What are the signs or symptoms of a tongue tie? Guest post by Dr. Amy Cassinelli of Peak Pediatric Dentistry.

The frenulum is a fibrous attachment that connects the tongue to the floor of the mouth and the lips to the gums. When the frenulum is too short, it can restrict the movement of the tongue and lips, and can interfere in normal swallow function, overall dental and craniofacial development can effect speech.

Typically a tongue tie or a lip tie can be diagnosed as early as the first few days post birth. This is especially true when a poor nursing latch, or painful breastfeeding are involved. However, sometimes the signs are not so obvious, and other symptoms arise, including speech delays, sleep disordered breathing, or improper swallow. Children appear in our office at three points in life for evaluation of lip and tongue ties.  We typically see newborns who have difficulty with nursing, children who are having difficulty with speech, and teens in orthodontia whose teeth are separated by the frenum and the orthodontist would like the frenum released for ideal esthetic results.

How is Tongue Tie treated?

For Dr. Cassinelli, your child’s health and well being is our primary concern. By utilizing a laser, we can assure a quick and minimally invasive procedure, with nominal soft tissue damage and scar tissue. The laser is used for the most intricate and delicate surgeries, and is the most gentle to the tissues when compared to other lasers and scalpels or blades. The procedure itself takes a matter of seconds, with minimal to no bleeding, and no sutures. There is no discomfort after the procedure and little to no risk of infection.

How does a Laser work?

The laser acts to vaporize the tissue. There is very little discomfort with a laser, and some babies and children do not even notice the procedure being done. The procedure is performed with minimal topical anesthetic- there are no shots or needles used! The procedure time takes about a minute, and there is minimal to no bleeding, no sutures, and the laser creates a sterile environment, meaning there is little to no risk of infection.

Are Frenectomies only for newborn babies with tongue ties?

Absolutely not! There is never a bad time to revise a lip or tongue tie if it is causing symptoms. Treatment modalities depend greatly on child’s age and cooperation levels. At Peak Pediatric Dentistry in Atlanta, we treat newborns, children, and teens with restrictive issues. We treat children having speech difficulties due to restricted tongue movement. We also treat pre teens and teens with frenums that separate the front teeth and inhibit good orthodontic results.

What can I anticipate post revision?

The frenectomy procedure is just the first step toward a happy and healthy breastfeeding experience with your baby. We HIGHLY recommend working with your Board Certified Lactation Consultant (IBCLC), as you will require further training in getting a proper and full latch.

If your child’s procedure was done to aid in development of speech and language, working closely with a speech pathologist is important.  Though the procedure helps with tongue and lip posture, remember, your child has never utilized their tongue in the way they can after the procedure.  Children need to work with a speech pathologist to retrain the muscles and the brain to coordinate speech.

If your child’s procedure was done in conjunction with an orthodontist, most orthodontists move the front teeth together and place a small wire on the back of the teeth to hold these teeth in position for the remainder of their life.  Children with strong lip ties have teeth that always want to drift apart.  The orthodontist will keep that from happening with a small wire attached to the backside of the front teeth.

Most infants and children do not require any pain medication, however, every child responds in his or her own way. You may notice more irritability or fatigue depending on the treated ties or individual sensitivities. 

At home you will notice that the upper lip is now freed into a new, fuller position. Keep in mind that this new lip and tongue mobility will be new and confusing to your child, and you must grant them a period of time to adjust to their improved muscle function. Be patient with your child, as they are relearning to properly use their muscles.

What to do at home?

Aftercare and wound management is the most critical part of the success of the procedure. The tissues of the mouth begin to heal within the first 24 hours, and this may result in premature reattachment of the tissues. You will notice a yellow diamond for the first week after the revision. In regards to the tongue and lip, the ideal healing pattern is in an open conformation, rather than closed. Meaning stretching the wounds, and massaging the wounds is incredibly important to avoid reattachment.

Stretches should be fun, and accompanied with a song, or laughing. If you are anxious, your infant or child will read this. Stretches should be performed 8-10 times a day for 3-4 weeks.