Maxillary Labial Frenulum Morphology and Maxillary Anterior Dental Caries in Children: A Scoping Review

Abstract

Background/Objectives: The relationship between maxillary labial frenulum (MLF) morphology and caries of the adjacent maxillary anterior teeth remains uncertain. This scoping review mapped the available evidence in children. Methods: Following Joanna Briggs Institute (JBI) guidance and PRISMA-ScR, PubMed/MEDLINE, Scopus, Web of Science, and TR Dizin were searched up to August 2026, plus reference lists. Analytical studies in participants under 18 years of age were eligible. Two reviewers independently screened records and verified charted data; included studies were appraised post hoc using the JBI analytical cross-sectional checklist. Results: Of 68 unique records, six cross-sectional studies (1659 participants aged 6 months–16 years) were included. Five used the Placek classification or an equivalent and one the Kotlow scale; caries outcomes ranged from approximal lesions to ICDAS-based severity. Three studies reported bivariate differences without a consistent gradient, whereas three found no significant association. In the only adjusted analysis, no attachment category differed significantly from the mucosal reference; the others were unadjusted. Conclusions: Evidence is limited and heterogeneous. MLF attachment should not be used as a stand-alone caries risk marker. Current evidence does not support recommending frenectomy solely for the purpose of preventing maxillary anterior caries; this reflects insufficient evidence of benefit rather than evidence of ineffectiveness. Prospective studies with standardized anatomical and functional assessments are needed.