Lip and Tongue Ties



Does your child have a lip or tongue-tie?


There are many children who have difficulties related to tongue-ties and lip-ties, but unfortunately, it’s often not identified until later in life. It can cause various nursing difficulties, failure to gain weight, speech difficulties, and cavities among other issues.

At our office, we take the whole mouth into consideration, not just the teeth. We have helped many families with tongue-tie or lip-tie issues. We have 1-week old babies having difficulty gaining weight, 1-year-olds with a big gap between their teeth and their parents have difficulty brushing their teeth, and even 14-year-olds that have a speech impediment due to an undiagnosed tongue-tie. We can easily release the tied-down tissues in the office with a dental laser with minimal to no bleeding and no stitches. We never use general anesthesia, but do use a numbing jelly and local anesthetic (novocaine). We use a CO2 laser that is very fast, heals quickly and causes very little pain. It’s called the LightScalpel CO2 laser. The procedure is 20 seconds for the lip and 20 seconds for the tongue.

If your baby is having nursing difficulties, reflux or colic, difficulties with taking a bottle (like clicking noises), or not gaining weight appropriately, they may have a tongue-tie and/or lip-tie. Breastfeeding should not be painful, but rather fun and enjoyable. If you are experiencing pain when nursing your child may have a tongue and /or lip-tie.  If your child is having speech difficulties, make sure that you have ruled-out tongue-tie as a contributing factor. It can be overlooked easily. It’s often genetic.

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 12-week old baby. A 4-year-old with speech issues will do better than a 7-year-old, etc.



What is a Tongue-tie or Lip-tie?


Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia. Lip-tie is a condition where the upper lip cannot be curled or moved normally. 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. 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 can lead to nursing, feeding, dental, or speech problems, which may be serious in some individuals. Problems can even persist into adulthood with migraines, neck pain, shoulder pain, and speech problems. 


When is tongue and lip-tie a problem that needs treatment?


Infants with Nursing Problems


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. This usually casuses mom to be exhausted due to frequent feedings.

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.

Toddlers and Older Children



Speech


While the tongue is remarkably able to compensate and many children have no speech impediments due to tongue-tie, others may. By the age of three, speech problems, especially articulation of the sounds – L, R, T, D, N, TH, SH and Z may be noticeable. 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.
  • Difficulty moving the tongue from side to side.

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.


Tongue-tie and Lip-tie Procedure


Tongue-tie and lip-tie release is a simple procedure and there are virtually no complications when using a 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. The revision can be performed in our office with some numbing jelly and local anesthetic. Our Doctor uses the highest quality, state-of-the-art CO2 laser 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 laser gently removes the tight tissue with virtually no bleeding and no stitches. The baby is allowed to nurse immediately after the procedure, and older children will notice an immediate difference in mobility of the tongue. Often speech is improved within a few minutes to a few weeks, but typically, speech therapy is still needed.


Results


One important thing to understand when your child has a tongue and/or lip-tie revised is that improvement sometimes is not immediate. The revision of the frenum is usually just the first step. Your child will need some time to figure out what to do with the new mobility of their tongue and lip.

The tongue is a muscle, and it becomes used to functioning in a certain way just like any other muscle in the body. When tongue function is restricted by a tongue-tie, the body adapts. Since the tongue isn’t able to function the way it’s supposed to, other muscles have to help compensate. When a tongue-tie is released, the child has no muscle memory of how to use their tongue without the restriction. It takes time for the brain to figure out how to use it effectively once the tie is released.

For infants, most of the time the mother notices a difference immediately, but it is also normal to not notice much difference in nursing right afterward. Sometimes there may even be a little regression in sucking (things get worse instead of better) for a day or two as your child’s brain tries to sort out how to use their tongue now that the restriction is gone. Sometimes babies need chiropractic or craniosacral therapy to address other issues such as torticollis (tight neck muscles) that can affect nursing.



Before & After Maxillary Labial Frenectomy



Before & After Lingual Labial Frenectomy