What is a tongue tie?
The tissue under the tongue that attaches the floor of the mouth to the tongue is called the lingual frenum. A tongue tie (ankyloglossia) is when a short, tethered lingual frenum prevents free movement and proper function of the tongue.
In the last two decades there has been great attention placed on the function and mobility of the tongue and lips and their impact on the mechanics of the infant suck, making this one of the most controversial topics in medicine and dentistry. The contradicting and often extreme views ranging from calling everything a tongue and lip tie, to outright dismissing it, causes great confusion, guilt and angst in parents, especially mums.
Tongue Tie Consult – What to Expect
At Adelaide cosmetic dentistry apart from taking a thorough history of what has happened and listening to your story, we recommend that as a first step you see an internationally qualified lactation consultant to see if issues can be resolved by simple techniques like a change in position. If issues are ongoing and the ability to breastfeed is diminishing, then we assess to see if there is a physical obstacle in the form of a tethered frenum in the way of proper function. Assessment needs to consider both anatomy and function of the tissues.
Tongue Tie Release Procedure:
Once the assessment is done and if release procedure is indicated, parents are left alone to decide if they would like to proceed. If they would like to consider the information further or get a second opinion they are encouraged to do so.
Assessment of history and referral letter, physical and tactile examination of the mouth, clinical photographs
Presentation of the findings, discussion of pros and cons including risk factors, parental consent
Laser release of the frenum(s) under safe and controlled conditions. This step takes 1-2 minutes. The laser ablates the tissues not in one single cut but as a “gradual” 1-2 second release. Since bleeding is negligible (if any), this gradual release allows us to see the anatomy clearly minimizing risks.
The child is brought back to you immediately to be fed under the supervision of the IBCLC. Post-operative instructions are given at this time.
You will have Dr Rosh’s and well as lactation consultant’s personal mobile numbers. Any time of the night and day you can text us if you have any questions.
Our Process
Assessment
You are thoroughly assessed to see if the frenum in question is actually restricting mobility. It is often helpful to have had an assessment done by another practitioner such as your GP, chiropractor, or physiotherapist. A myofuctional therapists involvement is often needed.
Anesthesia
The method of anesthesia used is often determined by the age of the patient. In adults, a small local anesthetic is sufficient to keep you comfortable during the procedure. In young children, happy gas may be used.
Release
We use a Waterlase laser to release restricted tissues and depending on the age of the patient we may get you to perform various movements of the tongue as we carry out the surgery to ensure a thorough and sufficient release is obtained and the tongue has gained a full range of motion.
Surturing
Suturing is often used in adult patients to minimise the need for post-operative stretches and minimise scar tissue formation. Suturing may not be possible in young children and infants. Luckily laser seals the tissues as it cuts minimising the risks of bleeding and infection.
Smile!
The results of laser frenectomies are often felt immediately and reported by adult patients as a dramatic sense of freedom of movement. They often feel their tongue sitting against the roof of the mouth for the first time. This position is the correct posture of the tongue. Needless to say, results vary between individuals.
Frequently Asked Questions
If another practitioner has also felt there is a tether in the way of the function or have observed a lip or tongue tie they are in a good position to send the family to us for further assessment. More importantly, a lactation consultant may be able to get you to feed better without a need for surgical intervention. Manual therapists such as physiotherapists, osteopaths and chiropractors may be able to improve the function of the tongue as well, again averting the need for surgery.
There is no conclusive evidence to show that tethered freni cause issues in the future. This could be because an individual with tethered oral tissues learns to use the muscles in a compensatory way. Many adults, even with a severe tongue tie, can eat and speak normally seemingly with no issues. It is only after the tongue tie is released; they notice the difference in how they have been functioning. There are some studies that have linked a short lingual frenum to impaired growth of the jaws and to obstructive sleep apnoea. However, the medical community still debates this. Therefore, it is very hard to predict if a child will have issues in the future or not and to what extent.
There is a lot less research done on the role of lip ties on feeding compared to the tongue and no research on the role of buccal ties (short or restrictive buccal freni). What we know is cumulative experience from practices around the world which have seen thousands of infants. No published data exists to this point.
Again, there is no conclusive evidence that says one tool is better than the other. Dr Amrein has been using the Waterlase (hard and soft tissue) laser daily since 2007. This tool allows her to quickly and efficiently “ablate” the unwanted tissues and remove them with little collateral damage to the surrounding structures.
Like many aspects of this topic there is a big controversy on whether post-operative exercises need to be given or not. There is no evidence to say these exercises are effective as there is no research done on their efficacy. In our clinical experience we have seen time and again in various age groups that the edges of the tissues tend to heal together as tissues fold on top of each other if stretches are not done. Stretches are therefore effective to promote “healing by secondary intention”.
No. No general anesthetic is needed. Topical anesthetic and a few drops of sucrose are administered with parental consent. The procedure takes seconds, and the child is brought back to be fed immediately. They are only away from you for 2-3 minutes.
The topical anesthetics in the form of a numbing gel applied locally is quit an effective method to numb up the area before the procedure. Sucrose solution will also distracts the child from any discomfort. We compare the discomfort to immunization.
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