Tongue-Tie | Smith Dental Specialties

Tongue-Tied Babies

Lingual Frenectomy

Ankyloglossia is also known as a tongue-tie. This condition restricts the range of motion of the tongue. Everyone has a lingual frenulum. It is the thin membrane seen under the center of the tongue. The frenulum is too short or too tight if you are tongue-tied. An infant with a tongue-tie may have trouble with breastfeeding, eating and swallowing. Later in life tongue-tie has been linked to pronunciation problems in speech, snoring, sleep apnea and craniofacial pain.

Symptoms of a Tongue-Tied Baby Include

Shallow or weak latch
Clicking sound during feeding
Frequent reflux or spit-up
Gassy tummy or Colicky
Fatigues quickly during feeding
Excessively frequent feedings
Excessively long feedings
Sucking blister or callus
Little or no weight gain
Becoming fussy or fighting you at the breast
Thrush
Popping on and off the breast

Symptoms of a Breastfeeding Mother Include

Pain or discomfort while feeding
Damage to the breast
Low milk supply
Oversupply
Breast still full after feeding
Mastitis or thrush
Recurrent nipple blisters/blebs

Tongue-tie is diagnosed in 4 grades. Grades 1 and 2 are thought to be posterior whereas grade 3 and 4 are anterior. The grade however does not technically determine the severity.

Grade 1

The lingual frenulum is still slightly visible however it is attached towards the back of the tongue.

Grade 2

The lingual frenulum is not seen. This is the most commonly missed tongue-tie. The sides and tip of the tongue are able to elevate however the middle of the tongue is tied to the floor of the mouth.

Grade 3

The lingual frenulum connects to the tongue just below the tip of the tongue. The heart shape is not present however the tie is still very clear.

Grade 4

The lingual frenulum connects at the tip of the tongue and when the tongue is raised shows the classic heart shape. This is usually the only tongue tie that is caught by medical professionals that are not familiar with tongue-ties.

Treating Tongue-tie

Medical professionals often suggest that treatment for a tongue-tie is not necessary if the infant can receive food and is gaining weight. This is NOT our philosophy.

Treating tongue-tie is a team effort. Our team includes a lactation specialist; a bodywork specialist; a myofascial therapist; a myofunctional therapist; a psychologist; and our dentist with a specialty in orthodontics, diplomate status in dental sleep medicine, and advanced infant and adult training in tongue-tie treatment.

Research demonstrates that there is a link between the tongue and sleep disorders. Dr. Smith has spent hundreds of hours studying the tongue and has found that even if your child is feeding well; it is also important that your child is sleeping well. Contrary to popular belief, your child should be completely silent while sleeping. Dr. Smith has met with many mothers who have stated, “I can hear one of my children sleep, but I worry that my other child is not breathing.” We worry about the noisy child. If an infant or child is breathing through his or her mouth, this is not normal. The silent child is actually the healthier child. The mouth is for eating and the nose is for breathing.

We have also spoken with many mothers who have stated, “It’s painful for me, but my child is doing great. Should I feel bad going through with treatment for my child?” It is very important to note that if your child is younger than 12 weeks old; the mom’s body is still doing most of the work. After 12 weeks, your baby’s tongue will need to work for the milk to continue good supply. Improper latching from the tongue-tie will prevent the baby from efficiently nursing and positive effects gained from breast-feeding will be lost.

The procedure

A bodywork specialist will relax any tension your child may have within 24 hours of having the procedure. It is very important that your child is relaxed so the lingual frenulum can be easily accessed. The bodywork also assists Dr. Smith in confirming the extent of tongue-tie after tension is reduced in the facial muscles.

We will then have you practice the exercises on your child. We will video you performing the exercises for a step-by-step guide to help when we are no longer there to walk you through it. This ensures that you are confident completing the exercises and we can help with any concerns or struggles you may have.

For the procedure, parents are allowed to be present if they would like however we will ask that you wear protective eye wear, remain seated in the designated area, and keep a calm tone if you would like to sooth your child through the procedure. Before the procedure, our assistant will swaddle your child and a sleep mask will be placed on your child to protect their eyes. During the release the assistant will securely hold your child while Dr. Smith places an instrument under your child’s tongue to elevate it. Using a laser, he will release the short membrane connecting the underside of the tongue to the floor of the mouth. Until a child is two years old, there are no developed nerves in the lingual frenulum. Therefore, the procedure is painless and only takes seconds.

After the tongue is released, your child will be brought immediately to you to attempt latching for feeding or bottle feeding if you are not nursing. Keep in mind, every child is different so some may start breastfeeding immediately where others will still need some time to adjust to their new tongue movements.

When you take your child home, you will be responsible for aftercare for approximately 30 days. The aftercare is simple and only requires you to be consistent. We also offer a Facebook support group to help you through the process. The day after the procedure you will begin the exercises. When you have a helping hand we will again have you video yourself completing the exercises and post it to the group so we can give you feedback to complete the exercises effectively as possible.

There will be at least two follow-up appointments with Dr. Smith. The first follow-up appointment will be at one week, to evaluate healing and that the exercises are being completed effectively. We also recommend follow-up appointments with your bodywork and lactation consultant unless otherwise stated by them. The second and final follow-up appointment will be four weeks after the procedure to evaluate tongue mobility, the new frenulum and the palate.