Post-Op Instructions

1. Post-op discomfort will likely only be mild to moderate and can be managed with over-the-counter medications such as Tylenol (Acetaminophen) or Arnica. We recommend Infants’ Tylenol every 6 hours for the first 24 hours. Do not administer Tylenol to child more than 3 days in a row. (Liquid Tylenol should be given a few drops at a time towards their inner cheek over several seconds).   
   *You can also use Arnica tablets.  Please dissolve 10 tablets in 1 oz of breastmilk or formula and put this in the refrigerator (please follow refrigeration safety guidelines).  You can use a dropper or a syringe and put a few drops on the healing sites and this should also be swallowed.  You can give 5-10 drops every 15 minutes during the first hour and then repeat once every hour after.  
   *Your child may be more fussy for the first 3 days.
2. A “white soft scab” will appear for the first 7-10 days while the frenotomy site is healing. This is not an infection and is simply a covering over the healing soft tissue. If a piece fluffs off, this is normal it can be discarded, and if child swallows it that is okay too.  The tissue may heal yellow as well.  
3. The procedure will create a diamond-shaped wound in your child’s mouth.  This is normal.  Some swelling or inflammation of the upper lip is normal.  Cold coconut oil and cold compresses can help with inflammation.
4. For the first 24 hours, frozen teethers, cold beverages, ice, “freezies”, or “popsicles” can be applied gently to the surgical site to help minimize swelling if these are age-appropriate for your child. The coconut oil we give you can also help with inflammation.  Breastmilk or formula popsicles are great for infants. 
5. Post-op: 7-10 days after the frenotomy is performed today, a post-op visit with us will be necessary to evaluate healing and discuss progress.
   Seeing lactation or a specialist within 72 hours of the procedure is highly recommended.
6. Stretches will be required to prevent reattachment.  Please begin the stretches within 6 hours of the procedure.   Remember, you are trying to “stretch” and change the normal movement of the tongue/lip/ and or cheeks. Stretches should be completed AT LEAST 4 TIMES A DAY, FOR AT LEAST 4 WEEKS.  However, the more the better. Diaper changes are a great time to do these in infants/young children or right before a feeding to wake them up. Do not go longer than 6 hours without stretching.  Using chilled coconut oil can help with inflammation and mobility after stretches.  We recommend using this AFTER the stretches not during.
   Using gloves may make stretches easier.
   *Place the coconut oil packet in the refrigerator.  When you are ready to use it, squeeze out a pea-sized amount and use it directly on the healing sites.

TONGUE (10-15 seconds): Position yourself behind your child and cup your child’s head with your palms, using your two clean index fingers enter the mouth from the corners of their mouth and place your fingers under the tongue, you want to apply pressure directly on the diamond wound, bringing your fingers together, pushing back towards their throat and then up towards the roof of their mouth-creating a wave-like motion.  You will want to make the diamond-shaped wound tall and skinny (you should see the entire diamond).  You will also use one finger to sweep across under the tongue from one side to the other (right to left) with pressure toward the back of the mouth.  You should not feel any significant bumps along the way, it should feel smooth.  You want to keep the diamond completely open, so it heals in a new position, the goal is to avoid the diamond from closing again.    

You should feel resistance and tension.  

LIP (10-15 seconds):  Position yourself behind your child and cup your child’s head with your palms, using your two clean index fingers enter the mouth from the corners of their mouth and pull their top lip up towards their nose and move it side to side.  Try to cover their nostrils first and then move side to side. You will also use one finger to sweep across, under the upper lip, from one side to the other (right to left) with pressure towards the nose (up).  You should not feel any significant bumps along the way, it should feel smooth.  You want to make the diamond long and skinny and you should see the entire diamond when stretching.  

You should feel resistance and tension. 

CHEEKS (10-15 seconds):  Use clean index fingers and pull the cheeks away from the bony ridge where teeth would be.  Think of making a funny face.  You will also use your fingers to apply pressure from the front to the back of the mouth within the cheek area.  The diamond-shaped wound will be difficult to visualize in these areas.  

1. If bleeding occurs during stretches at home, that is normal. That is an indication that you stretched harder than the previous time.

For patients older than 6 months:

1. Avoid sharp, spicy, and acidic foods/liquids for the first 72 hrs.
2. Brush your child’s teeth normally but be careful not to disrupt the soft tissue while it is healing. 
3. You can use the smooth and blunt end of a toothbrush if biting is an issue. You can also have your older child play games to encourage tongue and lip stretching such as making funny faces or licking off peanut butter or jam from their chin, nose, or cheeks to encourage the same movements listed above. 
4. You can use ibuprofen for pain relief if your child is over 6 months old. Please use over-the-counter children’s Ibuprofen (ex: Motrin) and use the dosage appropriate for their weight. You can administer Ibuprofen every 6 hours. You can also alternate Motrin and Tylenol every 3 hours so that each medication is given every 6 hours. 

• If there is excessive bleeding that cannot be controlled with pressure during today’s appointment, we will send you to Nationwide Children’s for assistance with obtaining hemostasis. This can occur but it is extremely rare.

The benefits of laser frenectomy compared to traditional surgical techniques have been shown in the literature to include:

• Reduced bleeding during surgery with consequent shorter operating time and rapid post-operative control of bleeding, thus eliminating the need for sutures.
• Improved post-operative comfort and healing.

Please call 614-304-9860 with any questions or concerns.