|Tongue/Lip Ties affect:
Feeding in Infants, Speech, Phonetics, can cause Reflux, Mal-development of the jaws / oral skeleton and poor Oral Hygiene.
Our Principal Dental Surgeon Dr Mody is a pioneer in Tongue/Lip tie surgery with 27 years of Dental Surgical experience.
He has performed over 2500 Tongue and Lip Tie surgeries and has been using Laser Surgery for over a decade.
He is one of the most experienced Tongue/Lip Tie Dental Surgeons in Australia.
What is a Tongue-tie and a Lip-tie?
Tongue-tie is a problem that is present at birth. It is a congenital condition which decreases the mobility of the tongue and lip. A lip or tongue tie is caused by an excessively thick or short, tight oral tissue known as a frenulum which connects the tongue to the lower jaw or lips to gum tissue. It happens when the tissue attachment is abnormal at the bottom of the tongue and below the lips. This can restrict the range of motion of the tongue and lip. It affects Phonetics, Feeding in infants and can cause Reflux, digestive issues, with poor Oral Hygiene, gaps in teeth, Crooked Teeth, Breathing dysfunction- such as Mouth Breathing, Snoring and Sleep Apnoea in adults.
Tongue or lip ties present in many different shapes and forms. Often health care providers only look for very prominent, classic tongue ties that often create a heart shaped tongue. However, tongue ties can be deceptively hidden in the base (back) area under the tongue and cannot be easily visualised. Critical for proper identification are not only a visual examination but a thorough investigation of the functional challenges as well as a manual examination of the mouth.
What causes tongue/lip-tie?
The cause of tongue-tie isn't always known. It can run in families or may occur in babies who have other problems that affect the mouth or face, such as cleft palate.
What are the symptoms?
Many babies do not have obvious symptoms. The tissue either stretches as the child grows, or the child adapts to the tongue restriction.
But some children with tongue-tie have:
- Trouble latching on to the mother's breast and poor ability to stay latched and sucking. (Bottle-fed babies usually don't have feeding problems, because it is easy to get milk from the nipple of a bottle.)
- Continuous “snacking”/feeding on the breast
- “Gumming” or chewing on the breast rather than sucking
- Risk of nipple pain, poor control of the milk during swallowing and mastitis for mums
- Maternal nipple pain or damage, increased maternal nipple or breast infection, compromised maternal milk supply
- Risk of poor weight gain for baby
- Increased gassiness or reflux due to additional air being swallowed and poor control of the milk during swallowing. Complaints of excessive gas, bloating and Reflux have reported significant relief when the lingual and maxillary ties were revised.
- Gaps or spaces between the front upper teeth.
- Speech problems, lisping, because the tip of the tongue cannot rise high enough to make some sounds clearly, such as t, d, z, s, th, n, and l.
- Personal or social problems related to the restricted tongue movement, such as problems cleaning food off the teeth and deep sulcus of the mouth with the tongue.
(A child with lip or tongue-tie may be made fun-of by peers.)
How is tongue/lip-tie diagnosed?
When the diagnosis is arrived at after full investigation and the surgery is done correctly where there is thorough removal of the restrictive attachment, the potential contribution a tongue or lip tie makes to challenges with proper feeding can be eliminated. Laser surgery allows a layer by layer, thorough removal of the attachment of lip and/or tongue tie. It is a relatively quick and straightforward process, not requiring general anaesthetics, the operating room, sutures or oral medications. It can be completed in the dental office within a few minutes. Your doctor will do a physical examination of your child's mouth and ask about his or her symptoms. In an older child or adult, the doctor may check the shape and movements of the tongue.
How can a Lip and Tongue Tie release help?
Infants : Relieves- breast feeding difficulties or painful breast feeding, Colic and Mouth Breathing.
Children: Growth of Face and Jaws, Prevention of gaps in teeth, Crooked Teeth and Speech difficulties.
All Ages: Overcome Speech difficulties, Breathing dysfunction- such as Mouth Breathing, Snoring, Sleep Apnoea and correction of soft tissue dysfunction (abnormal swallowing habits).
How is it treated?
If your baby is younger than 1 year of age and has problems with feeding, the doctor may do a surgical procedure (frenectomy) with a Medical Laser, to revise the lingual and labial frenulum. If your baby has tongue/lip-tie and is feeding okay, you may choose to wait and see if the lingual frenulum stretches on its own. While you wait and see, you can also: *Talk to a lactation consultant if you are having breast-feeding problem.*Consult a speech therapist if your toddler is having speech problems.
Lasers are an excellent alternative to scissors or a scalpel as a means to incise soft tissue. In laser terms the tissue is “ablated”. Light energy is used to incise tissue rather than cutting that occurs with scissors or scalpels. The use of lasers in surgery has a distinct advantage over other methods for a number of reasons: it reduces the collateral damage as it is more precise and removes skin layer by layer, it is bactericidal (kills bacteria as it ablates), reduces oedema, swelling and inflammation and therefore allows for better healing through the concept of photobiomodulation.
Dentists using lasers need to be properly trained in laser physics, laser safety and are required to complete a suitable course on laser oral surgery. All methods of surgery require a good knowledge of the purpose of the surgery as well as the necessary post-operative care.Treating the breastfeeding infant is not merely a quick “snip”. It involves informed consent by the parents, and a thorough clinical examination by an expert in the oral environment.
If tongue-tie may cause speech problems or personal/social problems as your child grows, the doctor may do a frenuloplasty.
In this surgery, the doctor performs an excision of the lingual frenulum and closes the wound with a Medical laser.
During the healing process a small white, yellow patch will be seen under the tongue/lip, this is normal and should resolve within 3-4 weeks of the release. If you have any concerns following the procedure, please contact your dentist.
The dentist may also teach your you or your child to do tongue lip stretches and massage to improve tongue lip movement.
Dr. Mody uses a topical Anaesthetic, prior to injecting a Local Anaesthetic to ensure that the revision with the state-of-the-art medical laser is not painful for your baby.
TONGUE / LIP TIE REVISION IS ROUTINELY DONE FOR ALL AGES INCLUDING OLDER ADULTS WHO HAD MISSED OUT IN THEIR EARLY YEARS. THERE IS NO AGE LIMIT FOR THIS PROCEDURE
The most common reasons to treat tongue and lip ties are as follows:
- For infants - Breast feeding difficulties, Reflux
- For children - Speech difficulties and narrow jaws, or crooked teeth
- For adults - Head and neck pains and snoring
What to Expect After Tongue-tie and Lip-tie Release
Appearance of tongue after laser tongue-tie release
Discomfort, Bleeding and Appearance
The discomfort from lip and tongue-tie release usually only lasts for about 24 hrs, although in older babies/toddlers the discomfort may last about 48 hrs. If a lip-tie was released, you may notice some swelling of the lip for a few days after the procedure. On rare occasions the discomfort may last up-to a week. Breastfeeding and skin-to-skin contact provide natural pain relief, however your baby may need something for pain if they are really fussy or refusing to feed in the first 24-48 hrs. Panadol or Nurofen are both effective forms of pain relief. What you give is a personal decision based on what you are most comfortable with. If you are giving medication, please check with your doctor or pharmacist for the appropriate dose and to make sure that the medication is right for your child. Remember that dosages should be based on a child’s weight, not age. Children under the age of 2 months should not be given ibuprofen and children should never be given aspirin due to the risk of Reye’s syndrome. Topical numbing ointments containing benzocaine should not be used due to health risks.
There may be minimal bleeding with tongue and lip-tie release when a laser is used. If your child experiences any bleeding after the procedure at the needle puncture site, then apply direct pressure on the area to quickly stop it. If bleeding seems excessive or you are concerned, then please contact your doctor who performed the procedure.
If your baby swallowed any blood during the procedure, you may notice some blood in your child’s diaper or spit-up in the first 24hrs after the procedure.
If it continues beyond 24 hrs, is excessive or you are concerned, then please contact your doctor.
The areas where the ties were released will be white or yellowish in appearance.
This is normal healing and is not an indication of infection. Complete healing takes 3-4 weeks.
Appearance of lip after laser release of lip-tie.
Research on the need for stretching exercises is limited, however the experiences of many of us in the profession suggest that stretching exercises after lip and tongue-tie release help to reduce the risk of reattachment and the need for further procedures.
Before starting the stretching exercises, make sure that your hands are clean and your nails are short to avoid accidentally hurting your baby. To stretch the lip you need to pull the lip out and upwards towards your baby’s nose, applying gentle pressure to expose the area where the release was made (see picture above). For the tongue, most parents find it easiest to position baby on its back with their head towards you and feet pointing away from you.
Use your index fingers to get under your baby’s tongue and elevate it so that the area where the release was made is exposed (see picture above). After holding the stretch for 3-5 seconds, position your fingers on either side of the diamond shape where the release was made, and pull your finger apart for 3-5 seconds to stretch the surgical site horizontally and vertically.
We recommend starting the stretching exercises at the second feeding after the procedure - approximately 6 hours post surgery, and stretching 6 times in a 24 hour period, including at least one stretching session overnight. Stretches should be quick you only need to hold them for 3-5 seconds. After the first 24 hours, you can add in gentle massage of the surgical sites, done for a few seconds after you do the stretches. Stretching should be continued for at least 7-10 days after the procedure and ideally for 30 days. For some babies healing may take a little longer, so if you stop the stretches and breastfeeding becomes uncomfortable, then restart the exercises and continue for another week.
When you do the exercises depends on what works best for you and your baby. Some babies do well with doing the exercises just before feeding because nursing helps them to calm down. Some babies may become a little fussy after stretches and don’t nurse as well, so for these babies, doing the stretches in between feedings, for example during diaper changes, tends to work best.
Babies usually don’t like the stretches, and they may cry or fuss but they should calm down quickly once you are done
Along with doing the stretches, it is a good idea to provide lots of opportunities for positive stimulation around your baby’s mouth. Lots of kisses, stroking and gentle massage can help to minimize any negative associations from the procedure and stretching.
Changes in sucking patterns
One of the most important things to understand when your child has a tongue and/or lip-tie released is that improvement is rarely immediate.
The release of the frenulum is usually just the first step. Your baby will need some time to figure out what to do with the new mobility of their tongue.
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. In turn, the muscles that are compensating for the restricted tongue function now aren’t doing their job properly, so more muscles have to help compensate. You have one muscle that isn’t able to do it’s job properly, and it can lead to whole cascade of compensations and adaptations throughout the body. When a tongue-tie is released, the child has no muscle memory of how to use their tongue without the restriction there.
It takes time for the brain to rewire itself and figure out how to suck effectively once the tie is released.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.