When it comes to tongue and lip ties, one of the most important decisions is choosing the right provider. Dentists and physicians are no longer trained to properly identify and treat tongue-ties. It’s highly unfortunate but the link between breastfeeding and the tongue is not understood by the medical profession as well as it needs to be. As a result of this, it is imperative that you seek out a provider that is experienced in releasing tongues and lips, understands the link between breastfeeding and ties, and checks for the presence of a posterior tongue-tie. Here are questions that can help you make this important decision.
How many (infant/child/adult) tongue and lip tie releases do you perform each week?
It is important know how experienced the provider is in working with all tongue and lip ties, but especially infants and children. Your provider will need to assess whether the frenulum is normal or actually needs release and whether bodywork is needed to help address issues like soft tissue tension or imbalance. Experience also makes a difference with speed and efficiency, ability to fully release the ties without going too deep, managing post-procedure healing process, as well as any difficulties that may be encountered. Because of the frequency of referrals, our office sees more and more tongue and lip-tie revisions each month. Call our office to ask how many we are currently performing.
Do you use scissors/scalpel or laser?
The technique used to revise the tongue is less important than the skill and knowledge of the provider. Both scissors and a laser can be equally effective in the right hands at revising. However, it is important to know the differences. When using scissors, local anesthetic will need to be injected, or no anesthetic will be used. When the provider uses a laser, topical anesthetic is sufficient to numb the area for the procedure.
Our office uses a laser because a laser offers a level of precision that cannot be met with a scalpel or scissors. When scissors are used, the entire tie may not be able to be released, especially in the hands of a provider who does not commonly perform releases. A big reason for this is that bleeding is expected and can impair the visibility of the tie. A laser makes it easier to accurately eliminate the entire tie. One reason for this is that the laser cauterizes the wound, which offers us the ability to work in a blood-free environment. This means that the tie is completely visible so it can be eliminated. One of the other advantages lasers is that they promote faster healing and stimulate the body’s own mechanism to heal.
How do you address posterior tongue-ties?
When many providers talk about tongue-ties they are talking about the anterior tongue-tie. This is often a thin piece of tissue that extends from the tip of the tongue to the floor of the mouth. When an anterior tie is present, it is an indication that there is also a posterior tie. Releasing the anterior tie is rarely enough to get the full benefits of a frenectomy and can often result in needing to have the tongue-tie further released. The posterior tie is the band of fibrous tissue that covers the muscles of the tongue. Because of where it is located, it is frequently missed and goes undiagnosed. Every time there is an anterior tongue-tie, there is also a posterior tie associated with it that needs to be revised at the same time.
What form of sedation (if any) will be used during the procedure?
Every provider has different levels of comfort working on children and therefore has different thoughts on sedation. Before having the procedure done, make sure to discuss what will be used on your little one. We believe strongly that general anesthesia is not required in order to have the tongue and lip-ties revised. For infants, no sedation is required in order to perform a laser frenectomy (tongue or lip-tie release). There are significant risks such as learning disabilities, ADHD and impaired recollection (insert links here for citation) associated with the use of general anesthesia on infants which is why we do not use this at all for infants in our practice. We use a topical anesthetic, which is enough to eliminate all of the pain of having both the tongue and lip revised. We have many different levels of anxiety-reduction medications in order to make it a more comfortable experience for older patients.
What pain control options do we have?
For the first few hours after having your baby’s tongue or lip revised with a laser there is not likely to be much—if any—pain. After that, you may use Tylenol, oral arnica dissolved in water or breast milk, Rescue Remedy stress reliever, Hyland’s Teething Gel and Orajel Naturals (NOT regular Orajel). If your child is over 6 months old, you may also use Ibuprofen. Make sure that you follow the directions for the dosage based on your child’s age and weight, and work in partnership with your pediatrician. It is wise, especially in the first few days, to administer pain relief proactively. In addition to these, taking a warm bath with your little one may help soothe any discomfort as well as putting frozen breast milk chips under her lip or tongue.
Will we need to do stretches after the procedure?
During the first few weeks after the tongue and/or lip are revised you will need to stretch the procedure site every 4-6 hours around the clock. When there is an oral wound—like what is created during the release of the tongue or lip tie—the two sides want to reattach, healing tighter than it was originally. Your job is to prevent this by faithfully performing the stretches. The stretches ensure that the revisions heal open and long, and the tongue and lip ties are no longer an issue. After the procedure we will review the stretches with you.
Do you have referrals for people who can help with the healing process?
Because of how tongue-ties impact the whole body, it is important that your provider have built an experienced team of other providers who can partner with the patient and parents to help them realize complete healing. This can include craniosacral therapists, chiropractors, cranio-osteopaths, lactation consultants (IBCLC) and myofunctional therapists.
What follow up care is needed?
Ideally, we like to see infants and their moms one week after the procedure to ensure that initial healing is going well and to make sure that stretches are being done properly. Three weeks after the procedure is the final follow up appointment. At this visit, we are ensuring that all of the baby’s and mother’s symptoms have resolved. If there are still residual symptoms, a plan is created to support the mom and her little one to ensure they get the support and care needed for complete health.
What if we need a re-revision?
If you need a revision for any reason within the first six months there is no additional charge to have this taken care of.