By Kacy Jo Williams, DMD E arly craniofacial growth is influenced by a complex inter-action of genetics, airway patency, oral posture, neuro-muscular function, and environ-mental factors. Increasingly, dental professionals are encountering infants and children with feeding difficulties, speech concerns, malocclusion, and signs of sleep-disordered breathing. Among these patients, restrictive oral frenula— particularly ankyloglossia—are frequently identified as a possible contributing factor. While frenectomy procedures have become more common in pediatric care, particularly in infancy, questions remain regard-ing appropriate indications, long-term benefits, and how the approach should be integrated into comprehensive early-intervention strategies. For dentists, the clinical question is not whether frenec-tomy is effective in isolation, but how it fits into a broader frame-work that includes functional ther-apy, airway screening, and guided craniofacial development. Ankyloglossia & Functional Outcomes in Infancy Ankyloglossia is characterized by a restrictive lingual frenulum that limits tongue mobility and may interfere with normal oral function. In infants, the strongest and most consistent evidence supporting frenectomy relates to breastfeeding outcomes. Multiple studies and clinical reports demonstrate that frenectomy, as well as less-invasive frenotomy, can reduce maternal nipple pain and improve latch and feeding efficiency in infants with symp-tomatic tongue ties. A 2024 American Academy of Pediatrics clinical report empha-sizes that frenectomy should be considered only when functional limitations are present and persist despite appropriate lactation support. The report highlights the lack of standardized diagnostic criteria and cautions against proce-dure-driven decision making based solely on the visual appearance of the frenulum. These recommenda-tions reinforce the importance of a functional, team-based assessment involving pediatric providers, lactation specialists, and dental professionals when appropriate. 1 26 Winter 2026 JAOS
Journal of the American Orthodontic Society Winter 2026: Page 26
