EXPLANATION OF DIAGNOSIS: I have been informed of the presence of abnormal frenum attachment near the gum line of my teeth or behind my lower front teeth (tongue-tie). I understand that this condition has restricted movement of my lip and/or tongue. This may cause altered jaw development, function, range of motion and/or recession of the gumline around affected teeth.
PURPOSE OF FRENECTOMY SURGERY: I have been informed that the purpose of this surgical procedure is to release and relax this abnormal frenum attachment. I understand that this will not reverse the recession if present.
SUGGESTED TREATMENT: It has been suggested that the frenectomy surgery be performed in areas of my mouth where I have abnormal frenum attachment. It has been explained that this is a surgical procedure involving an incision in the mucosa, to reduce the pull on the lip and/or tongue.
RISKS RELATED TO SUGGESTED TREATMENT: While this could be considered a low risk procedure, risks related include, but are not limited to post-operative bleeding, swelling, pain, infection, altered nerve sensation, facial discoloration, transient or, on occasion, permanent tooth sensitivity to hot or cold, sweets or acidic foods. Risks related to the local anesthetics might include, but are not limited to, allergic reactions, accidental swallowing of foreign matter, facial swelling or bruising, pain, soreness, or discoloration at the site of injection of the anesthetics.
COMPLIANCE WITH SELF-CARE INSTRUCTIONS: I understand that excessive smoking and/or alcohol intake may affect healing and may limit the successful outcome of my surgery. I also understand that strenuous exercise can cause the loss of a clot and excessive bleeding and so possibly reduced success of surgical procedures. I agree to follow instructions related to the daily care of my mouth.