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What Parents Need to Know About Lip Ties and Tongue Ties? Written By: Dr. Ankita Shah, Feb 2020

breast feeding

Many parents are not familiar with the term “lip ties” or “tongue ties”. When a paediatric dentist or paediatrician mentions their baby has a tongue tie or lip tie, it can be alarming for parents. Thus, parents need to understand what causes tongue and lip ties and how they are treated. In this article, we have explained everything you need to know about tongue ties and lip ties.

WHAT IS A TONGUE TIE?

A tongue tie occurs when the thin membrane under the baby's tongue (the lingual frenulum) restricts the movement of the tongue. All babies are born with some of this tissue, but for approximately 5-12% of newborns, it is so tight that they cannot move their tongues freely. This can affect their ability to breastfeed and lead to poor latch, nipple pain and trauma, decreased milk intake and a decline in milk supply over time. The medical term for tongue tie is "ankyloglossia" and studies show the defect is hereditary.

TONGUE TIE

WHAT IS A LIP TIE?

Many babies with a tongue tie, also have an abnormally tight membrane attaching their upper lip to their upper gums (the labial frenulum). This is called a lip tie. Babies with a lip tie often have difficulty flanging their lips properly to feed and cannot create a proper seal at the breast. This can cause them to take in excess air during breastfeeding, which often makes these babies gassy and fussy.

Lip Tie

The above photos are only examples of ties - NOT ALL TIES LOOK THE SAME. It takes an experienced provider to thoroughly investigate tongue function and symptoms associated with each tie, and to take into account the variations of its clinical appearance.

HOW AND WHY DO TIES AFFECT BREASTFEEDING?

The mobility of the tongue is important during breastfeeding, both for the mother and the baby. A baby with a tied tongue may not be able to latch deeply onto the breast, past the nipple onto the areola. This compresses the nipple onto the gums in the baby’s mouth, leading to nipple pain and skin breakdown for the mother. Also, in tongue tie, the tongue doesn’t rest on the roof of the mouth, so the babies have a high palate, which decreases the suction and further reduces milk transfer.

Babies with ties may not maintain a latch for long enough to take in a full feeding, while others may remain attached to the breast for long periods without taking in enough milk. Some infants will feed only during the mother’s milk ejection reflex, or “let-down” when the milk ejects more freely, but will not continue to draw milk out of the breast when this slows. Bottle feeding allows milk to drip into the mouth without effort, thus requiring less tongue muscle effort than is needed for breastfeeding.

An infant’s inability to breastfeed often results in the mother giving up breastfeeding entirely, while being told that the problem is her fault. In reality, the problems may result from restricted tongue and upper lip attachments - making normal function, mobility and breastfeeding difficult or impossible.

WHAT CAUSES TONGUE TIE AND LIP TIE?

There are several theories and researches behind the causes of tongue tie and lip tie. However, there is no one concrete reason for it as of today. It could be a defect in cellular apoptosis or hereditary.

Tongue and Lip Ties Symptoms and Signs

Some babies with tongue ties and lip ties are able to attach to the breast and suck well. However, many of these infants have breastfeeding problems. Below is a list of the tongue and lip tie symptoms and signs that are common amongst infants and children. However, it is important to note that these signs can be linked to other breastfeeding problems and are not solely related to ties.

Breastfeeding Mother's Symptoms

Painful latching

Blanched and bleeding nipples

Creased/Infected nipples

Nipple Thrush

Reduced milk supply

Incomplete breast drainage after feeding

State of mind: Anxious / Depressed

Tongue Tie Symptoms in Infants

Poor/shallow latch

Prolonged latching/long feeding hours

Unsettled after feeding

Falls asleep during feeds

Pulls the body away from the breast while feeding

Short sleep duration

Chewing on nipples and reflux symptoms

Colic symptoms/Gassiness

Tongue Tie Symptoms in Toddlers/Children

History of difficulty in breastfeeding

Clicking sounds while feeding

Difficulty in brushing upper front teeth

Forward neck & shoulder posture

Speech difficulties

Restlessness & lack of attention

Day time sleepiness/hyperactivity

Sluggish/Picky/Slow eater

Constipation or Food in faeces

Digestive problems (refluxes, colic)

Gags easily

Frequent cold, cough & allergies

Short sleep episodes or Grinding teeth at night

Delayed speech

Learn more: Tongue/Lip Tie in Toddlers/Children

HOW ARE TONGUE AND LIP TIES DIAGNOSED?

Tongues and lips are only considered to be tied if their “movement is restricted, impairing mobility. Correct examination of infants requires the infant be placed on the examiners bed/table with the infant’s head facing the same direction as the person evaluating the infant. It is important to note that not all ties cause problems and require correction. Each case needs to be assessed by an educated and trained practitioner on an individual basis. Tongue tie is a diagnosis based upon function, so what your baby’s tongue looks like can sometimes be less important than how it can move.

Tongue And Lip Ties Diagnosed

TREATMENT FOR TONGUE TIES AND LIP TIES

Frenectomy procedure removes the tissue or tight frenulum under the tongue or upper lip. Dr. Ankita uses a state of the art laser for a safe and quick procedure that allows for greater tongue and lip mobility. In some instances, frenectomies can aid in prevention of other health problems like dental decay or spacing, speech difficulties and digestive issues. Dr. Ankita is also laser certified by Global Laser Oral Health, (GLOH), LLC to perform laser frenectomies. While the procedure can be done with a laser or scissors, advantages of revising ties with a laser include:

Minimal discomfort

Minimal bleeding during and after the procedure - the laser aids in hemostasis

Faster healing

Bactericidal properties

Increased precision and complete removal of a tie

Treatment For Tongue Ties And Lip Ties

Learn more: FAQs on infant laser tongue tie release

OUR TEAM APPROACH

Dr. Shah feels that post-op care is important to the success of the release. Essentially, the baby must learn how to use his or her tongue in a new way. Some babies need no help at all and immediately breastfeed post-procedure, while other babies may need help from additional professionals.

An International Board Certified Lactation Consultant (IBCLC) provides full feeding observation, latch/position adjustment, suck assessment, pre and post-feeding weight checks and strategies for correcting problems and managing to breastfeed.

A speech or developmental feeding therapist can help babies learn to use their tongues for more effective eating and speech.

A craniosacral therapist, osteopath, chiropractor, occupational or physical therapist can help babies to release tight muscles that have compensated for a tight Frenulum or improper suck. Bodywork encourages an infant to express postural reflexes and explore natural movement inclinations through the nervous system.

If you suspect your baby has a tongue tie or lip tie that is causing breastfeeding problems, please feel free to Contact Us.

FAQs

1)Can a tongue tie cause speech problems?

While not all tongue ties cause speech problems, about 70% of tongue ties do cause speech problems. If a tongue tie is left untreated, it can cause speech problems as the baby grows older. It can also affect swallowing, posture, jaw growth and airway development. However, it is difficult to say which type of tongue tie may cause a speech problem.

2)Why do tongue and lip ties need to be released?

Restricted mouth/tongue movement (due to taut lingual frenulum or labial frenulum) can affect breastfeeding, nasal breathing, eating habits, speech, posture, digestion, development of the jaws and sleeping patterns. To avoid this, tongue and lip ties need to be released. Check out this blog to learn more.

3)When do you need tongue tie revision?

If your child faces any of the above symptoms, it is advisable to schedule an appointment with a paediatric dentist. Depending on the severity and examination by the tongue tie specialist, appropriate treatment for tongue and lip ties will be recommended.

4)Does the treatment for tongue tie and lip tie hurt?

No. The laser frenectomy treatment for tongue tie and lip tie is safe, quick, simple and painless. Prior to the treatment, a topical anaesthetic gel is applied to the frenulum to ensure it causes no pain. Also, the anaesthetic lasts for approx. 30 minutes.

5)How long does the tongue tie/lip tie surgery take?

A pen-sized laser is used to remove tongue/lip tie, and the entire procedure takes only a few minutes.

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