Tongue-Ties and Lip-Ties

Does Your Child Have a Lip or Tongue-Tie? tongue-tie

There are many children who have difficulties related to tongue-ties and lip-ties, but unfortunately it’s often not identified until later in life. It can cause various nursing difficulties, failure to gain weight, speech difficulties, and cavities among other issues. The picture to the right is of a seven year old with a tongue-tie that was not diagnosed until he came to our office.

This is a topic that is near and dear to my heart. I had a tongue-tie and didn’t know about it until dental school when it was partially released, and more recently I had it fully released. It made it difficult for me to pronounce “L” sounds, harder to speak clearly and speak fast. After it was fixed with a laser, I could move my tongue more freely (touch my palate and clean my back teeth) and say words more clearly. Afterward, I didn’t tire when reading aloud. When our twin girls were born, we had difficulty nursing and soon realized they were both tongue-tied (it’s often genetic, so mom or dad likely has one), and their top lip was tied down to their palate. We were able to find a dentist in Ohio that was able to complete the procedure with a laser, and later that day, they were both nursing better and we were very relieved!

At our office, we take the whole mouth into consideration, not just the teeth. We have helped countless families with tongue-tie or lip-tie issues. We have 1 week old babies having difficulty gaining weight, 1 year olds with a big gap between their teeth and their parents have difficulty brushing their teeth, and even 14 year olds that have a speech impediment due to an undiagnosed tongue-tie. We can easily release the tied-down tissues in the office with a dental laser with minimal to no bleeding and no stitches. We never use general anesthesia, but do use a numbing jelly. For toddlers, we may use a mild in-office sedation to prevent them from having a traumatic experience. We used to use a pen-like diode laser (what most dentists use), but we upgraded to a new CO2 laser that is faster, heals better, and is less painful. It’s called the LightScalpel CO2 laser. Now, instead of taking around 3 minutes for the procedure, we can accomplish it in 20 seconds for the lip, and 20 seconds for the tongue.

If your baby is having nursing difficulties (we have helped families just out of the NICU, and 3 day old babies), reflux or colic, difficulties with taking a bottle (like clicking noises), or not gaining weight appropriately, they may have a tongue-tie and/or lip-tie. Breastfeeding should not be painful, but rather fun and enjoyable. If you are experiencing pain when nursing your child may have a tongue and /or lip-tie.  If your child is having speech difficulties, make sure that you have ruled-out tongue-tie as a contributing factor. It can be overlooked easily. It’s often genetic, so sometimes the parents realize they are tongue-tied, and we will release the parent’s as well if they wish to help with anything from speech to migraines to reflux.

We are the only “preferred provider” for the state of Alabama on a national database (Tongue-Tie & Lip-Tie Support Network – see the directory Clickhere

We help families from as far away as Florida, Georgia, Mississippi, and south Alabama who drive to our office for their baby’s tongue-tie release.  If you have any questions, Dr. Baxter or one of our team members would be happy to speak with you. Our phone number is 205-419-7444. For babies having feeding difficulties, we will schedule an appointment for them on the same day or next day (Dr. Baxter knows how hard it was with his girls!). The sooner the tongue is released the better the child is able to adapt to the new mobility of the tongue. A 1 week old baby will do better than a 3 week or 12 week old baby. A 4 year old with speech issues will do better than a 7 year old, etc.

To learn more about tongue and lip-ties, and to see some videos of Dr. Baxter examining a baby, aftercare exercises and a video of the procedure itself, continue reading.

What is a Tongue-tie or Lip-tie?

Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia. Lip-­tie is a condition where the upper lip cannot be curled or moved normally. Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenum. As we develop in the womb, this frenum is supposed to recede and thin. The lingual (tongue) or labial (lip) frenum is visible and easily felt if you look in the mirror under your tongue and lip. Everyone has a frenum, but in some people, the frenum is especially tight or fails to recede and may cause tongue/lip mobility problems.

The tongue and lip are a very complex group of muscles and are important for all oral functions. For this reason having a tongue-tie can lead to nursing, eating, dental, or speech problems, which may be serious in some individuals.

When is tongue and lip-tie a problem that needs treatment?

Infants with Nursing Problems

A new baby with a too tight tongue and/or lip frenum can have trouble sucking and may have poor weight gain. If they cannot make a good seal on the nipple, they may swallow air causing gas, colic, and reflux or spitting up. You may hear clicking noises when the baby is taking the breast or a bottle. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue and lip tie. It can also cause thrush, mastitis, nipple blanching, bleeding, or cracking in the mother and inability to hold a pacifier. The mother often reports it’s a “full time job” just to feed them because they are constantly hungry, not getting enough milk, and spitting up what they do get.

Although it is often overlooked or dismissed by other medical professionals, a tongue and lip-tie can very often be an underlying cause of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breastfeeding altogether. Very often, after releasing the tongue and/or lip, mothers report immediate relief of pain and a deeper latch. The symptoms of reflux and colic almost disappear and weight gain occurs rapidly. The sooner the tongue-tie is addressed the better the child will learn to use his or her tongue correctly.

Notice in the photo how the lip will not roll outward when lifted. After the release, it fully lifts to the nose. The tongue is held down all the way to the gum. This is a severe tongue-tie, but even less severe ties can cause similar problems. Afterward, notice how high the tongue can lift and the greater mobility.

Posterior Tongue-Tie

This is a photo of a posterior tongue-tie. If a baby has  symptoms of a tongue-tie (not gaining weight, poor latch, clicking when nursing, gumming the nipple, painful nursing, reflux, gassy, etc.) and there is not an obvious string, it is very likely a “posterior tongue-tie”. This is a hidden tie that is felt easily, but very often overlooked by other medical professionals that have not been trained to identify it. Notice the picture on the left, it looks like there is no problem, but the baby and mother are having lots of difficulty nursing. When it is pulled back with two fingers, notice the tight string that pops up. After release, a diamond shape shows that the tongue-tie was complete and the baby instantly nursed better and mom noticed a huge difference in the depth and quality of the latch. The baby took twice as much milk in half the time they normally spent nursing.

Reviews

We made the trip from Pensacola, FL and took our 11 week old daughter to Dr. Baxter for a tongue and lip tie revision. He did a wonderful job explaining everything to us and ensuring that we were making the right choice. Everyone in the office including Dr. Baxter was very friendly. I highly recommend Shelby Pediatric Dentistry! Shayla A.

I took my grandson and his mom to Dr. Baxter’s office on Friday, July 15th. Anderson was both lip and tongue tied. We traveled a hundred miles to find a delightful office and staff. Special thanks to Carlos and Dr. Baxter for the kind care Anderson received. What a joy for my daughter-in-law to be able to sit in seclusion and feed her son directly after the procedure. Kudos to Dr. Baxter and staff for making us at home. Cheryl H.

Dr. Baxter saved our breastfeeding relationship! I took my 3 month old in for a lip/tongue tie consultation, & they were revised at the same time. I noticed an immediate difference in the nursing room following the procedure! I cannot speak highly enough of this practice or the staff. Christy J.

My daughter (2 weeks) and I were having a very hard time nursing. I was in constant pain and she would get so frustrated she would just give up. I started researching tongue and lip ties and thought I needed to get her checked out. After my pediatrician wrote me off, I found Dr. Baxter. The staff was so welcoming and friendly and Dr. Baxter did a great job revising my daughter’s ties. She is now nursing like a pro. Thank you Shelby Pediatric Dentistry! Emily G.

Dr. Baxter came highly recommended for fixing my daughters lip and tongue-tie and now I know why!! He was so understanding and sympathetic to the nursing mom. He was also very compassionate with my daughter. He provided us with all the information we needed, answered any questions and is very personable. I drove from Montgomery to come to Shelby Dentistry and it was worth the drive! Highly recommend to anyone having similar issues! Allie B.

My little guy had the tongue-tie and lip-tie procedure along with a tooth pulled yesterday. I was highly impressed with Dr. Baxter and Kourtni as they made sure Bray was comfortable and not scared. I highly recommend Dr. Baxter. My son is 5 and no other dentist he has seen even mentioned he had the tongue and lip tie. His speech had improved immediately after the procedure. Stacie M.

I cannot say enough good things about Dr. Baxter and his whole staff. They’re all so wonderful and we were very impressed! I was so nervous going in for my sweet girl’s tongue-tie and lip-tie revision but they handled it so well and eased my worries. We couldn’t be more thankful for their kindness and professionalism. Misty H.

Everything they’re talked up to be. It was such a pleasant experience and the staff put me at ease for my baby’s laser procedure. Jamie K.

Toddlers and Older Children

Speech

class-iv-tt-7yo

While the tongue is remarkably able to compensate and many children have no speech impediments due to tongue-tie, others may. By the age of three, speech problems, especially articulation of the sounds -­ L, R, T, D, N, TH, SH and Z may be noticeable. Evaluation may be needed if more than half of a four-year-old child’s speech is not understood outside of the family circle. The child with a tongue-tie may have a lisp or have difficulty speaking when tired. It can also lead to sleep apnea, mouth breathing, other airway issues and cause difficulty chewing and swallowing food. It can be difficult for older children and adults to “roll” their R in Spanish.

Although there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common:

  • Heart-shaped tip of the tongue, or a thick band of fibers under the tongue.
  • Inability to stick out the tongue past the lower lip.
  • Inability to touch the roof of the mouth with the tongue.
  • Difficulty moving the tongue from side to side.

Dental

For older children with a lip-tie, it is common to have a gap between the two front teeth. This often closes if the frenum is removed (typically done before 18mo old, or later around age 8 when the permanent teeth erupt). The tongue-tie can also pull against the gums on the back of the teeth and cause recession. The tight lip-tie may trap food and make it difficult to brush off plaque from the front teeth, leading to cavities.

Tongue-tie and Lip-tie Procedure

Tongue-tie and lip-tie release is a simple procedure and there are virtually no complications when using a laser with good technique. The procedure may be performed as early as a couple of days after birth and can be performed into adulthood. Typically, once a problem with a tongue-tie or lip-tie has been discovered, the sooner it is addressed the better the procedure will work and the less issues the child will have. The revision can be performed in our office with some numbing jelly. Dr. Baxter uses the highest quality, state-of-the-art CO2 laser to perform the release. Older children who understand the procedure receive some numbing medicine and laughing gas, and usually report no pain at all during the procedure. Younger children and babies usually cry more due to us working in their mouth than the pain. The parents are encouraged to wait in the private nursing room during the quick procedure for around 2-3 minutes (1 minute for procedure and another minute or two to set up and take photographs). The laser gently removes the tight tissue with virtually no bleeding and no stitches (see video below). The baby is allowed to nurse immediately after the procedure, and older children will notice an immediate difference in mobility of the tongue. Often speech is improved within a few minutes to a few weeks, but typically, speech therapy is still needed.

Results

One important thing to understand when your child has a tongue and/or lip-tie revised is that improvement sometimes is not immediate. The revision of the frenum is usually just the first step. Your child will need some time to figure out what to do with the new mobility of their tongue and lip.

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. When a tongue­-tie is released, the child has no muscle memory of how to use their tongue without the restriction. It takes time for the brain to figure out how to use it effectively once the tie is released.

For infants, most of the time the mother notices a difference immediately, but it is also normal to not notice much difference in nursing right afterward. Sometimes there may even be a little regression in sucking (things get worse instead of better) for a day or two as your child’s brain tries to sort out how to use their tongue now that the restriction is gone. Sometimes babies need chiropractic or craniosacral therapy to address other issues such as torticollis (tight neck muscles) that can affect nursing.

Videos

The following are some helpful videos Dr. Baxter made about examining a baby for tongue-tie and lip-tie, aftercare exercises, and a video of Dr. Baxter performing the tongue-tie release procedure with the CO2 laser. Notice there is no bleeding and no stitches. It takes about 10-20 seconds, and the baby is taken immediately back to the mother in a private nursing area to feed. Almost always an immediate difference is noted in the quality of the latch, less pain, less clicking noises, and more milk is taken. We also use a highly accurate baby scale to measure the amount of milk taken. It’s best to not feed your baby for an hour before the procedure so the baby is hungry and wants to nurse afterward. We use no sedation, injections, or general anesthesia for the babies, and there is virtually no risk when performed by a knowledgeable provider such as Dr. Baxter.

Please call us if you have any questions or to schedule an appointment.
205-419-7444.