What is a tongue tie/lip tie?

Tongue tie or ankyloglossia is a congenital condition that negatively affects breastfeeding. The thickened, tightened, or shortened frenulum affects the infant’s ability to suck and frequently results in sore and painful nipples. Other problems that have been associated to this condition are speech pathology, malocclusion and gingival recession.

A lip tie is the relation of the upper lip frenum insertion and position. Common findings with a prominent labial frenum have been associated with breastfeeding difficulties among newborns. It can also interfere with proper oral hygiene measures which can lead to caries as well as initiation and progression of gum disease due to difficulty with cleaning the upper teeth area. Diastema or a gap between teeth can be affected by the position of the upper lip frenum.

Symptoms

Mother: A breastfeeding mother may have problems with:

  • Breast pain
  • Plugged milk ducts
  • Mastitis due to poor or incomplete breast drainage

Infant: A newborn infant that suffers from limited movement of the tongue can be acting irritable or fussy even after feeding. Some symptoms include:

  • Poor weight gain/weight loss
  • Falling asleep while nursing often due to the infant experiencing difficulty creating or maintaining suction and latching onto the nipple.
  • Symptoms of colic due to excessive air being swallowed
  • Lip Blisters

Toddlers and older: A child with a tongue tie can often experience speech problems due to restricted movements of the tongue intervening with pronunciation and development sounds. A child with a lip tie can also present with gum recession on the teeth, gaps between the upper teeth, tooth decay since a lip tie makes it difficult to properly brush teeth properly.

Procedure

In general, the procedure is very well-tolerated by children. We take every measure to ensure that pain and stress during the procedure is minimized.

1.) General anesthesia is not used in the office and is rarely necessary for this procedure.

2.) For babies under the age of 12 months, a topical numbing gel is applied to the area that will be treated. This medication works very quickly.

3.) For children 12 months of age or older, numbing gel is applied and in some instances, an injected local anesthetic may be applied for additional anesthesia.

4.) Our pediatric dental specialists will utilize a LightScalpel CO2 Laser to release a tongue tie/lip tie. The use of this laser means minimized bleeding, less risk of infection, faster recovery, and less swelling and discomfort.
You may breastfeed, bottle-feed or soothe your baby in any manner you’d like following the procedure. You may to stay in our office as long as necessary.


Post Care

  • Diet: Soft diet. Encourage fluids to avoid dehydration. Avoid salty and spicy foods (such as salsa), acidic drinks and foods (such as citrus drinks, lemons, oranges, etc.) or sharp foods (such as chips or tostadas) for the first 72 hours.
  • Oral Hygiene: Lasers are antibacterial so infection is very unlikely. In some cases, Gly-Oxide (oral antiseptic) may be recommended. It can be applied to the area with clean hands or with a cotton tip and is available for purchase in our office or over the counter at a pharmacy. Brush teeth with a soft bristle tooth brush carefully around the wound until it heals.
  • Care: There can be minimal swelling intraoral or extraoral in the following days after the procedure. Cold fluids, ice-cream, slushies and popsicles can be used for the first 24 hours to minimize swelling.
  • Evaluation: Patient should return in 10-14 days to evaluate healing.

Functional Exercises

The Upper Lip: Functional exercises that stimulate and promote healing by active movement like blowing kisses, sucking on a pacifier, bottle or breastfeeding and massaging the upper lip from the exterior.

Sucking exercises: Let your child suck on your finger and do a tug-of‐war, slowly trying to pull your finger out while they try to suck it back in.

The Tongue: Insert both index fingers into the mouth and stretching the cheeks. Then use both index fingers to dive under the tongue and lift it towards the roof of the baby’s mouth for 1-2 seconds. Release it and repeat the exercise. The goal is to completely unfold the tongue to keep it from reattaching.

Slowly rub the lower gumline from side to side and your baby’s tongue will follow your finger. This will help promote lateral movements of the tongue.

Team Approach

Why is it important to seek further medical care after treatment?

It is important that mothers who are breastfeeding or wish to breastfeed afterwards see an IBCLC. Many mothers who report pain while breastfeeding prior to the procedure may have already compensated in order to breastfeed. Infants may need to retrain in attaching to the mother and strengthen their muscles.

Speech and Language Pathologists can assist a child who is having difficulty with speech or feeding even after a release.