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A cheerful baby beams with a smile at Spokane Valley Washington

Tongue, Lip and Cheek-Ties

Tongue-Tie and Lip-Tie Assessment at Mollygunsaulis, Washington

Tongue-Tie and Lip-Tie Assessment:

The initial assessment begins by discussing the patients' symptoms and if the patient is an infant, the mother's symptoms too. Dr. Gunsaulis will examine infants and small children 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.  Knee to knee position.

Releasing the Tongue-Tie and Lip-Tie

If a frenum is contributing to functional deficiency and scores high enough on appearance and functional examination, it is a tie, a tethered oral tissue; and a frenectomy will be recommended to release the tie (see bottom of page, questions and answers, regarding therapy necessary prior to release).  Releasing tethered oral tissue does NOT require any general anesthesia and is safely, quickly and easily completed in the dental office using a CO2 laser for infants to adults.

Surgical release of an infant's tethered oral tissue takes less than 30 seconds and requires NO numbing, sutures or other drugs.

Active wound management after the release of a tethered oral tissue is necessary to prevent reattachment and 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 feed.  For children or adults this may mean achieving coherent speech, or a restful nights sleep without pain/headaches the following day.

As Michelle Price Emanuel has said, "Releasing the tie is a big part of improving latch and nursing, but there is also a need to do intentional therapy and exercises to help bring on healthier oral function. Somethings will improve spontaneously, but most oral function needs intentional activities to promote optimal function." This is also true of older children and adults.

Child before
 
Child after
 
Child after with stitches
 
Infant before
 
Infant after
 

Active Wound Management

A person with blue gloves is holding their mouth at Mollygunsaulis, Washington

Tethered Tissue

Active wound management after the release of a tie, also known as tethered tissue, is critical to prevent reattachment when there are no sutures.  Wash your hands well before and after lifts (gloves are not necessary).  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.

Lift the tongue by pushing back and down with one or two index fingers directly above the wound to stretch the tongue back and down, toward the throat, as far back as it will go for 5 seconds so you can fully see the diamond shaped wound.

2025 tethered tissueLift the lip by putting your two index fingers above the wound, pushing the lip up to fully stretch the lip to the nose for 5 seconds, so you can fully see the diamond shaped wound. Use one index finger in the shape of a hook to pull the cheek up as far as it will go for 5 seconds. Do not be afraid, you cannot over stretch the lip, cheek or the tongue.  The lifts are the sorest the week following the procedure.

Lift the lip, tongue and/or cheek until fully moved free from the wound for 5 seconds. Do this at least 3 times a day, every 8 hours, for at least 4 weeks. Trim nails as fingernails should NOT touch the wound. Use Smart Phone Alerts to make sure lifts are occurring once every 8 hours. Start 8 hours after the release for all lip and cheek ties.  Wait 24 hours after the release to start the tongue lift. Elevations or lifts of the wounds can be done prior to feeding for infants but not less than once every 8 hours.   

If at the end of the 4 weeks, you can only see a vague outline of the diamond/oval wound and the skin inside is the normal color and appearance of the surrounding skin, you no longer need to continue with active wound management. Most patients require a minimum of 4 weeks of active wound management, however there are exceptions:  If at 4 weeks of stretches you see any white inside the diamond/oval shaped wound, add one more week of wound management, even if the next day no white remains. 

A small amount of spotting or bleeding is common after the procedure, especially in the first week when doing the lifts. You may use Tylenol, Ibuprofen (if 6 months of age or older), Arnica, Rescue Remedy or other measures to help with pain control. As of October 2016, the FDA has requested that teething gels no longer be used. A suitable replacement is organic coconut oil, which can be safely used in the mouth following the exercises.  Do not use coconut oil before the exercises as it may inhibit full retraction, too slippery. Frozen coconut oil to wound further helps with pain control, cooling the wound.  

I recommend Arnica montana 30 c pellets.  (Spokane Valley Fred Meyer's on Sullivan and Roasurs grocery store on University). Place 2-3 pellets in a dropper bottle with 1 ounce of breast milk.  Keep refrigerated and discard in one week. Place 1-2 drops on each wound every hour for the first few days or as needed for pain.  

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 at mid-line and on either side of the tongue, sometimes more on one side than another, in response to the tie and its effect on the growth. The lip/cheek-tie release is always located at the insertion of the frenum to the attached gingiva, gums extending to the depth of the vestibule, where the lip, movable inner oral mucosa and skin meet. Release of all sites results in a diamond to oval shaped wound.  

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.  This is not an infection; it is normal wound healing.

Serrapeptase is recommended to all wounds during contracture of wounds-usually noted at 2-5 days following releases and again 2.5-3 weeks after releases. 

Website to purchase Serrapeptase: Amazon.com: Arthur Andrew Medical, Serretia, Serrapeptase Formula for Muscle and Sinus Support, 30 Capsules : Health & Household

Instructions will be provided at the time of release. 

laser to release at Mollygunsaulis, Spokane Valley Washington

Laser

Dr. Gunsaulis prefers to use a CO2 laser 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 train the mouth to function correctly.  For infants this can be done by massaging the front half of your infant's roof of mouth. Use your finger to do this, 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. Other exercises will be provided when you visit my office. If you don't have a lactation consultant already we will give you the name of one of the many IBCLCs in our community that can help you achieve the best possible outcome. 

We also routinely refer our infant and older children post-operative frenectomy patients to other professionals experienced in treating infants, children and adults  that can further evaluate and/or provide treatment to enhance growth and development, such as myofunctional therapists, midwives, lactation consultants, pediatricians, speech and feeding therapists, osteopaths, cranial sacral therapists, chiropractors, physical therapists, functional orthodontists and many more integrative providers.

We encourage parents to engage their infants in tummy time and provide gentle body massage to aid in healing, regain balance and provide comfort.

Please feel free to contact Dr. Gunsaulis with questions anytime: Molly@GrowSmileShine.com

Frequently Asked Questions

  • Question:
    My 2 1/2 year old was just referred for a possible tongue tie that may need to be released.  I wanted to ask how you handle toddlers who need this procedure versus infants. He will definitely not sit still, and we are wondering if he will need to be put under anesthesia and if you handle these cases or if there is another doctor or dentist you might recommend.
  • Answer: 
    I routinely see toddlers without anesthetic, anesthesia or conscious sedation, but I do recommend a consultation/examination so I can determine if a release is necessary and we (guardians and me) can determine what, if any, immobilization may be necessary (immobilization is a device that restrains a sedated or pre-cooperative patient so there is little to no body movement). I do use local anesthetic to numb the tie when my patient is age 3 and older and weighs enough to support its use.

A laser release is performed in seconds, only a few minutes in the dental chair.  Healing is without stitches and so guardians must be prepared to do wound management for at least 4-6 weeks following the procedure.  My wound management protocol is listed above. 

Frequently Asked Questions