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Tongue-Tie and Lip-Tie in Children

Fast, Gentle Treatment of Tongue-Ties and Lip-Ties

A small percentage – estimated between 4 and 15% – of people are born with what are called tethered oral tissues. This means a short, tight membrane of tissues connects, or tethers, the tongue or lip in such a way that it inhibits natural movement. This can cause problems with breastfeeding and, if untreated, with speech and function and a myriad of other concerns as serious as sleep apnea. However, a much larger percentage of people have posterior tongue-ties and have learned to compensate with other muscles instead of the tongue. Therefore, most are not even aware of it. At Arlington Smile Center, Dr. Roca uses a light scalpel CO2 laser to sever this tight tissue with little to no bleeding and therefore little to no pain. This can be done for patients of any age, from newborn through adult. Before she can release your tongue- or lip-tie, she needs you to spend a good month strengthening your tongue in order to get your best results from the tongue-tie release. After the release, you are required to continue the oral myology she teaches you, to prevent the tongue-tie from reattaching.

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The procedure can be performed for a baby as young as two days old. On infants, it takes a maximum of only 15 seconds for lip-ties and eight seconds for a tongue-tie. Treating these babies has become the most rewarding part of being a dentist for Dr. Roca. She received her tongue- and lip-tie training directly from Dr. Richard Baxter, the renowned speaker and author of Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More. She was one of three doctors who spent the day training under him as he did several lip- and tongue-ties on newborns and kids of all ages. Her favorite part is listening to the change and emotion in the new mom’s experience from before the procedure to after and seeing a full, happy baby. Dr. Roca is very passionate about this topic, since she is the mom of two tongue-tied children and remembers all the struggles she faced with nursing. She wishes today’s research was available back when her kids were born. She said, “Knowing what I know, I would have given my right arm to have taken my kids right out of the hospital if this CO2 laser existed when my kids were born.”

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Here’s a look at a repaired tongue-tie of one of our patients.

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Super tight and skinny frenum you can barely see in the middle of the tongue. 05/30/2019

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Patient came in for five month check up. Showed her how tight and scar tissue that forming is the thick white line down center and down the sides. 10/15/2019

Five minutes of tongue clicks, suction hold, and stretching. Look how scar tissue is gone. Patient felt so much looser after she stretched. Healing goes on for nine months. Be proactive and stretch or it was a waste of time. Look how much more her mouth can open! 10/15/2019

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Tongue tie

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Dr. Soroush Zaghi at The Breathe Institute
The lingual frenulum is a small fold of mucous membrane that extends from the floor of the mouth to the midline of the underside of the tongue. Find your own lingual frenulum by looking in the mirror, opening your mouth, and stretching your tongue towards the palate. See the whitish cord beneath your tongue? Ankyloglossia, or tongue-tie, is simply a lingual frenulum that is tight enough to restrict the movement of the tongue. It is a congenital oral anomaly caused by an unusually thick, or unusually short, lingual frenulum.
Absolutely. Just because the tongue has normal motion in one direction doesn’t mean it has normal motion in ALL directions. The most important movement for the tongue during breastfeeding is UP and not OUT, so the normal outward movement of the tongue is as relevant as normal shoulder movement for the purposes of breastfeeding.
In our experience, in over 90% of cases, but depending on the age we will usually not recommend doing both the same day.
Yes. The real restriction of a tongue-tie is typically at the posterior component (for the motion necessary during breastfeeding).
The band that had tethered the tongue to the floor of the mouth travels from within the substance of the tongue down to the floor of the mouth. Cutting that band somewhere in the middle doesn’t remove the portion of the band inside the tongue. That can still change the shape of the tongue but typically doesn’t affect function.
Absolutely. The most common letters affected are R, S, L, Z, D, CH, TH, and SH, but other sounds are also difficult. While some kids can make these sounds in isolation, stringing the sounds together during speech can be very difficult. Recent studies have shown some improvement in speech function following a frenotomy. Dr. Roca feels that speech can be improved in specific cases where restriction is prominent and the child has had speech therapy and improvement hasn’t been noted. As more studies are done, she believes we will see an improvement in objective speech measures with the procedure, but not every patient will benefit. Most children will learn to compensate their tongue muscles and learn to say all words and never realize they were tongue-tied until they are released.
Generally, Dr. Roca says no. In some severe cases, if the lip-tie is causing the child some discomfort with mouth opening (because of tension), they may alter their oral anatomy to minimize pain, which could impact speech. Also, if the lip tie is causing a space between the front teeth, it is possible that the air is moving through the space, causing a lisp.

Yes. The most affected are the two teeth on either side of the upper lip-tie (the incisors). Cavities on the teeth in the back (molars) typically happen in the setting of tongue-tie (can’t sweep the tongue back there to clean). Dr. Kotlow has a great article describing the impact of a lip-tie on cavities.

Dr. Roca, herself, thought she had no trouble with breastfeeding. In fact, she thought her son loved to breastfeed, but now she knows that the reason he wanted to nurse all the time was because he was never full, which would explain why he would start to cry as soon as he was put into his crib. He was still hungry, so he would tire himself out trying to obtain enough milk, and as soon as they went to put him down, he would wake up and want to nurse again. SO, the moral of the story is that even if your baby is nursing fine and gaining weight, it would still be worth looking into releasing the tongue-tie, because the tongue-tie will lead to more serious health issues as an adult.
The infant frenectomy is a straightforward outpatient procedure that can be completed during the same visit as the initial assessment. If a release is recommended, the treatment takes only a few minutes, and a baby can go to the breast immediately following. The baby is swaddled and safety goggles are always used to protect baby’s eyes. Dr. Roca uses a pen-sized laser on infants to remove the tight lingual frenulum. She applies an effective topical anesthetic gel on the frenular tissue prior to treatment, allowing for zero to minimal discomfort during the procedure. The anesthetic lasts for approximately 30 minutes.
Yes, indeed it can. Untreated tongue ties in infants can lead to difficulty chewing and swallowing firmer foods, altered jaw and dental development including a high palate and narrow facial structure, poor sleep patterns, mouth breathing, and increased gas and bloating resulting from poor tongue coordination and corresponding swallowing of air. Significant ties may result in delayed speech development due to the tongue being restricted in movement. Also, when tongue movement is restricted, the tongue cannot sweep across tooth surfaces and spread saliva, both crucial to oral cleansing, which is why we see more decay in tongue-tied patients. If you have a posterior tongue-tie, you are most likely using the floor of your mouth, which is causing neck and shoulder tension. Not to mention the fact that if you are tongue-tied, you are most likely not getting enough deep sleep, which leads to memory issues as an adult from your mouth being open and not getting enough oxygen to your brain.
Studies have shown that an infant with tongue-tie can have issues latching, gaining weight, creating suction, and staying awake during feeding due to the extra exertion required. In addition, mothers with infants who are tongue-tied may experience significant pain in their nipples, to the extent that they can become cracked and abscessed. If symptoms including inadequate latch, poor breast draining, painful nipples, and/or fussiness at the breast have not improved and a lactation consultant is concerned about a possible tongue-tie, she will refer mom and baby. Babies are smart – over the weeks they figure out what to do to survive and make compensations. Mothers think they are nursing great, but if the mother needs to supplement, or if the baby eats like the mom is a snack bar and doesn’t want to fall asleep for a long period, the baby may appear to be nursing fully but is not able to fill out so will be looking for the breast repeatedly.
Dr. Roca’s goal during the first visit is to gather as much information as she can about the specific breastfeeding issues mom is facing. Therefore, prior to an initial consultation appointment, she will be in contact with the lactation consultant working with mom and baby in order to gain background knowledge on their sessions together. This allows us to work together to best gauge a baby’s progress in nursing. Dr. Roca works with a number of reputable lactation consultants in our community who are comfortable in assessing oral restrictions. When communicating with moms pre-treatment, we cannot stress enough the importance of continued lactation support following the frenectomy procedure.
Breastfeeding is encouraged immediately following the procedure while still in our office. However, typically there is a healing period that your infant must undergo before the full benefits are realized. Mothers are always thrilled right after they nurse, and we tell them it will only get better if they keep up with full stretches. We teach each mother proper active wound management and daily stretching exercises in order to facilitate healing. We cannot stress enough the importance of continued lactation support following the frenectomy procedure. Post-treatment follow-up is just as important as pre-treatment care. Dr. Roca sends a detailed report of her assessment and/or procedure to the lactation consultant and stays up to date with baby’s progress after our four-day follow up. Baby will continue to build strength over the healing period and will require further guidance on developing positive breastfeeding habits. It is not only the tongue and jaw that prove to be key components in breastfeeding, but in fact the whole body. For this reason, tongue-tied babies often have additional structural stressors to be addressed and we will recommend taking baby to see a bodyworker, a licensed professional such as an occupational, craniosacral, or physical therapist. Bodywork encourages body awareness and encourages an infant to express postural reflexes and explore natural movement inclinations through the nervous system. After a tongue-tie release, the infant’s tongue will need to adapt to a new and profound range of motion. Often while in utero the babies develop Wry neck, or torticollis, which is a painfully twisted and tilted neck. The top of the head generally tilts to one side while the chin tilts to the other side. This condition can be congenital (present at birth) or acquired. It can also be the result of damage to the neck muscles or blood supply. Wry neck sometimes goes away without treatment. But often we can tell an infant has torticollis because they prefer one breast to the other or their neck is very tight. This is an example where we would refer your baby for some body work.
Yes, we would love to meet your baby for a quick visit. Dr. Roca would even come out to the parking lot to take a quick peek, or you could send her a photo. It is always best to be sure. Mothers always know best – even new moms!
Yes, often we release tongue-ties on children that have been released as many as four times. Scar tissue can grow back if not stretched correctly post-op and for the weeks following the release. Arlington Smile Center sees all releases one week post-op to make sure the membrane is not starting to reattach.
Dr. Roca completely agrees. If your baby is feeding every three hours during the day and you are sleeping all night and baby settles easily without waking, enjoy your baby. However, please note that if a posterior tongue-tie or anterior tongue-tie exists, you want to make sure it is released as a toddler to have the best chance to avoid an airway breathing disorder and unnecessary compensations that will lead to medical concerns.
No one needs to live with the difficulties of tongue-ties and lip-ties. Call (703) 237-7622 now to schedule a visit to see how we can help you or your child.