Severe Early Childhood Caries with Abnormal Maxillary Labial Frenum Attachment: A Case Report

Introduction: The risk factors of early childhood caries (ECC) include bacterial factors, feeding habits, brushing habits. Abnormal maxillary labial frenum attachment is a risk factor contributes to facial caries of maxillary anterior teeth. It causes plaque easily accumulation and hard to remove. This case presents a boy that suffered from severe-ECC with an abnormal labial frenum attachment which need full mouth dental treatment under general anesthesia (GA).

Case Report: A 3-year-10-month-old boy was referred from LDC due to severe-ECC with abnormal maxillary labial frenum attachment. The boy had breast-feeding at night till 3 years old. The clinical examination revealed his maxillary labial frenum attached to palatal papilla with severe-ECC. Medical history was non-contributory. Due to his behavior problem and the complexity of the treatment, we decided to have maxillary labial frenectomy and full mouth dental treatment under GA, which included composite resin filling, pulpectomy following by the zirconia crown for anterior teeth, SSC for posterior teeth. We started from maxillary anterior teeth pulpectomy, then we performed classical frenectomy which done by scalpels and sutures following by zirconia crown restoration. Finally, we finished the pulpectomy and SSC restoration of posterior teeth. Six months after treatment, the wound healing well with maxillary labial frenum attached to a higher position. One year follow-up revealed no scar tissue formation with normal maxillary labial frenum attachment. It’s easier for parents to brush his teeth.

Conclusions: Abnormal maxillary labial frenum attachment restricts upper lip movements and thus forms a pocket to trap retained milk or plaque on feeding. It also makes cleaning teeth difficult, thus causing facial caries of maxillary anterior teeth. Classical frenectomy removes all of the tissue and no sign of relapse after a year. The risk of ECC also reduced. Early diagnosis and treatment can prevent ECC from occurring and improve oral hygiene.