Lip and tongue ties have become quite a buzz topic and determining whether or not your child has one can be as simple as a quick check by your pediatric dentist. A tongue-tie is a condition in which an unusually short, thick or tight band of tissue tethers the bottom of the tongue to the floor of the mouth. A lip tie references the length and thickness of the band of tissue extended between the upper lip and gums above the upper front teeth. Both a lip tie and tongue-tie (ankyloglossia) are congenital conditions in which the lingual (tongue) or labial (lip) frenum is too tight. This causes restrictions in proper movement. This can significantly impact the oral functions related to speaking, feeding, swallowing and proper oral hygiene.
At KidZdent, we recommend a thorough evaluation in the early stages of infancy to determine proper development of all oral tissues ensuring there are no restrictions of the tongue or lip’s range of motion. The goal of the examination is to determine the length of the lip and tongue frenum and its point of attachment to surrounding tissues as well as any signs or symptoms that the child may be experiencing. A tight frenum will often turn white or blanch and restrict the movement of the tongue or lip. There may also be a large space between the upper front teeth called a diastema and the tongue may be heart shaped at the tip or have a cupped appearance. When a lip or tongue tie is having a negative impact on a child’s oral function or development, a simple procedure called a frenectomy will be recommended to minimize the attachment and restore proper movement and function.
Lip and tongue ties are not always recognized right away, but they do play an imperative role in the relationship between the infant and mother while breastfeeding. Infants with a lip or tongue tie can exhibit symptoms such as reflux, colic, gassiness, and even failure to thrive, especially if breast milk is the baby’s only source of nourishment.
Ultrasound studies have shown that the tongue movements used by tongue-tied babies are qualitatively different from those by babies who are not tongue-tied. These movements are not as effective at removing milk from the breast and can cause pain for the nursing mother. In these studies, tongue-tied babies also did not draw the nipple as deeply into the mouth as babies who were not tongue-tied resulting in inadequate milk intake.
Some babies with tongue and/or lip-tie may manage to nurse well enough to gain weight adequately in the early weeks, but they may not be able to maintain a full milk supply as they grow. Their restrictions will likely continue to affect the ease of breastfeeding. Feeds may be long and as frequent as 10-12 times a day or more. These babies do not nurse for comfort and may have difficulty managing solid foods when they are older.
- Difficulty latching on or falls off the breast easily
- Gumming or chewing the nipple while nursing
- Unable to hold a pacifier or bottle
- Gassy (babies with ties often swallow a lot of air because they cannot maintain suction properly)
- Poor weight gain
- Excessive drooling
- Baby is not able to fully drain breast
- Choking on milk or popping off to gasp for air while nursing
- Falling asleep during feedings, then waking a short while later to nurse again
- Sleep deprivation (due to the need for frequent feedings)
- Extended nursing episodes – aka marathon nursing sessions
- Clicking noises while sucking
- Popping on and off breast often
- Biting – Babies who have trouble grasping the nipple sometimes try to use their teeth to hold on. (Once they come in, of course)
- Diastema(space between upper front teeth)
- Tongue/Lip Ties and OSA
Tongue and lip-ties affect more than breastfeeding. Even if a baby can breastfeed well, without digestive issues or causing discomfort to the mother, restrictive frenums can affect jaw bone and dental development, breathing, chewing, swallowing ,digestion and initiate reflux which can cause significant pain for babies and may result in the need for medication.
There is also a correlation between tongue ties and obstructive sleep apnea, which is detrimental to a child’s growth and overall well being. Children with frenum restrictions show a much greater incidence of nighttime restlessness, wakeful sleep patterns, snoring, sleep apnea, behavioral problems, ADHD, mouth breathing, tonsil, and adenoid issues.
Medical and dental professionals as well as parents have come to realize that lip and tongue ties present a structural defect, which is responsible for a range of developmental difficulties for infants, children and adults resulting in long term reduction in the quality of life of the patient. There is no place for a wait and see approach when diagnosing and treating patients with a frenum restriction, especially when the correction is a quick, simple surgical procedure that is virtually devoid of complications.
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