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Pediatric Frenectomies

Lip and Tongue Ties

Pediatric frenenctomies: Lip and Tongue Ties Releases

Pediatric frenenctomies are needed when the frenum, a muscular attachment found under your upper and lower lip, and underneath your tongue is too tight. The function of a frenum is to provide stability for your lips and tongue.

A frenum that is too short restricts movement of your tongue and/or lips. As your child grows, a short frenum affects jaw development and can cause crooked teeth. Also, lips and tongue that don’t function well can affect your child’s ability to breathe, chew, swallow and speak. Thus, causing a Frenectomy.

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what is a tongue tie?

Babies are born with a thin membrane under their tongue called the lingual frenulum. However, 5-12% of babies are born with their lingual frenulum so tight that it restricts the movement and mobility of their tongue.

This can affect a newborn’s ability to breastfeed leading to:

  • poor latch
  • mom’s nipple pain and trauma 
  • decreased milk intake and milk supply

The medical term for tongue tie is “ankyloglossia” and studies show the defect is hereditary.

Image attribution: Ankyloglossia_1 Gzzz© CC BY-SA 4.0

Pediatric-frenectomy-Ankyloglossia tongue tie

Anterior and Posterior Tongue Ties

What is the difference between an anterior tongue tie and a posterior tongue tie?

Anterior tongue ties

This tie is easy to visualize because it is located closer to the baby’s gums when they lift their tongue, and it looks like a distinct string that’s tethered between the floor of the mouth and the bottom of the tongue.

Image: Ankyloglossia_2 Gzzz© CC BY-SA 4.0

Ankyloglossia tongue tie

Posterior tongue ties

This tie is located much deeper in the mouth and not as easy to see. This a result of being hidden under the mucous membrane of the mouth. We evaluate this by manually lifting the baby’s tongue and doing a sweep with a finger. Misdiagnosis of anterior tongue ties is common because of its location. Clinicians sometimes release the anterior tongue tie without assessing the posterior portion, leading to incomplete symptom relief for the mom and the baby.

Anterior and posterior tongue ties share the same symptoms. It is very important to assess both when considering a frenectomy.

cute-baby-with-tongue-sticking-out

What is a lip tie?

 

Many infants with a tongue tie also have a lip tie. A lip tie, aka labial frenulum, is an abnormally tight membrane attaching their upper(or lower) lip to their upper(or lower) gums.

This condition may cause babies to have:

  • difficulty flanging their lips properly to feed and creating a good seal at the breast
  • excess intake of air during breastfeeding resulting in painful gas
  • maternal pain during breastfeeding
  • lip tie may also cause a diastema (gap between the teeth) later in child’s development

Diagnosing tongue and lip ties

How are tongue and lip ties diagnosed?

Not every frenum needs a frenectomy. We evaluate tongues or lips ties based on how they move and function and the symptoms they produce, NOT on how they look. That is why it is important to have an assessment by a trained healthcare professional to make sure your infant is getting the right treatment.

How are tongue and lip ties treated?

We can correct tongue or lip ties by performing a frenectomy (aka tongue tie release or lip tie release). A frenectomy is a safe and quick procedure that allows for greater tongue and lip mobility and improved function. Frenectomies help not only with tongue mobility, but they can also help with:

  • prevention of dental decay and spacing
  • avoid speech difficulties
  • digestive issues
  • optimizing baby’s facial and oral development

Pediatric frenectomies: What to expect

What happens after a frenectomy?

Immediately after a frenectomy procedure, we give the baby back to the mom for their first breastfeeding session. Our lactation consultant on staff will offer guidance and support to assist with the first latch after the procedure. 

During the first week after the frenectomy, you can expect the baby to be fussy and sometimes inconsistent in her feedings because of the post-operative discomfort. This is normal and Dr. Stas recommends several strategies to help soothe the baby as outlined in our post-op care brochure. Dr. Stas will also provide you with several exercises and stretches to do for your baby in the first six weeks in order to ensure a successful frenectomy. It is ABSOLUTELY crucial to keep up with the prescribed exercises and stretches. If not performed properly and consistently, there is a high it is possible that the frenums will regrow and the breastfeeding issues will return. Therefore, parents’ commitment to baby’s post-op care is of most importance.

Dr. Stas will also schedule a check up appointment a week after your baby’s frenectomy to ensure that there is no frenum reattachment and assess for post-op complications.

We recommend continued collaboration with your lactation consultant in order to establish a proper latch and ensure mom’s and baby’s breastfeeding success.

How long does it take to do a frenectomy, and how do you prepare babies?

Frenectomy is a very safe and fast procedure that can take less than 2 minutes to perform. Because the duration of the procedure is so short, Dr. Stas will offer to do the procedure right after the assessment without having to delay treatment and wait for a separate appointment.

We will use an infant swaddle to keep the baby calm and keep the baby’s hands safely away from the face. We will put special infant laser glasses to protect the baby’s eyes during the procedure. Our staff will always keep two hands on the baby to keep them safe during the short duration of their treatment.

What equipment is used to perform a frenectomy?

To perform a frenectomy, Dr. Stas uses a LightScalpel CO2 laser to remove and release the tissue. The benefits of using a CO2 laser include:

  • minimal discomfort with faster healing
  • minimal bleeding during and after the procedure
  • kills bacteria on contact
  • increased precision resulting in a more complete removal of a tie

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Does My Baby Need a Frenectomy?

Do you have any of the following symptoms:

  • flattened nipples after breastfeeding
  • nipple pain, damage & bleeding
  • prolonged feedings
  • poor breast drainage
  • decreased milk production

Does your baby have any of the following symptoms:

  • noisy suckling or clicking
  • popping on and off the breast
  • leaking on the sides of the mouth
  • poor weight gain
  • coughing or gagging
  • lip blisters
  • gas pain
  • noisy breathing/snoring sounds when sleeping
  • reflux or colic.

How and why do ties affect breastfeeding?

The mobility of the tongue is important for both mom and baby during breastfeeding. To properly feed, a baby needs to latch past the nipple onto the areola. Tongue-tied babies often latch the nipple, compressing it, leading to nipple pain and skin breakdown for the mother.

Breastfed babies with lip/tongue ties often:

  • have difficulty maintaining a latch for long enough to take in a full feeding
  • remain latched for long periods of time without taking in enough milk
  • feed only during the mother’s milk ejection reflex, or the milk “let-down”
  • will not draw milk out of the breast when the milk flow slows

Mothers of tongue or lip tied babies often give up breastfeeding and assume it is their fault. When in reality, the tie is making breastfeeding difficult for their newborn.

Bottle feeding allows milk to drip into the baby’s mouth with minimal effort, requiring less tongue muscle effort. While bottle feeding keeps the baby nourished and growing, the muscles of the tongue may become weak, which may lead to poor orofacial development. Poor orofacial development can have a negative effect on how the baby is chewing, swallowing, breathing and talking, leading to a poor bite, crowded teeth, TMJ and airway problems.  

If you are experiencing trouble breastfeeding your baby, contact our resident lactation consultant, Megan Schafers, IBCLC.

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