Infant Tongue Ties and Lip Tie Release by laser dentist

 Dr. Geisler is passionate about helping families with young children who are having difficulty feeding.  Her story in this field started like many dentists who treat infants.  When her newborn was first handed to her, it was evident to her immediately that there was a tongue tie.  The tip of her tongue was heart-shaped, tied to the lower ridge and the tip of the tongue could barely pass over the ridge. After lactation consultant recommended "wait and see" it became clear after a few weeks that the tethered oral tissue was negatively influencing their breastfeeding experience.   Her only regret was waiting and not doing it immediately.  Pain-free, successful nursing was the instant result for her and her daughter.   Even though that was her experience, we recommend seeing a lactation consultant, a feeding consultant or myofunctional therapist, and a cranial sacral therapist for the best outcome.   All children are different, so what one family experiences after a release may not the same for another family. Helping child and mother successfully bond and nurse is more rewarding than completing the most beautiful veneer case .  

Dr. Geisler is a dentist in Minnesota who treats infants and children with tongue-ties and lip-ties

Dr. Geisler is a dentist in Minnesota who treats infants and children with tongue-ties and lip-ties

 

What is a frenum?

A frenum, or another term, frenulum, is a small fold of tissue that holds and restricts our lips and cheeks with relation to our jaw.  We have seven frenums in our mouths, but the most commonly problematic ones are the lingual frenums (under the tongue) and the maxillary labial frenum (upper lip).  Less frequently, the lower lip frenum and side ones can contribute to a problem.  However, frenums are not always a problem, or every person God created would need a release!  Dr. Geisler will discuss with you if the frenum release is medically necessary.  The definition of medically necessary treatment is "health-care services needed to prevent, diagnose, or treat an illness, injury, condition, disease or its symptoms."  We discuss symptoms in the baby,  symptoms of the mother, the babies function, the appearance of the anatomy of the oral cavity, suck testing, to determine if a tongue or lip tie release is recommended. 

The following are symptoms that may point to anklyoglossia as a problem:

In the child:

  • difficulty achieving a good latch
  • falls asleep attempting to nurse
  • slides of breast when attempting to nurse
  • reflux shown by clicking, swallowing air or inflated tummy
  • short sleep episodes (needing to feed frequently)
  • apnea, snoring, heavy breathing
  • unable to keep pacifier in
  • waking up congested
  • sleeping only in upright position
  • unhappy when laying on back
  • discomfort when upper lip is raised by adult
  • gagging once solid food introduces
  • picky and messy eater once solid food is introduced
  • colic
  • milk leaking out sides of mouth or nose during feedings
  • failure to thrive, not gaining weight
  • long nursing sessions
  • swallowing air
  • uncoordinated suck
  • gas
  • gulping or swallowing a heavier let down
  • clicking sound while nursing
  • cannot keep nipple of a bottle in mouth
  • blisters on lip(s) and or tongue
  • difficulty swallowing
  • unable to move tongue side to side and lift up
  • heart shaped tongue or cleft in tip of tongue
  • can extend tip of tongue over lower ridge only or not even to lower ridge
  • cannot raise tongue
  • A scissors "snip" at birth that did not resolve problem
  • A health professional suggesting a tie may be a problem

In the mother:

  • cracked, creased, misshapen or blanched nipples
  • painful nursing
  • painful latching
  • bleeding, abraded or cut nipples
  • poor or incomplete draining
  • feeling of baby chomping
  • infected nipples or breasts
  • plugged ducts
  • mastitis
  • lipstick shaped nipples
  • breast, areola, or nipple thrush
  • feelings of depression
  • over or under supply of milk
  • knowing "something isn't right" compared to a previous breastfeeding experience
  • nursing for long periods of time

Consequences of Tongue tie

The following are possible short and long term consequences of restricted tongue and to some degree, the upper lip:

  • Poor breastfeeding experience, therefore higher chance of switching to formula
  • Speech problems
  • Gulping air leading to gassiness
  • Sleep apnea
  • Snoring
  • Narrow dental arches
  • Swallowing  problems
  • High vaulted palate (roof of mouth)
  • Difficulty chewing and swallowing food
  • Dental decay on front upper incisors (lip tie)
  • Central incisors that are rotated in
  • Malocclusion
  • Symptoms of gastric reflux
  • Breathing through mouth instead of nose (leading to lifetime poor oxygenation)
  • Inability to move tongue for licking ice cream cones and other foods
  • Affect sexual activity as adult
  • Contribute to TMJ or TMD 
  • Space between front two teeth
  • Gum recession lower incisors
  • Head and neck postural problems which leads to pain in neck and back and headaches
  • Anxiety

A simple revision, done early in life, can prevent a lot of health problems. A frenulectomy for a newborn infant is much easier than when a child is a toddler or preschooler.  A frenulotomy (different term but same as a tongue tie release) can be done at those ages, but it is a difficult procedure for the child and is also difficult to do the necessary stretches in the weeks that follow to prevent reattachment.  That being said, Dr. Geisler has seen 3 day old child up to a mature adult for tongue tie releases.   

Why hasn't this been diagnosed yet?

Many parents we see are beyond frustrated with the amount of appointments and time it took them to find someone who would diagnose the tethered oral tissues as a problem and could offer the solution.   They have brought their child to multiple providers who tell them there is no tie, there is a tie but it's not the problem, or that release would be dangerous and require hospital sedation.  It takes a trained practitioner to diagnose the tie, especially if the tip of the tongue is not severely tied to the lower arch.  Dr. Ghaheri, a leading expert in Oregon, uses the analogy of a sailboat to explain that every anterior tie has a posterior tongue tie component.  When a tongue tie is "clipped" just at the front, an incomplete release is done.  Imagine a sailboat with the sail up trying to get under a low bridge.  The sail is "lowered" with a (quick scissor clip) but the mast that is still upright will prevent the boat from moving under that bridge.  The mid to back (posterior) portion of a frenum also needs to be released to allow the tongue to move correctly.  Our mouths are designed to have the central part tongue seal up against the palate, creating a vacuum.  This vacuum is what expresses milk and when lacking, contributes to a problem feeding.  Recent ultrasound videos of a baby swallowing show the healthy way a tongue should move.  A restriction makes the body compensate and doesn't allow the shape of the mouth to develop correctly.  Many parents discover a tongue-tie when the child is a toddler, preschooler or older.  The procedure can be done for older children, and for adults for that matter, and we will the discuss the when and how questions at your consultation.  Our goal is to offer treatment without having a surgical intervention by an ENT the operating room.

The subject is somewhat controversial, stemming for the lack of education and the need for more studies.   Traditional training for physicians, dentists and lactation consultants often downplays or opposes entirely, the impact a tie can have.  Breastfeeding is not taught in most professional schools.  Recent pushes in training of professionals has increased the number of providers, but only for those who are eager to learn about it.  The scientific studies are being published more and more, but it is difficult to do a double-blind study, when delaying treatment for a child who is failing to thrive is unethical.    As the word is spreading, lactation consultants, pediatricians, mid-wives, speech therapists, dentists and other are being educated about oral restrictions.  Frenums are significantly more prevalent and problematic than believed in the past.  The increase in breast feeding in this country in the past twenty years has increased the number of children that present with a tie. It is suspected that a dominant gene could be part of the increase in tethered oral tissues, it is not a fad to do a frenectomy.   For a child's best health, nursing is recommended exclusively for the first six months of life.  The World Health Organization promotes feeding to age two for best health of children.  We are not here to judge your goals with feeding your child, but want to help.  We also do see children that are bottle fed (with breast milk or formula) who are having difficulty feeding from a bottle due to inability to use the tongue correctly or flange the upper lip.  Children starting on solid foods often gag, have swallowing difficulty, prefer soft (unhealthy) foods and take a long time to eat.  The influence of a lip tie is more debated among professionals, where some say "where's the harm in a lip release" and others say "wait and see."  The wait and see approach may be risky in that fact that part of "Medically necessary" care involves preventative treatment services.  An infant who is not getting a good seal from a turned under upper lip will still be swallowing air, leading to gassiness, fussiness and sometimes screaming after a feeling.  Did you know that an infants brain grows by 1% every single day in the first three months?  If the child doesn't get enough oxygen due to sleeping poorly, or isn't getting the nutrition he needs, the brain is effected negatively.  The procedure to release oral tethered tissues is simple and has very low risks with very high benefits.

So how do you know if your child has tethered oral tissues that should be released?  A consultation is the first step.  Having seen a lactation consultant to work out any other contributing factors in nursing is very helpful.  For older children and adults, a visit with an orofacial myologist is recommended prior to a frenectomy.  At the consult, we discuss health issues, maternal symptoms, infant symptoms, and other health professionals opinions.  A simple exam is done with Dr. Geisler standing at the 12 O'clock position.  We take photos and discuss the findings.  Parents have the choice of whether to do a laser frenectomy, and no judgement is made if they decide to hold off.   Most are ready for treatment and only want to know what is involved in the procedure. At Life Smiles, we swaddle the child and have them laying on a flat but soft surface.  Laser goggles are worn by the baby.  Numbing is based on the age and weight of the patient and length of time the frenectomy will take. Sweet Ease is a sucrose liquid that can be dropping on their cheek prior to treatment.  It doesn't alleviate pain but distracts their brain, and is frequently used in NICUs prior to procedures.  Sweat Ease is optional, some choose to forgo.  We use both a CO2 laser by LightScalpel.  We also use low level light therapy (which looks like a weird flashlight) to improve healing.   Laser releases heal faster and are less uncomfortable that scissors or a scalpel, and causes no bleeding.  The laser is much more precise than an electrocautery (which burns and cauterized) and the collateral damage is very small.  A dental laser seals lymph nodes and promotes healing. It may take ten seconds for a thin upper lip tie, or up to one minute for a thick, posterior tongue-tie release.  As soon as your child is finished, we bring him or her directly to you so you can nurse in private or give a bottle.  We work with lactation professionals and body workers (for cranial sacral therapy) to treat any problems with a team approach.  For older children, a referral is given to an oral facial myologist to help train the muscles involved in breathing, swallowing and speaking.   Tongues don't automatically know how to function well without some training and exercises.  Please schedule a consultation, and if the procedures are recommended, we often offer to perform the them the same day.  We will educate you on what to expect afterwards, and give information of how to care for the site(s).   Vitamin E or coconut oil is useful to rub over the site(s) three times per day for two weeks after. Some moms have used a combination of essential oils or arnica to help healing and reduce discomfort and some choose infants Tylenol.  We also have a soothing and healing gel available called SockIt! at our office, which is optional and is an additional $15.  We offer follow-up visits for all who have a frenectomy, typically at one week and as needed after.  Please feel free to ask questions about fees, billing and insurance of our two patient coordinators, Julie and Carin.  Find the questionnaire form for the first appointment in the "Download Forms" section under our menu.