The frenum are bands of muscle attaching the lips, cheeks, and tongue to the bone in the mouth. Since no significant functional problems are encountered when a frenectomy (removal of the frenum) is completed, there is a minimal role in the function of the tongue or muscles of facial expression. Individual needs or problems may dictate when and if a frenectomy should be preformed. For the upper front frenum, a frenectomy is often postponed until the permanent lateral incisors and permanent canines erupt (permanent canines usually erupt about 11-13 years old). This recommendation is based on the fact that when the laterals and canines erupt, they will generally close the diastema (space) between the permanent central incisors. When a frenum is especially large, it prevents the closing of this space. If the diastema is not closed by the normal eruption of the upper anterior permanent teeth, a frenectomy may be helpful, although orthodontics may also be necessary. A large and highly attached frenum could also cause gum recession in adults. Newborns with enlarged upper frenum may have difficulty breast feeding and cause pain for the mothers. An upper frenum problem does not seem to affect speech patterns. On the other hand, the lingual or tongue frenum, which is attached to the underside of the tongue, may interfere with speech. Generally, this will become apparent when child begins to speak. If notching of the tongue is noted when the tongue is protruded, it is generally recommended to have the frenum removed. Speech therapy may also be required in conjunction with the surgery.