Tongue-Tie and Lip-Tie

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Tongue-Tie and Lip-Tie Assessment

The initial assessment of your infant requires only a few minutes.  We begin by discussing your symptoms and your infant’s symptoms.  Dr. Gunsaulis will examine your infant in the same position we recommend active wound management after the revision of an upper lip-tie, cheek-tie and/or tongue-tie:  the person doing the examination will hold the infant’s head in his or her lap with the infant’s feet toward the examiner’s knees.  In this way, the examiner is looking straight down into the infant's mouth.

Releasing the Tongue-Tie and Lip-Tie

Releasing the lip, cheek and tongue does NOT require any general anesthetics and is safely, quickly and easily completed in the dental office using the dental laser for infants to adults.

Surgical release of an infant’s tie takes less than 30 seconds and requires NO numbing, restrictive sutures or other drugs.

Active wound management after the release of a lip-tie, cheek-tie and tongue-tie is necessary to retrain the now-free muscles to function efficiently to form the mouth correctly through growth and development.  For an infant, this means achieving an efficient latch without clicking.

An infant requires a good latch to properly breastfeed but clicking while feeding is a sign that air is being swallowed and your infant’s belly can enlarge with air and result in colic and reflux.

Besides clicking, we will review other symptoms and their causes with you while you are in our office.

Active Wound Management

Active wound management after the release of a tie, also known as tethered tissue, is critical to prevent reattachment.

Wash your hands and place your baby in the correct assessment position, see above.  Apply organic coconut oil to your index fingertips.  Place your index fingertips ON the wound and rub the wound with your fingertips so the lip, tongue or cheek is fully moved free from the wound.  Do this at LEAST 3 times a day for 3 weeks.

Your index fingertips should touch each other while doing this at the mid-line of the lip or tongue while moving the lip or tongue free from the wound by rubbing your fingertips ON the wound at all times.  Do this at least three times, 3 seconds each time for a total of at least 9 seconds per wound.  For cheek-ties, also known as buccal-ties, you do the same but with only ONE fingertip, whichever is most comfortable for you to reach the wound.  Do the same rubbing on the wound to lift the cheek away from the wound fully with your fingertip, three times for at least 9 seconds total. 

Use light force while rubbing the wound with your fingertips and trim nails as finger nails should NOT touch the wound.

Tongue-tie release is always located where the tongue and the floor of the mouth meet, it often requires a horizontal, superficial extension to release fascia on either side of the tongue, sometimes more on one side than another, in response to the tie and its effect on the growth in utero.

Dr. Gunsaulis will let you know if there was more than one location under the tongue that required a release. When a tongue-tie exists it always runs from the tip of the tongue to the lower back side of the gums.  In some cases, to fully allow the tongue to elevate and to avoid a gingival defect and malposition of teeth in the future, an anterior release may also be required.  Imagine where your infants front two bottom teeth will be in the future, (or are now if your baby was born with teeth) then run your finger behind the gums that support these teeth until you feel where the gums and the soft floor-of-the-mouth join.  This is where an anterior release would occur, if necessary. 

The posterior release is necessary in all tongue-ties.  The anterior release of the tongue-tie is rarely necessary and always requires a posterior release too. 

Keep in mind that laser release of ties results in less bleeding following the release than with other surgical treatments and a white to yellow colored wound will be seen and decrease in size while healing and resolve upon full healing.  This is not an infection; it is normal wound healing and because it is free from sutures, heals with less restriction and pain and with less chance of reattachment of the tie.

Laser

Dr. Gunsaulis prefers to use lasers to release ties because it is the most state-of-the art method and because it is her preference and what she has been trained to use.  However, Dr. Gunsaulis knows this procedure can be successfully done in many manners and is quick to point this out to parents and patients seeking her services. 

Regardless of the surgical technique used, ensuring full release of all oral tethered tissue is critical to the patient's growth and development of optimal feeding, chewing, swallowing, breathing, speech, tooth and jaw positions and preventing oral diseases.

It Takes A Community

After a frenectomy, or tie-release, it is necessary to retrain your infant to suckle correctly.  This can be done by massaging the front half of his or her roof of mouth.  Use your finger to do this and if you feel your infant is uncomfortable dissolve a teaspoon of sugar in one cup of water and dip your finger in this solution.  Your infant should be able to suck on the area between the first and second knuckle.  Do this at least 3 times a day for 3 weeks following the frenectomy.

If you don’t have a lactation consultant already we will give you the name of one of the many IBCLC in our community that can help you achieve the best possible outcome.  We also routinely refer our post-operative frenectomy patients to other professions experienced in treating infants  that can further evaluate and/or provide treatment to enhance your infant’s growth and development such as Myofunctional Therapists, Cranial Sacral Therapists and Chiropractors, just to name a few.