulum.
    • Also referred to as a Frenum.
    • These are folds of mucous membrane that are midline and extend from the gingiva to the lips.
  • They can be easily torn when the mouth is hit or the lip is pulled/stretched.
  • Often bleeds “a lot” (as many injuries to the face/mouth do), but usually will spontaneously stop bleeding.

 

Frenulum Tear: Management

  • This is easy… management is reassurance that it will heal fine on its own! 🙂
    • Let families know that they may bleed intermittently if people keep pulling open the lip to see the injury.
    • Simple pressure on outside of lip usually is enough to stop bleeding.
    • May want to advocate for a soft mechanical diet for a few days to help avoid reopening the wound with sharp crackers and chips (the typical diet of most American kids).
  • Does not typically require specific closure or intervention.
    • Heals well on its own without primary closure.
    • If the tear is more than the frenulum, extending to the surrounding gingiva, repair may be necessary – be sure to use absorbable sutures!

 

Frenulum Tear: It is Trauma!

  • Unfortunately, another consideration needs to cross your mind: Non-Accidental Trauma / Abuse.
    • A frenulum tear is NOT pathognomonic for abuse, but intra-oral injuries are seen in a significant number of abuse cases. [Maguire, 2007]
    • The history, obviously, plays an important role in helping to raise concern for abuse.
      • Knowing the developmental milestones can help determine whether an reported cause of injury would be reasonable.
        • A 2 month old would not have caused her/his own frenulum tear by falling.
        • An 18 month old may have fallen an hit the lips on a table edge.
        • Non-ambulatory children with facial injuries should raise your level of concern for abuse. [Starr, 2015; Thackeray, 2007]
      • The most frequently reported abusive injury to the mouth is injury to the lips, but a frenulum tear in isolation does not equate to abuse. [Maguire, 2007; Thackeray, 2007]
    • Several abusive mechanisms have been proposed to cause a frenulum tear: [Maguire, 2007]
      • Forceful feeding
      • Forceful placement of a pacifier
      • Gagging
      • Gripping or stretching of the lip
      • Vigorous rubbing of the lip
      • Direct forceful blow to lip

 

Moral of the Morsel

  • A frenulum tear can be managed with simple, non-surgical interventions.
  • A frenulum tear is intra-oral trauma. Remain vigilant and evaluate for other trauma.
  • Undress the child and look for other trauma. I know it is tempting to just look in the mouth… but be thorough and look for other signs of non-accidental trauma.
  • A frenulum tear is not pathognomonic for abuse, but make sure the story and developmental milestones make sense.

 

References

Starr M1, Klein EJ, Sugar N. A Perplexing Case of Child Abuse: Oral Injuries in Abuse and Physician Reporting Responsibilities. Pediatr Emerg Care. 2015 Aug;31(8):581-3. PMID: 25426684. [PubMed] [Read by QxMD]

Maguire S1, Hunter B, Hunter L, Sibert JR, Mann M, Kemp AM; Welsh Child Protection Systematic Review Group. Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries. Arch Dis Child. 2007 Dec;92(12):1113-7. PMID: 17468129. [PubMed] [Read by QxMD]

Thackeray JD1. Frena tears and abusive head injury: a cautionary tale. Pediatr Emerg Care. 2007 Oct;23(10):735-7. PMID: 18090110. [PubMed] [Read by QxMD]

Naidoo S1. A profile of the oro-facial injuries in child physical abuse at a children’s hospital. Child Abuse Negl. 2000 Apr;24(4):521-34. PMID: 10798841. [PubMed] [Read by QxMD]

da Fonseca MA1, Feigal RJ, ten Bensel RW. Dental aspects of 1248 cases of child maltreatment on file at a major county hospital. Pediatr Dent. 1992 May-Jun;14(3):152-7. PMID: 1528783. [PubMed] [Read by QxMD]

Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

You may also like...

20 Responses

  1. Hannah says:

    I have torn my frenum three times (maybe four) and it has never healed properly. It doesn’t hold my lip down like it’s supposed to and it kind of sticks out. I might have done something to it again because it hurts. Is this normal?

  2. Shaun says:

    I was either 6 or 7 when I tore my upper frenum. I did a belly flop on my trampoline and my upper lip got streatched to far when I landed. I remember a lot of pain and blood but that’s about it. I can’t even remember how long it took to heal. Works fine now though.

  3. Hunter says:

    My sisters upper lip was tore and it was seriously bleeding but the bleeding stopped her upper lip is a bit purple now. is she fine

    • Sean Fox says:

      Obviously,I cannot give out specific medical advice to patients who I have never evaluated. That being said, where the injury actually is matters in to assessing whether any intervention is needed. If you are concerned, you should see your physician.
      Hope all is well,
      sean

  4. evans says:

    what is the function of the frenulum

  5. monique says:

    I am 17, recently I had some pain in my jaw, it was stiff and hard to chew or open my mouth too wide. it lasted for about 2/3 days ,I initially thought it had something to do with my wisdom teeth growing, which is partially grown out; the rest is still under the gum. so I usually try to open my mouth really wide to look at my wisdom teeth on about the 3rd/2nd day my jaw stopped hurting but then my frenulum started to pain and has been 4 days now and its hasn’t seem to be getting any better. my question is this a frenulum tear/ damage as well because I haven’t really seen it bleed.

  6. Lesley says:

    My son is 11 months old he fell and tore his upper labial frenulum. The bleeding stopped but I am worried about his labial frenulum. What should I do?

    • Sean M. Fox says:

      Intraoral lacerations and frenulum tears heal exceptionally well WITHOUT needing repair. If you ever are uncertain, ask your physician or friendly neighborhood Emergency Physician!

      Hope all is well,
      Sean

  7. Eve says:

    (I’m 15 by the way) My upper labial frenulum got stuck between my two front teeth as I was growing which is probably why I get pain from time to time. But it comes randomly. I have literally just woken up and it hurts. What could it be and how can I fix this.

  8. Harry says:

    Some of the frenulum under my tongue just disappeared can you expliane it please because I’m scared of the rest breaking

  9. Tsomo says:

    My 8 month old just tore his upper labial frenulum. He must have pulled his lip too forcefully because he was literally just lying next to me.
    He doesn’t seem to be in any particular pain or anything. Seeing my baby’s blood hurt me more than it did him.
    Anyways, my question is what is the function of this and will this little injury cause any issues later on (speech development etc.)?

    • Sean M. Fox says:

      The lip’s frenulum is an attachment point between the lip and the gingiva. Tears usually heal without complication and have no lasting ill-effects.
      It is important, though to ensure continued good oral hygiene.
      All the best,
      sean

  10. Kennieth says:

    My 4 year old frenulum is stuck between his two front teeth, but he saying it doesn’t hurt. Can it be removed, or will it come out on its own?

  11. Kaylana says:

    I noticed that my upper frenulum had a small tear a long time ago. But recently, i think i did something while brushing and now its much larger of a rip. Its quite painful. What should i do ? Have had a little blood while brushing. But thats all I’ve noticed

  12. Lubna says:

    Hi my 18 months old smashed her lip Frenum in a very bookish table edge injury
    Her lip sticks out and she intermittentlybhas a bleed but always provoked like wipe nose etc.
    My concern
    Does she need Antibiotics to prevent infection
    How long does it take to heal
    The dentist saw her yesterday and said she may or may not need a stitch /Glue for better healing.
    She a
    Dr Sean thanks for all above info.
    I will really appreciate if you can answer some questions in general . Completely understand won’t be specific to my child .

    • Sean M. Fox says:

      I’m sorry your child was injured… although these types of things happen often so do not fret.

      Obviously, I cannot specifically advise you on how to care for your child. In general though, frenulum tears / injuries need nothing more than time to heal (usually not much time… as the mouth heals very quickly). Keeping the area clean with good dental hygiene is all that is usually needed. No antibiotics will be beneficial for uncomplicated injuries.

      All the best,
      sean

  13. Trystan says:

    Hi, I’ve had an upper lip frenelum most of my life but I remember rubbing it this time last year. It used to connect the midle of my upper lip to the gum. If it heals, will it stretch down again to my upper lip (in the middle)? I want to say in past years it’s grown back but im concerned if it will again. Are these years of healing?

  14. Yumi says:

    Urgent response requested, if possible. My 9 mo old has a slight case of lip tie. He was, when he was born, advised to get it cut so it would be easier for him later in life. We didnt do it, but he just fell and it tore… will it heal together or will it remain separated? If it heals together, do we need to see a doctor to help it heal separately so he doesn’t have to get it cut in the future if it bothers him? Please help.

  15. Abigail says:

    I was unaware that my upper frenulum was torn into I got it pierced it was torn before but I’m not sure when. But since I got it pierced I have had horrible headaches and I was wondering if it was the reason why. If anyone knows please tell me.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.