Tongue & Lip Ties

Shiny Happy Smiles & tongue ties

After the birth of her first child, Dr. Rebecca Pikos personally experienced the challenges of breastfeeding caused by her daughter’s tongue tie. After countless lactation appointments, poor weight gain, irritability, and weeks of agony, a lingual frenectomy (tongue tie release) procedure was suggested by her lactation consultant. This procedure truly saved her breastfeeding journey, and Dr. Rebecca Pikos became committed to educating herself to help other mothers and babies in need. It’s a known fact that Dr. Rebecca Pikos loves learning, and she didn’t even wait for maternity leave to end before she dove headfirst into continuing education regarding tongue ties during naptimes! After learning about tongue and lip ties in infants, her knowledge expanded into children, adolescents, and teens.

Lip tie vs. tongue tie

What is a tongue tie?

The lingual frenum (AKA lingual frenulum) is a piece of soft tissue that attaches the tongue to the floor of the mouth. A tongue tie occurs when the frenum is too short or too tight and symptoms result. A diagnosis is not made off appearance only, but rather if functional issues are present.

What is a lip tie?

The maxillary labial frenum (AKA labial frenulum) is a piece of soft tissue that attaches the upper lip to the upper gums. A lip tie occurs if the frenum inserts too far on the gum tissue and symptoms result because the lip is unable to move freely. Lip ties commonly occur with tongue ties, and both may require treatment.

Why does this occur and is this a “fad”? There are genetic factors involved, and tongue/lip ties run in the family. Releasing tight lingual or labial frena is not a fad. It is debatable if the increase in treatment is due to an increase in awareness or truly due to an increase in ankyloglossia (tongue tie). Breastfeeding rates are increasing in the US, which naturally leads to an increase in mothers and babies that are struggling to successfully breastfeed due to a tongue or lip tie. Interestingly, an association between folic acid and tongue or lip ties may be present. There is an increase in awareness of consumption of folic acid in pre-conception and during pregnancy for neural tube formation. Folic acid helps form midline structures such as the brain, spine and heart and may lead to a thickening of frena, which are also midline structures.

Tongue Tie

  • Depending on the child/adults age, symptoms vary.

    Breastfeeding mother’s symptoms:

    • Shallow and/or painful latch

    • Difficulty maintaining latch

    • Mastitis, clogs or incomplete emptying of breast

    • Nipple pain and/or changes in nipple shape

    • Prolonged nursing sessions

    Infant symptoms:

    • Slow or poor weight gain

    • Clicking, clucking, or smacking at breast or bottle

    • Irritability

    • Frequent nighttime waking to eat

    • Gassiness, reflux, constipation

    • Nasal congestion, noisy breathing

    • Frequent hiccups

    Child symptoms:

    • Snoring

    • Mouth breathing

    • Speech delay

    • Trouble with sounds or mumbling

    • Slow eater

    • Picky eater

    • Restless sleeper

    Adolescent/adult symptoms:

    • Headaches

    • Neck/shoulder tension

    • TMJ pain

In babies, 1 out of 5 children are affected by a restricted lingual frenum. Simply put, 20% of children could benefit from a lingual frenectomy.

Lip Tie

  • • Lip curls under when nursing or bottle feeding

    • Milk dribbling out of mouth due to poor anterior seal

    • Difficulty brushing front teeth

    • Distress when lifting upper lip

    • Diastema (space) between front teeth

My Child has a lip or tongue tie. what’s next?

  • Frenectomy

    A frenectomy is used to describe the procedure of releasing or removing the tongue or lip tie. Simply put, a frenectomy is a tongue or lip tie release. A frenectomy a is low-risk intervention with potential for huge impacts in all ages

  • Frenuloplasty

    A frenuloplasty is a rearrangement of tissues under the tongue. This involves releasing the tongue in a horizontal plane, then placing sutures in a vertical plane. This is done in older children, adolescents and adults if indicated.

 FAQs

  • In our office, we start with a questionnaire regarding symptoms appropriate for the child’s age. Then, an extraoral and intraoral examinations are completed. During this exam we evaluate the appearance of the frena, the insertion point, the range of motion, palate shape, symptoms, and much more. If a functional deficit is present and a tongue and/or lip tie release is deemed necessary, a treatment plan will be made and presented to you. Once consent is given for the procedure, we will proceed in a manner appropriate for the age and development of the child. A numbing agent is applied under the tongue and a CO2 laser, which offers the most precise method available, will be utilized for a full release. Typically, there is minimal bleeding or discomfort. The actual use of the laser is under 1 minute. For older children, adolescents, or adults, laughing gas and additional numbing agents will be utilized. Because the procedure is quick in nature, sedation is rarely required.

  • The medical risks are low and include discomfort and minor bleeding. While most experience an improvement or complete resolution of symptoms, there is of course the risk of not as much improvement as hoped.

  • With breastfeeding, about 50% experience immediate improvement. Others, experience a temporary rejection in nursing for 1-2 days after the frenectomy, but this is temporary! Realistically, mom and baby can expect both gains and setbacks as the baby relearns their suckling, sucking and swallowing pattern with the help of a lactation consultant. Feedings can continue to be inconsistent, but overall, an improvement in 1 feed per day is expected.

    For children, again, many notice an immediate improvement, but this is not always typical. Success requires a team approach and may involve speech therapist, feeding therapist, myofunctional therapist, and/or body work providers (chiropractor, physical therapist, occupational therapist). With a restriction, the tongue, lips, cheek, head and neck muscles learn to compensate, and these adaptations must be unlearned.