Lip-Ties and Tongue-Ties
Dr. Vo and The Children’s Dental Cottage is proud to provide lip and tongue-tie releases with the use of a laser. We do a full examination on each patient and determine the patient’s individual needs before giving the option of treatment. If treatment is recommended, we can perform the procedure the same day in many cases. We would be honored to care for your child and help you through understanding more about this condition.
Dr. Vo has completed continuing education courses to gain further knowledge on detecting lip and tongue-ties, how they could affect child development, the most effective way to release lip and tongue-ties, and management of children with lip and tongue-ties. She is a graduate of Dr. Richard Baxter’s course, Tongue-Tied Academy, where extensive knowledge and skills were gained on how to effectively provide frenectomies. Additionally she is TOTS trained, where her knowledge has expanded further into the importance of creating a team approach with myofunctional therapists, speech and feeding therapists, chiropractics, and bodyworkers.
What Is a Tongue-tie or Lip-tie?
Before we are born, a strong cord of tissue that guides the development of mouth structures is positioned in the center of the mouth. It is called a frenum. As we develop in the womb, this frenum is supposed to recede and thin by birth via a process called apoptosis, but in about 10% of children, this doesn’t occur for the tongue and/or lip. This leaves the tongue and/or lip connected.
Tongue-tie (or ankyloglossia) is a condition that limits the use of the tongue. Lip-tie is a condition where the upper lip cannot be curled or moved normally.
The lingual (tongue) or labial (lip) frenum is visible and easily felt if you look in the mirror under your tongue and lip. Everyone has a frenum, but in some people, the frenum is especially tight or fails to recede and may cause tongue/lip mobility problems.
The tongue and lip are a very complex group of muscles and are important for all oral functions. For this reason, having a tongue-tie or a lip-tie can lead to nursing, feeding, dental, speech and/or sleep problems, which may be serious in some individuals. Problems can persist into adulthood with migraines, neck pain, shoulder pain, speech problems, and sleep apnea.
Does My Infant Have a Lip or Tongue-Tie?
Does Your Baby Experience any of these symptoms?
- No latch or poor latch
- Prolonged feeding
- Frequent feeding
- Baby seems unsatisfied despite long feeding and adequate milk supply
- Baby falls asleep on the breast
- Colic and/or reflux symptoms
- Baby gums or bites the nipple rather than sucking
- Poor weight gain
- Inability to hold the pacifier
Do You Experience any of these symptoms from nursing?
- Creased or discolored nipples after feeding
- Flattened nipples after feeding
- Cracked, bruised, blistered or bleeding nipples
- Painful latch
- Incomplete drainage
- Infected nipples
- Plugged ducts
- Mastitis and nipple thrush
If you notice any of these symptoms, it’s important to have your infant evaluated for tongue or lip-tie. The sooner the tongue is released the better the child is able to adapt to the new mobility of the tongue. A 1-week old baby will do better than a 3-week or a 12-week old baby. A 4-year-old with speech issues will do better than a 7-year-old, etc.
When is tongue and lip-tie a problem that needs treatment?
In Infants
A new baby with a too tight tongue and/or lip frenum can have trouble sucking and may have poor weight gain. If they cannot make a good seal on the nipple, they may swallow air causing gas, colic, and reflux or spitting up. You may hear clicking noises when the baby is taking the breast or a bottle. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue and lip tie. It can also cause thrush, mastitis, nipple blanching, bleeding, or cracking in the mother and inability to hold a pacifier. The mother often reports it’s a “full time job” just to feed them because they are constantly hungry, not getting enough milk, and spitting up what they do get.
Although it is often overlooked or dismissed by other medical professionals, a tongue and lip-tie can very often be an underlying cause of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breastfeeding altogether. Very often, after releasing the tongue and/or lip, mothers report immediate relief of pain and a deeper latch. The symptoms of reflux and colic almost disappear, and weight gain occurs rapidly. The sooner the tongue-tie is addressed the better the child will learn to use his or her tongue correctly
Although it is often overlooked or dismissed by other medical professionals, a tongue and lip-tie can very often be an underlying cause of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breastfeeding altogether. Very often, after releasing the tongue and/or lip, mothers report immediate relief of pain and a deeper latch. The symptoms of reflux and colic almost disappear, and weight gain occurs rapidly. The sooner the tongue-tie is addressed the better the child will learn to use his or her tongue correctly
Posterior Tongue-Tie
If a baby has symptoms of a tongue-tie (not gaining weight, poor latch, clicking when nursing, gumming the nipple, painful nursing, reflux, gassy, etc.) and there is not an obvious string, it is very likely a “posterior tongue-tie”. This is a hidden tie that is felt easily, but very often overlooked by other medical professionals that have not been trained to identify it.
In Toddlers and Older Children
Speech
By the age of three, speech problems can become evident, especially articulation of the sounds - L, R, T, D, N, TH, SH, and Z may be noticeable. An evaluation may be needed if more than half of a four-year-old child’s speech is not understood outside of the family circle. The child with a tongue-tie may have a lisp or have difficulty speaking when tired. It can also lead to sleep apnea, mouth breathing, other airway issues and cause difficulty chewing and swallowing food.
Although there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common:
- Heart-shaped tip of the tongue, or a thick band of fibers under the tongue.
- Inability to stick out the tongue past the lower lip.
- Inability to touch the roof of the mouth with the tongue or get close (this is the best test!)
- Difficulty moving the tongue from side to side.
Feeding
Children that are tongue-tied often eat slowly (are the last one to finish a meal) and eat very picky, especially with textures. Often, they have trouble with nursing as a baby or taking a bottle and the problems persist into childhood and even adulthood. When transitioning to solids they may choke, gag, or spit food out. They may refuse to wean because they don’t “like” or tolerate solid food. They can have difficulty swallowing, so they can get distracted while eating further prolonging meal times and leading to grazing on food throughout the day. The textures that are often difficult are purees, mashed potatoes, meats, and other soft mushy foods, but sometimes chewy foods or hard foods can be difficult as well. Not every feeding problem is a result of a tongue-tie, but there are many that are, and it is likely the most common reason for feeding issues that is easily overlooked.
Dental
For older children with a lip-tie, it is common to have a gap between the two front teeth. This often closes if the frenum is removed (typically done before 18mo old, or later around age 8 when the permanent teeth erupt). The tongue-tie can also pull against the gums on the back of the teeth and cause recession. The tight lip-tie may trap food and make it difficult to brush off plaque from the front teeth, leading to cavities.
One of the most common questions about lip-ties revolves around a space or gap between the front teeth and the frenulum. Spacing in infant and children’s teeth is extremely beneficial and ideal. These baby teeth that are spread out and have spaces are easier to clean and the space between the baby teeth will be later occupied by the much wider adult teeth. Genetics play a large part in spacing between the front two teeth and is referred to as a diastema. If the child’s parent or grandparent has a prominent space between the two front teeth or the gap was corrected through braces or cosmetic dentistry, the infant will likely have a diastema as well later on in life. Revising or fixing the frenulum as an infant will NOT resolve the genetic cause of this diastema.
One of the most common questions about lip-ties revolves around a space or gap between the front teeth and the frenulum. Spacing in infant and children’s teeth is extremely beneficial and ideal. These baby teeth that are spread out and have spaces are easier to clean and the space between the baby teeth will be later occupied by the much wider adult teeth. Genetics play a large part in spacing between the front two teeth and is referred to as a diastema. If the child’s parent or grandparent has a prominent space between the two front teeth or the gap was corrected through braces or cosmetic dentistry, the infant will likely have a diastema as well later on in life. Revising or fixing the frenulum as an infant will NOT resolve the genetic cause of this diastema.
In Young Adults
For older children with a lip-tie, it is common to have a gap between the two front teeth. This often closes if the frenum is removed and the permanent canines erupt. Sometimes orthodontic treatment is needed for a full closure if the gap is too large. A tight lip-tie may trap food and make it difficult to brush off plaque from the front teeth, leading to cavities.
The tongue-tie can pull against the gums on the back of the teeth and cause recession, which can lead to gingival problems and loss of bone support for the teeth.
What is a Frenectomy
Frenectomy is a procedure used to correct a tongue tie and/or lip tie. A frenectomy can be done surgically or with the use of a laser.
The benefits of using a laser (compared to a surgical frenectomy) are:
- Minimal to no bleeding allowing better visibility for the doctor
- Enhanced precision due to better visibility
- Complete removal of desired tissue
- Minimally invasive
- Short treatment time (1-2 Minutes)
- Less trauma to underlying tissue layers
- Rapid healing and recovery
Tongue-tie and Lip-tie Procedure
The removal of lip or tongue ties where previously only performed surgically. With the latest developments in laser dentistry, frenectomies can now be safely performed in office, with minimal or no discomfort, and with no need of general anesthesia or deep sedation.
Tongue-tie and lip-tie release is a simple procedure and there are virtually no complications when using the Solea laser with good technique. The procedure may be performed as early as a couple of days after birth and can be performed into adulthood. Typically, once a problem with a tongue-tie or lip-tie has been discovered, the sooner it is addressed the better the procedure will work, and the fewer issues the child will have.
Babies tolerate the procedure very well, and we try to ensure that discomfort is minimized. The revision can be performed in our office with some numbing jelly. Dr. Vo uses the highest quality, state-of-the-art laser technology to perform the release.
Older children who understand the procedure receive some numbing medicine and laughing gas and usually report no pain at all during the procedure. Younger children and babies usually cry more due to us working in their mouth than the pain.
The actual procedure is very easy on your child, and we work hard to make it as easy as possible. We have done this many time, and we know the ways to ensure minimum discomfort and stress. In most cases only a topical numbing anesthetic for the baby’s comfort needs to be used. This works very quickly. For older and larger children (typically over 12 months), we may supplement with an injection of anesthesia to ensure the entire area is adequately numbed (topical cream may only work on the surface).
For the best outcome for nursing moms, we do not have you in the treatment room. We will carry your baby to and from the treatment room. Parents are encouraged to wait in the waiting room during the procedure. Your baby will be away from you for just about five minutes, of which the actual laser treatment takes two minute or less. The laser gently removes the tight tissue with virtually no bleeding and no stitches.
Crying and fussing are common during and after the procedure. You can soothe your baby in any manner that works, including breastfeeding or bottle feeding in our office. We won’t rush you out–you can stay until both you and your baby have recovered and feel comfortable leaving.
Laser surgery is essentially risk free. The procedure does not involve medications, so there is no risk of an allergic reaction; no other complications have been identified at this time.
After the Procedure
The primary concern after the procedure is that the healing site will reattach due to the rapid healing capability of the mouth. This could cause a new limitation in mobility, and the return of symptoms. Therefore, it is recommended that you perform post-op stretching exercises for your baby.
Post-op exercises and instructions will be provided after your baby’s procedure.
Follow-Up Care
There is a follow up appointment that is scheduled for you and your baby one week after the procedure to monitor healing. Dr. Vo implements a team approach, and highly recommends that patients also be followed up by a lactation consultant both before and after the procedure, to increase breastfeeding success. Additionally, there may be a need to have a chriopractor, myofunctional/speech therapist, or bodyworker be included in the process to aid in the best outcome for the child’s release.