238 - Incidence of Unreleased Lip Tie in Patients with Primary Maxillary Anterior Caries

Purpose: Restrictive frenum attachments present as a thick or tight tethering from upper lip to the maxillary labial attached gingiva. The attachment is theorized to interfere with the ability to flange the lip, creating pockets retentive for food, liquids and interfering with proper oral hygiene measures. This contributes to the complex dynamics of odontogenic demineralization and remineralization.This study intends to add to the literature on anatomical interferences and caries development. Specifically, if a more severe frenum classification is associated an increased in caries in maxillary anterior teeth.


Methods: This prospective cross-sectional study was conducted at the Children’s National Medical Center Division of Oral Health following approval from the Institutional Review Board at Children’s National Medical Center. The study population consists of 26 children (ages 2 years to 6 years) with untreated facial-cervical caries on at least one maxillary incisor presenting to the Children National Medical Center’s Dental Clinic for routine care. Though photographs are within the standard of care, dental providers received verbal consent from the patient’s guardian prior to taking photographs. Photographs were taken and frenum attachment graded using Kotlow Classification Method (Figure 1). Caries severity was determined using the Smooth Caries International Caries Detection and Assessment System II. Data was analyzed using Analysis of Variance (ANOVA).

Results: The distribution of ICDAS classification by frenum class demonstrates that higher frenum classes have more teeth identified as ICDAS 5 or 6. Regardless of frenum class, 64%-74% of all carious teeth have a severe (ICDAS ≥ 4) caries presentation. ANOVA test classification comparing severity between the different frenum classes had an F-stat = 0.39, p-value = 0.76. There is not a statistically significant difference in amount of severe caries between frenum classes. When evaluating ICDAS classification by tooth, there is an overall increase in the percentage of of teeth with severe caries in the central incisors.

Conclusions: The consistency of ICDAS ratings, and the higher rate of severe caries presentation on the central incisors supports our hypothesis that restrictive frenum attachment may contribute to a more cariogenic environment. Future studies could further incorporate age of caries formation, diet, plaque score, oral hygiene practices, gender, race, or social economic status.