ASK THE EXPERT:
Dr Cavan Brunsden, DMD
Brunsden – Villa Pediatric Care Center – Rutgers School of Dental Medicine
National Lecturer – Autism, Special Needs Dentistry, Dental Practice Management, Airway Dentistry for Infants and Children
Pediatric Dentist and Founder – KidZdent.com
Q: Do parents come to you often for help with nursing/breastfeeding problems?
Dr. Brunsden: Yes, oftentimes a mother may have difficulty nursing their newborn-especially in the beginning. And they cannot seem to figure out why they are having trouble. To seek a solution, hospitals, pediatricians, and lactation consultants often refer parents to Kidzdent for evaluation.
Q: What are some of the problems that mothers can sometimes have when starting to breastfeed?
Dr. Brunsden: The mothers that we see typically describe the following difficulties while nursing their new born.
Some of the infant’s difficulties are:
- Inability or incomplete latch
- Loud sucking and gurgling while nursing
- Inability to stay latched with clicking sounds when releasing
- Sputtering and choking while attempting to nurse
- Frequent nursing to get enough milk
- Compromised milk supply
- Poor weight gain
- Exhausted due to difficult nursing
And the mother may experience:
- Painful feedings with damaged nipples
- Engorgement, blocked ducts, and mastitis
- Low milk production due to ineffective milk removal
- Tiredness, frustration, and discouragement
- A premature end to breast feeding
Q: Is Tongue Tie associated with inability to nurse or poor nursing?
Dr. Brunsden: In many cases, a restricted tongue can prevent proper latching and create a poor and unsuccessful nursing experience for the mother and child. If the tongue cannot properly extend and press upon the breast and nipple, then it cannot create the suction pressure to extrude the milk. Release of the tongue tie can, in most cases, provide immediate relief. Since the infant is born with a restricted tongue, the newly released tongue will require daily stretching and massage in order to establish the proper muscular tongue action for nursing.
Q: Besides problems with nursing, what other challenges does a tongue-tie create?
Dr. Brunsden: Before birth, the tongue is supposed to press upon the roof of the mouth. This is to prepare the new born for proper nursing post birth. Nursing requires that the tongue press the nipple against the palate allowing the milk to flow freely without much effort.
In addition, and this is extremely important, the muscular tongue is the main force upon the palate, or roof of the mouth. This force expands the upper dental arch, increases the width of the face, and guides the proper development of the child’s developing airway, face and teeth. Without forceful tongue pressure upon the roof of the mouth, the child will develop a narrow face, a narrow mouth, have a restricted airway and probably have over-crowded teeth.
Q: How do you evaluate an infant for tongue tie associated with nursing difficulties?
Dr. Brunsden: A comprehensive parental interview usually reveals the issues that are associated with nursing difficulties. The doctor then completes an intra-oral evaluation that identifies the extent of tongue mobility in a vertical and horizontal direction. If the tongue is diagnosed as having a tongue tie, treatment is recommended.
Q: What is the treatment for a tongue tie?
Dr. Brunsden: If it is determined that the infant’s tongue is restricted, a tongue-tie release is indicated– known as a frenectomy. A release involves the reductionof the thin tissue that holds the tongue to the floor of the mouth.
Q: Is this procedure painful or difficult for the newborn, and what are the risks associated with this procedure?
Dr. Brunsden: The tissue beneath the tongue is very thin and has very little blood supply. Usually, a topical anesthetic is applied even though there are very few nerves present in this tissue. Bleeding is usually minimal and recovery is very quick. In most cases, the infant can immediately nurse after the procedure, usually with immediate success, and this calms the child right away. As with any surgical procedure, there may be risks associated with bleeding or infection, but these are extremely rare and can be managed by your doctor.
Q: How is the tongue-tie released?
Dr. Brunsden: Releasing the frenum involves reducing the attachment of the thin tissue that connects the tip of the tongue to the floor of the mouth. This can be accomplished by use of surgical scissors or with a laser. Stiches are usually not indicated. The entire procedure is completed in under five minutes.
Q: What do I do to prepare for this procedure and what do I do after the procedure?
Dr. Brunsden: We recommend that the mother stretch the tongue prior to the procedure and also provide post-operative stretching and massaging. The muscular tongue must be trained to develop a complete range of motion which can be achieved with this therapy before and after surgery. Instructions on how to exercise the tongue and provide proper stretching will be provided including the viewing of instructional you- tube videos.
Q: Is this procedure usually covered by medical or dental insurance?
Dr. Brunsden: Most medical and dental insurance plans do provide some level of coverage for this procedure. Every insurance plan differs, so we will always contact your insurance provider to identify your coverage and to assist you in processing your claim. In addition, we provide comfortable payment options to assist you in managing the cost of this procedure.
A special note from Dr. Brunsden:
All of my team members are dedicated to always doing what is best for the child, so that they receive the best chance possible to become the best that they can be.
Providing an infant with a great start to life, by helping them to nurse properly, is truly a privilege. Our team is dedicated to this effort, and as such we take our responsibilities very seriously. We are dedicated to growing the complete child from birth onward, and this includes providing the growing face with a healthy environment for normal growth and development.
I realize how important it is for any parent to be truly comfortable with their health care providers and I can assure you that we are here for you. We are prepared to assist you in understanding and developing trust in our practice and in our recommendations.
Please do not hesitate to contact me or one of my team members, at email@example.com, to assist you in any way possible.
Dr Cavan Brunsden