As a pediatric dentist and owner of Arlington Tongue Tie Center, I pride myself on having a conservative and collaborative approach when it comes to treating oral restrictions. Too many providers rush to release, and too many parents are misinformed thinking the Laser Frenectomy procedure is going to be a magic fix.
I’ve composed a list of important things that I feel everyone should know about tongue-ties and lip-ties in infants and children.
A tongue-tie is a physical condition in which the tongue’s movement is restricted due to an attached lingual frenum that is too tight, thick or short.
Everyone has a frenum, which connects the tongue to the floor of the mouth. Simply seeing a “string” under the tongue does not confirm the presence of a “tie”. It’s necessary to determine if the tissue allows full movement and function of the tongue or if a restriction of tongue mobility is present.
There is a difference between tight tissue and a functionally “tied” tissue. An experienced provider can distinguish between the two and determine if a symptomatic functional restriction is present. This is critical in helping prevent misdiagnosis and overtreatment of tongue-ties.
It is important to find a provider that takes a conservative and collaborative approach. A collaborative release provider acts as a quarterback for your child. When an infant or child presents with symptoms related to an oral restriction, a conservative, collaborative provider identifies that patient’s needs and provides an appropriate referral. A release is only considered if symptoms do not resolve after conventional therapies, like those provided by IBCLCs and bodywork specialists.
Easy ways to identify an experienced, conservative provider include asking the following questions: Do you require pre-frenectomy work? Feeding therapy and myofunctional therapy before a frenectomy are important to a successful outcome. Do you provide any aftercare exercises or follow up visits? Follow up is essential. If your release provider does not provide a 1 week follow up, find a different provider. Do you provide virtual follow up? Follow ups are being done to evaluate the healing wound and ensure aftercare stretches are being done with enough tension. This is not possible to evaluate virtually. Find a different provider. Do you use a CO2 laser? If the provider uses scissors, a diode or an Erbium laser (such as a WaterLase), find a different provider.
If a symptomatic functional restriction is present, a frenectomy is indicated – preferably using a CO2 laser. The CO2 laser promotes rapid healing and minimizes the risk of bleeding and infection. It is also associated with the lowest intra-operative and post-operative pain, as well as the quickest procedure time. Scissors pose challenges with hemostasis, precision and ability to navigate anatomical complexities. In addition to a release, aftercare exercises are critical to help maintain and improve mobility and flexibility of the healing tissue.
The release of the frenum is just one piece of the puzzle. It takes teamwork to make the tongue work! Following a release, it takes time to figure out what to do with the new mobility of the tongue & lip, so support from professionals like Lactation Consultants, Speech Therapists/OT/PT and Myofunctional Therapists is key to the success of treatment.
Many healthcare providers do not fully recognize the complexity of oral restrictions. It’s recommended to consult with an IBCLC (International Board-Certified Lactation Consultant), Feeding Therapist, Myofunctional Therapist or an experienced Release Provider (such as a pediatric dentist or an ENT).
In order to provide optimal care for the mother-infant dyad, it is critical to be able to identify signs and symptoms of oral restrictions. Not every oral restriction requires release, but every restriction does require referral to appropriate specialists (such as an IBCLC or feeding therapist). Babies with a tongue-tie and/or lip-tie may experience trouble latching, poor weight gain, clicking sounds while feeding, as well as increased air intake due to a disrupted seal leading to reflux symptoms and gassiness. Mother’s may experience symptoms like nipple pain, bleeding, ineffective breast drainage, clogged ducts, mastitis and milk supply issues.
Untreated symptomatic functional restrictions can have long-term implications and lead to dental problems, speech delays, picky eating, improper development of the jaws, orthodontic issues, as well as sleep disordered breathing.
Dr. Allie Lonneman is an award-winning pediatric dentist and tongue-tie and lip-tie specialist providing Laser Frenectomy treatment at Arlington Tongue Tie Center. Your child deserves the best. Click here to schedule a Consultation.
