What are tethered oral tissues?
- Every child has multiple oral connective tissue attachments called frenums or frenulums, but in some children a short/tight/thick attachment can limit function and mobility of the lip and/or tongue.
- When function is impaired, the frenae are known as symptomatic oral restrictions or tethered oral tissues.
- Oral restrictions are remnants of embryonic tissue that should have receded at the 12th week in utero.
- Tongue-tie (ankyloglossia)= attachment at midline beneath tongue and floor of mouth is tight enough to restrict normal tongue movement
- Lip-tie= attachment of lip inserting into gingiva is tight enough that upper lip cannot flange outward normally
What are the benefits of a frenectomy?
- A frenectomy, or release of a lip-tie or tongue-tie, can significantly impact a child’s quality of life by improving breastfeeding, bottle-feeding, solid feeding, sleep, and speech. Release of tethered oral tissues can also optimize dental and orthodontic outcomes.
- The laser frenectomy procedure is a gentle, quick, and straightforward outpatient procedure that can be completed during the same visit as the initial assessment when desired.
- There is minimal risk for a laser frenectomy procedure and significant potential benefits.
- We want our children to thrive, not just survive.
How is it determined if a child may benefit from a frenectomy?
Symptoms/function is more important than appearance when determining if treatment is needed.
Infant Symptoms:
- Shallow latch at breast or bottle
- Falls asleep while eating
- Slides or pops on and off the nipple
- Gagging, choking, or coughing when eating
- Poor or slow weight gain
- Gumming or chewing the nipple when nursing
- Pacifier falls out easily or won’t stay in
- Snoring, noisy breathing, mouth breathing
- Lip curls under when nursing or taking the bottle
- Clicking or smacking noises when eating
- Sucking blisters or callouses on lips
- Reflux symptoms
- Gassiness
- Milk leaks out of the mouth when nursing
- Restless sleep, short sleeping and waking often
- Baby frustrated at the breast or bottle
- Baby seems always hungry and not full
Maternal Symptoms:
- Creased, flattened or blanched nipples
- Lipstick shaped nipples
- Blistered, cut, or bleeding nipples
- Painful latch
- Poor or incomplete breast drainage
- Plugged ducts/engorgement/mastitis
- Using a nipple shield
Child Symptoms:
- Speech (ex: frustration with communication, difficult to understand, difficulty speaking quickly, speech delay, stuttering, speech harder to understand in long sentences, mumbling, difficulty with certain sounds)
- Feeding (ex: frustration when eating, difficulty transitioning to solid foods, slow eater, packing food in cheeks, picky with textures, choking or gagging on food, spitting out food, won’t try new foods)
- Sleep (ex: sleeps in strange positions, sleeps restlessly, wakes easily of often, wets the bed, wakes up tired and not refreshed, grinds teeth while sleeping, sleeps with mouth open, snores, gasps for air (sleep apnea)
What healthcare professionals are involved in diagnosis and treatment?
- A frenectomy alone may not result in adequate resolution of symptoms. Pre-op and post-op therapy with appropriate therapists is necessary for optimal results.
- At Smile Arc Pediatric Dentistry our pediatric dentists work with a team of allied health care professionals including lactation consultants, feeding therapists, speech therapists, bodyworkers, and multifunctional therapists in order to ensure the best possible results for each child. We will let you know which of these services may be indicated for your child.
Laser Frenectomy Treatment
What is a frenectomy?
The release or revision of a tongue-tie or lip-tie is called a frenectomy. At Smile Arc Pediatric Dentistry our pediatric dentists perform frenectomies using a state of the art carbon dioxide laser.
Benefits of CO2 Laser (vs. Scissors)
- Little to no bleeding
- Quicker and less painful healing
- More precision, allowing for a full release
- No sedation or general anesthesia needed (note: anxious children may benefit from laughing gas)
- No sutures needed (note: we will place sutures under the tongue for cooperative older children and teens)
What to expect the day of treatment
- Consultation with the pediatric dentist, ample time to have questions answered
- Pre and post-op intraoral photographs
- Infants are swaddled during treatment
- Application of numbing jelly
- Patient eye protection
- Quick treatment time (Laser treatment time typically ranges from 10-15 seconds for a lip-tie and 5-10 seconds for a tongue-tie. Due to laser safety protocols, parents and guardians are asked to wait in the consult room during the procedure)
- Breastfeeding and bottle feeding infants are encouraged to feed immediately following treatment
- Hands-on demonstration of post-op exercises and stretches (will be done at home for 2-3 weeks)
After the visit
- Tylenol or Advil dosages will be advised based on your child’s weight to manage discomfort
- Return to lactation, feeding, speech, bodyworker and/or myofunctional therapist for follow up
- Note: The specific therapist your infant or child will see pre and post frenectomy varies based on his or her age and individual needs and symptoms.
- 1 week follow up at Smile Arc Pediatric Dentistry to evaluate healing and effectiveness of stretches and exercises.
