There are 7 frena in the mouth, and four of them are in the cheeks, and referred to as “buccal frena.”A frenum is considered a “tie” (tongue-tie, lip-tie) when it causes a problem. Otherwise, it is a “normal frenum.
So a buccal tie is an abnormally tight frenum in the cheeks. Typically the maxillary frena are the ones most often cause issues, but occasionally a mandibular buccal frenum can be restrictive as well.
When pulling the cheeks back, you will notice the frenum blanching the gingiva, it might elicit pain from the patient, and it will look like the sail of a sailboat. But appearance alone does not justify their release.
Buccal ties can theoretically interfere with nursing and nipple stabilization in infants (although there is no quality research supporting this), can cause gum recession in adults, lead to excessive fascial tension around the mouth (harder to move your lips), and are even the likely cause for dimples! With dimples, the cheek pulls in, because the frena are so tight.
That being said, we only occasionally release buccal ties in infants or children unless they are restrictive and the benefits outweigh the risks.
The biggest risks to releasing buccal ties are bleeding (minimal if using CO2 laser), reattachment (they can grow back together if stretches are not performed properly), and discomfort (not terrible, but still can be uncomfortable).
With babies, the tongue is the primary place to release if a baby is struggling, the lip-tie is secondary and contributes to seal issues (excessive gas, clicking sounds, milk leaking out, etc.) and the buccal ties are tertiary, but possibly make an impact.
We give parents the information from the exam, along with the risks, and potential benefits, and we let them decide. We do not charge anything for buccal ties (some dentists do charge, but as there is no research backing them up, you leave yourself open to criticism). It only takes a few seconds extra, maybe 5 sec per tie.
Babies do well with just lip and tongue releases, but possibly they could do better with buccal tie releases as well. Check for buccal ties, inform the parents, and use shared decision-making to come up with the best plan for that individual patient.