Tongue-tie is at birth occurs when the ligament (lingual frenulum) connecting a baby’s tongue to the floor of their mouth and inside the lower jaw is shorter than usual. Typically, this ligament separates before birth, allowing the tongue free range of motion. With tongue-tie, the lingual frenulum restricts the tongue from flattening and the mouth from opening when nursing to contribute to a shallow latch both for the bottle and at breast.
Typically many infants with tongue tie also have a maxillary lip tie, which is an extension of the muscle around our mouth. Nursing infants need the lip to flange when nursing so the inside of the lip creates a seal. Strong lip ties prevent normal function when the lip curls down, trying to create the seal with the edge of the lip causing too much air to be swallowed when the infant is nursing. When infants have have incomplete latches at the breast or bottle, they are gassy and often uncomfortable. Often swallowing too much air during nursing masquerades as reflux.
Signs of tongue-tie include:
- Restriction of the tongue’s movement, making it harder to breastfeed
- Difficulty lifting the tongue up or moving it from side to side
- Difficulty flattening the tongue
- The tongue looks notched or heart-shaped when stuck out
- Chomping and lip pulling in attempt to compensate when nursing
Treatment of Tongue & Lip Ties
The treatment of tongue & lip tie for infants is a simple surgical procedure called a frenotomy. Typically the upper lip tie is too tight as well and can be treated at the same time. We review the history of then infant latching and after examination, we can release the ties (also known as oral tethers) with a dental laser. Stitches are not necessary. We usually treat infants the same day in the parent's arms using only topical anesthetic and the dental laser.
Frenectomy for tongue-tie and lip ties in older children and adults can be completed in the office with dental lasers as well. If the child is pre-cooperative, we can bring our laser to the operating room to provide treatment. We routinely work with lactation consultants, cranial-sacral therapists and speech therapists.
