Lip and Tongue Ties :: A Mom’s Guide to These Functional Issues

Disclosure :: This post is sponsored by Associates in Pediatric Dentistry (AIPD). 

Lip and Tongue Ties :: A Mom’s Guide To These Functional Issues

With the increasing number of new mothers breastfeeding, the issues of tongue ties and lip ties have become more prevalent in the community.  As we learn more about the benefits of breastfeeding and breast milk, more health entities are advocating for breastfeeding.  Since the primary mechanical success of breastfeeding is posterior tongue elevation, which is not as significant in bottle feeding, it is creating greater awareness of breastfeeding difficulties in babies that are tongue tied.  

What is a Lip Tie and/or Tongue Tie?

The soft tissues that connect the upper lip to the gums and the tongue to the floor of the mouth are called frenula. When one or both of these tissues restrict the natural function of the lip or tongue, this condition is known as lip tie and/or tongue tie (LT/TT). The frenula can present in several different ways, thin and tight, thick and short, but the end result is the same—loss of function related to a tissue tether. 

Who treats and identifies Lip and Tongue Ties?

There are a number of different health professionals involved in the care of LT/TTs. These include but are not limited to, pediatricians, dentists, ENTs, speech and language therapists, lactation consultants, physical therapists, occupational therapists, myofunctional therapists and craniosacral therapists. The message is there needs to be collaboration among these different fields to produce the best outcomes for the treatment and resolution of LT/TTs. The initial finding of LT/TT should trigger a protocol that will involve some or all of these professionals, based upon each child’s condition. 

Who is affected by Lip and Tongue Ties?

LT/TT are suggested to be part of a genetic predisposition with a 4:1 ratio of males being more commonly affected than females. Babies begin learning to suck in utero, so tongue tied (TTd) babies begin to compensate early on. This inevitably causes problems once born and, if left untreated, can continue well into adulthood. These symptoms are not merely pieces to be picked apart, but are part of a total picture. Just because your baby is gaining weight doesn’t necessarily mean LT/TT should be rejected as the culprit for breastfeeding difficulties.  LT/TT are often the last complications an infant is evaluated for.  

What are the possible consequences of untreated Lip and Tongue Ties?

INFANTS/MOTHERS

• Impacts milk supply
• Painful latch/inability to latch
• Failure to thrive
• Sleep deprivation
• Nipple damage, bleeding, blanching
• Mastitis, nipple thrush, blocked ducts
• Difficulty sucking a bottle or pacifier
• Reflux, colic, gas, bloating
• Termination of breastfeeding
• Difficulty introducing solids
• Poor bonding between dyad
• Depression, sense of failure

CHILDREN

• Difficulty chewing age appropriate foods; gagging, choking, vomiting
• Persistent food fads
• Difficulties with dental hygiene and increased dental problems 
• Persistence of dribbling and drooling
• Delayed development of speech and/or deterioration in speech
• Behavior problems
• Sleep disordered breathing
• Loss of self confidence because they feel and sound “different”
• Acquiring strong incorrect habits of compensation 

ADULTS

• Inability to open mouth widely 
• Difficulty talking even after moderate amounts of alcohol
• Clicking/pain in jaw
• Migraines/tension headaches
• Negative effects in work, social situations, dining out and relationships
• Poor dental health, inflamed gums, increased need for dental restorations
• Esthetic concerns
• Emotional factors resulting in rising levels of stress, anxiety and depression
• Sleep disordered breathing

ORAL HYGIENE, DENTAL HEALTH, GROWTH AND DEVELOPMENT

• Poor swallowing, risk of anterior open bite
• Mouth breathing, propensity to allergies
• Open mouthed posture associated with an imbalance in skeletal structure
• Restricted dental arch and facial development
• Recurrent orthodontic issues

What is the first step if you have a newborn and are experiencing difficulty in breastfeeding?

If you and/or your baby are experiencing difficulty in breastfeeding, seek help from an International Board Certified Lactation Consultant (IBCLC). Following this evaluation, a referral to one of the other professionals may be made based upon findings to determine if there is a LT or TT. When a consensus has been reached by the team confirming loss of function based upon a tissue tether, then a frenectomy may be the treatment of choice recommended for your baby.  However, it is not simply a laser or snip the tissue and send the patient on their way to figure out how to use the freely released tissues.  Whether the issue is breast-feeding, speech, feeding/swallowing, oral motor function, or sleep breathing related, follow-up care with the appropriate IBCLC, therapist, body worker and/or doctor is critical to the success of the revision.  Stretching, exercising and strengthening these freely released muscles is crucial for appropriate healing, prevention of reattachment, and improving function and range of motion.

How can Associates in Pediatric Dentistry assist you in your issues with Lip and Tongue Ties?

In April 2016, all 4 of Associates in Pediatric Dentistry’s (AIPD) board certified pediatric dentists, Dr. Robert Delarosa, Dr. Bradley Comeaux, Dr. Paige Sigsworth, and Dr. Brynn Leroux, became Standard Proficiency Certified by the Academy of Laser Dentistry.  Between the 4 doctors, AIPD is able to care for pediatric patients of all ages, including infants, children through adolescence, including those with special health care needs.  They are also able to provide any level of anesthesia or sedation needed in office to ensure the safety and comfort of your child if necessary. All AIPD specialists are suggested providers by the Louisiana Tongue Tie Support Group. In addition to their main Baton Rouge location where all laser procedures are performed, AIPD also has 3 other offices in Prairieville, Geismar and Denham Springs to conveniently serve the community. Parents and siblings are welcome to join patients in the clinic area at AIPD.  The American Academy of Pediatric Dentistry recommends the establishment of a dental home within 6 months of the eruption of the first tooth and by no later than the first birthday.

Looking to learn more about Associates in Pediatric Dentistry for general dentistry concerns and/or assistance with Lip and Tongue Ties?

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Other Resources 

Louisiana Tongue Tie Support Group on Facebook is a valuable resource for support and accurate breastfeeding information for moms. Providers are also welcome to join, learn and be a part of advocating for better access to care. 

The Evidence Supports Treating Tongue Tie for Breastfeeding Problems – Bobby Ghaheri, MD

Tongue and Lip Tie Articles – Larry Kotlow, DDS

The Basics of Tongue and Lip Tie: Related Issues, Assessment and Treatment – Melissa Cole, IBCLC, RLC and Bobby Ghaheri, MD.

Dr. Brynn Lewis Leroux, a Board Certified Pediatric Dentist, is a graduate of the Louisiana State University School of Dentistry in New Orleans. She then proceeded to the Medical University of South Carolina to complete a two year residency in Pediatric Dentistry, acting as Chief Resident during the second year of her program. A native of Maringouin, LA, Dr. Leroux graduated as Valedictorian from Catholic High School of Pointe Coupee in 2000 and continued on to study Biological Sciences at Louisiana State University in Baton Rouge.  Dr. Leroux is an active member of the American Academy of Pediatric Dentistry and the Academy of Laser Dentistry. Dr. Leroux, her husband and their two children enjoy entertaining family and friends, attending LSU football games, exercising, and traveling.