Infant & Toddler Laser Frenectomy
What is a frenum?
During the 4th week of development in utero, the tongue begins to form. It starts out completely attached to the floor of the mouth. As it develops, it separates from the base of the mouth. It becomes free & mobile, except for one location. The lingual frenum is the name given to the connective tissue remnant, or fibrous band, under the tongue that serves to support and limit the tongue’s movements in different directions.
What is a tongue tie?
A tongue tie is a physical condition that restricts the mobility of the tongue. Between 6 – 11 weeks in utero, the lingual frenum shortens. In approximately 20% of the population, the frenum fails to shorten and instead remains attached and restricted, which is termed ankyloglossia or a tongue-tie.
A tongue tie diagnosis and treatment recommendation should be made based upon a true functional restriction. Rather than a tongue tie, we commonly refer to it as a “functional tongue restriction”, as simply seeing a frenum under the tongue does not necessarily mean it is restricting the tongue's range of motion. A comprehensive assessment from an appropriate team of specialists is needed to provide critical insights on a baby’s feeding and oral motor skills. It takes an experienced release provider to thoroughly investigate the anatomical presentation and associated symptoms.
How can a tongue tie affect breast or bottle feeding?
The tongue needs full range of motion to create adequate suction to express milk from the breast. Breastfeeding infants use primarily vacuum, or negative pressure, to remove milk from the breast. The front-mid portion of the tongue draws in, cups and compresses breast tissue while strength and flexibility in the mid-back portion of the tongue is needed to create the negative pressure to remove the milk from the breast.
A baby with a tongue tie may be unable to latch deeply onto the breast, leading to possible nipple pain and damage. When the tongue cannot extend up and over the lower jaw, a baby’s latch may feel uncomfortable. Some babies would struggle to latch, while others may remain attached to the breast for long periods of time without taking in enough milk.
When the suction is compromised and a baby repetitively loses the seal at the breast or bottle, milk can spill out the sides of the mouth and air may be swallowed. This can lead to excess gas and fussiness.
What is a lip tie & how can it affect feeding?
A lip-tie is a condition where the upper lip is restricted and cannot move normally. A tight labial frenum can cause difficulty with nursing by disrupting the seal around the breast or bottle nipple. This can lead to increased air uptake, contributing to reflux and gas symptoms, as well as breast pain from the tight upper lip. The upper lip should play a passive role when a baby is feeding, gently rounding to maintain the seal at the breast or bottle nipple so milk doesn’t spill out. In toddlerhood, a lip-tie may impact a child’s ability to clear food from a spoon, pose challenges when brushing the teeth & can also lead to a gap in the teeth.
What are the signs & symptoms of a tongue (& lip) tie?
The tongue and lip are made up of a very complex group of muscles and are important for all oral functions. For this reason, having a tongue- or lip-tie can lead to nursing, feeding, dental, speech, sleep, or breathing problems. The following symptoms are commonly seen in babies & their mothers. These signs can be linked to other factors & feeding challenges.
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Babies & toddlers may exhibit:
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Clicking or smacking noises during feeds, indicating a repeated loss of suction
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Inefficient, long feeds resulting in exhaustion and frustration
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Air intake due to a disrupted seal leading to reflux/colic symptoms and gas pain
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Snoring, mouth breathing and/or wakeful sleep patterns due to low resting tongue posture
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Milk dribbles out of mouth from a poor latch
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Poor weight gain
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Unable to hold pacifier
Mothers may experience:
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Painful nursing
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Nipple pain or damage
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Creased or flattened nipples after breastfeeding
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Blistered or cut nipples
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Incomplete breast drainage
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Decreased milk production
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Plugged ducts or mastitis
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Using a nipple shield
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Prolonged feeds
Tongue & Lip Tie Treatment
A tongue or lip tie release, also called a frenectomy, is a minor surgical procedure that removes the tight frenum, allowing for improved range of motion and flexibility. A frenectomy procedure is a minimally invasive dental procedure that an experienced tongue tie specialist, like Dr. Allie, can perform in our office.
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A topical numbing agent is applied to the area near the frenum before the laser gently removes the tight tissue with typically no stitches, minimal bleeding and no sedation or general anesthesia. Older children who understand the procedure receive numbing medicine and laughing gas and often report no pain at all. Most of the time the release procedure only takes about 20 seconds or less.​​
LIP TIE TREATMENT RESULTS
PRIOR TO THE PROCEDURE
Prior to having a tongue or lip tie evaluation, Dr. Allie requires patients to be evaluated by an International Board-Certified Lactation Consultant (IBCLC) or feeding specialist (a trained SLP or OT). Lactation consultants are healthcare professionals who specialize in lactation and breastfeeding. They are experts in guiding mothers throughout their feeding journeys and address concerns regarding milk supply, latch comfort, breast- and bottle-feeding techniques, infant feeding patterns, positioning and so much more. Speech language pathologists or occupational therapists have additional training in pediatric feeding and swallowing. They are able to assess and address concerns regarding oral tone, strength and oral motor coordination in infancy and childhood. Working with a functional specialist provides important insight to help differentially diagnose the root cause of the symptoms.
DURING THE PROCEDURE
In general, the procedure is very well-tolerated by infants & children. We take every measure possible to ensure that pain & stress during the procedure is minimized. Dr. Allie utilizes a CO2 laser for a quick, precise, and gentle frenectomy procedure. The CO2 laser promotes rapid healing & minimizes the risk of bleeding, discomfort, or infection. Due to laser safety regulations, parents are not permitted in the treatment room during the procedure. Dr. Allie will bring your child to and from you, & the approximate time away from you is about 10 minutes. The actual time of the laser procedure is 30 seconds. Infants and children will be swaddled & safety goggles/glasses will be placed on the eyes for safety. A topical numbing agent is applied to the area near the frenum. Some bleeding may occur and will usually subside within a few minutes. Crying & fussing are common during & after the procedure.
AFTER THE PROCEDURE
Many children are able to quickly adapt and thrive following the procedure. Others may take some time to adjust to the new movement. One of the most important things to understand when your child has a tongue and/or lip-tie release is that improvement is a team approach. The release of the frenum is just one piece of the puzzle. Support from other professionals like lactation consultants, speech therapists, occupational therapists, craniosacral therapists, myofunctional therapists and other therapeutic modalities is highly recommended. The tongue is a muscle, and it becomes used to functioning in a certain way just like any other muscle in the body. When the tongue function is restricted by a tongue-tie the body adapts. It takes time for the brain to figure out how to use the tongue effectively once the tie is released. For infants, often mothers notice a difference immediately. It is also normal to not notice much difference right after. Sometimes there may even be a little regression in sucking for a day or two as your child’s brain tries to sort out how to use their tongue now that the restriction is gone. Some babies need chiropractic care, physical therapy, or occupational therapy to address other issues that can affect nursing.