Your Kids

Education & prevention

District Dental believes the best type of dentistry for children is no dentistry at all and that good oral care begins with education. Our staff will always take the time to ensure that you and your child leave the office feeling completely equipped with the best knowledge and tools available in order to make the right decisions at home. Good oral care often equals good overall health and our mission is to ensure that every child we see is given the best chance at having a good, healthy start.

One of the most common questions we get is: “At what age should I start bringing my child to the dentist?”. While it is the general consensus to bring your child in when the first tooth appears (approximately 6 months), we believe that it is best to visit before you give birth, sometime in your third trimester. This allows us to help you prepare for the future needs of your child and lets us offer some education in regards to their oral development. Our goal is to provide you with a professional source of information that will help you determine what is best not only for your baby, but for yourself and your lifestyle.

While in the office, we can answer all of the questions you may have regarding your baby’s oral development, including:

  • Breastfeeding vs. Bottle Feeding
  • Formula vs. Breast Milk
  • Pacifiers
  • Night Feeding
  • Tongue-Ties
  • When to introduce solids, etc

Early interceptive orthodontics

If you’ve ever wondered if there is anything that can be done to correct your child’s crowding/crooked teeth before the age of 11, District Dental can consult with you to develop a plan. We look at the child’s development as a dynamic process which can be affected by various forces throughout life. It’s with this principle in mind that we cater our approach to treating children’s malocclusions (bad bites).

Why Does my Child have Crowding/Crooked Teeth?

The simple answer to this question is that your child’s jaws are too small. However there are many factors when it comes to this. Often times as parents we contribute small jaws to heredity and although not incorrect, it prevents us from discovering other factors which may be a factor. These other factors are mostly controllable and give us the ability to guide the growth of the child to accommodate all of their teeth and their tongue in a well-aligned and physiologically balanced manner.

Treatments can include:

  • Myobrace — a no-braces orthodontic approach to help straighten the teeth and develop the jaws.
  • Jaw expansion/development appliances
  • Planas direct tracks — composite tooth buildups to guide teeth into alignment.
  • Myofunctional therapy — the neuromuscular re-education or re-patterning of the oral and facial muscles. Therapy includes facial + tongue exercises and behavior modification techniques to promote proper tongue position, improved breathing, chewing, and swallowing.

sleep disordered breathing

While most of us have heard of adult sleep apnea, there are few of us who have heard of Pediatric Sleep Disordered Breathing (Sleep Apnea). It is estimated that 1 to 4% of children suffer from sleep apnea and is most commonly found in those aged 2 to 8.

Sleep Apnea can be detrimental to a child’s overall health and development and if left untreated, it can put a child on life-long path of pain, poor development, depression and major health issues (i.e. heart conditions, high blood pressure etc).

Common symptoms of pediatric sleep apnea include:

  • Failure to thrive
  • Headaches, especially in the mornings
  • Difficulty waking up
  • Mouth breathing
  • Nasal voice
  • Irritability and aggressive behavior
  • Fatigue
  • Hyperactivity
  • Bed wetting
  • Depression
  • Poor behavior/Poor performance in school
  • Poor health
  • Social isolation

At nighttime a child with sleep apnea may exhibit:

  • Frequent loud snoring
  • Pauses in breathing, gasping and snorting
  • Restlessness and constant movement
  • Abnormal posture during sleep with their head in unnatural positions
  • Heavy sweating from labored breathing

If you believe your child may be suffering from sleep apnea, contact District Dental today

Lip & tongue tie release

What is a Frenum?

A Frenum is a muscular attachment commonly found under your upper and lower lip and underneath your tongue. The function of the frena (multiple) isn’t fully understood, other than providing stability for your lips and tongue.

When we encounter a frenum that is either too short or attached inappropriately, it can lead to a functional impediment of the lips and tongue. When function is affected, it can lead to poorly developing jaws resulting in crooked teeth. Additionally, poor functioning lips and tongue can affect the ability to properly breathe, chew, swallow and speak. Thus, necessitating a Frenectomy.

What is a Frenectomy?

A Frenectomy is, quite simply, the removal of the frenum from one or more areas of the mouth. District Dental employs a soft tissue diode laser for all frenectomies. This laser gives us greater control in the removal of only the tissues that need to be removed with essentially no bleeding during the surgical procedure. Post-operatively pain and discomfort is minimal compared to the more conventional approach with a scalpel.

Infant Frenectomies

District Dental Tongue Tied Infant

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 a tongue tie is “ankyloglossia” and studies show the defect is hereditary.

Dr. Stas Pavlenko talks infant frenectomies for tongue & lip ties  

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

Anterior tongue 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.

Posterior tongue 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, therefore it is very important to assess both when considering a frenectomy.

Here’s a great video illustrating the effect of an anterior and posterior tongue tie on breastfeeding:

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 (a gap between the teeth) later in child’s development.

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.

Proper infant breast latch vs. tongue tied infant breast latch

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

• minimize speech difficulties

• digestive issues

• optimizing baby’s facial and oral development.

What equipment is used to perform a frenectomy?

To perform a frenectomy, Dr. Pavlenko uses a 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.

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

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. Pavlenko 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.

Infant frenectomies Newborn breastfeeding

What happens after a frenectomy?

Immediately after a frenectomy procedure, we give the baby back to the mom for their first breastfeeding session. Once the baby is settled and mom and the baby reconnected, Dr. Pavlenko will come in to do his final check on the baby and mom before they leave. We highly recommend to connect with your lactation consultant in the first 48 hours to obtain any support needed with the breastfeeding. If you don’t have a lactation consultant, we will be more than happy to connect you with one. 

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. Pavlenko will recommend several strategies to help soothe the baby as outlined in THIS post-op care brochure. He 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, 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. Pavlenko will also schedule check up appointments 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. 

Download “District Dental Home Care Information for Post-op Frenectomy”.

Frustrated mother breastfeeding tongue tied infant

What happens if a lingual or labial frenum is left untreated?

A lingual or labial frenum that impairs function needs treatment. If left untreated, it has a high chance of affecting a child’s oral development, and could lead to:

• crooked teeth
• speech defects
• underdeveloped jaws
• breathing issues
• sleep apnea.

Benefits of a frenectomy at a young age.

Infants and newborns do not need anesthesia during a frenectomy. However, older children will require full sedation or will have to wait until they can tolerate a local anesthesia. Also, 50% of facial development occurs by the age of 2. A frenectomy performed as early as possible promotes and encourages good facial development.

Does my newborn need a frenectomy? 

Not all ties cause problems and require a correction. Here are some signs and symptoms of a tongue & lip tie: 

Moms

• flattened nipples after breastfeeding

• nipple pain, damage & bleeding

• prolonged feedings

• poor breast drainage

• decreased milk production.

Infants

• 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.

Call Dr .Stas Pavlenko

Questions?

It is important to note that the above signs can also point to other breastfeeding issues. If you suspect your baby has a tongue or lip tie and would like an evaluation, call or text us at 780-429-1076 and we will be happy to set up an evaluation with Dr. Pavlenko for you today!