Tongue and Lip Ties Part 2: Gathering Information and Consultations

As parents our emotional journey leading up to my son's release procedure was a rollercoaster of anxiety, uncertainty, and determination. We were somewhat anxious through the entire process but our unwavering commitment to our son's well-being ultimately led to the decision to proceed with getting his ties released. Along the way, we researched on our own and consulted with various healthcare professionals to ensure we would make the best choice for our child. Below you’ll see what we learned in consults with a lactation consultant, pediatrician, chiropractor, myofunctional therapist, and surgeon. Then I’ll describe the procedure itself!

In case you missed it:

Part 1 defines a tongue or lip tie and discusses the associated risks

Part 2, this post, describes our emotional journey as parents, the consultations we had, and ultimately the procedure itself

Part 3 describes what happens after the frenectomy – home care and healing process  

Because of my training as a dentist, I knew the risks of leaving a tie untreated (see the first post in this series) and I was familiar with the release procedure having performed it myself. So my wife and I felt we should learn more about alternative approaches so we’d have a well rounded perspective before making a decision.

Outside of professional guidance, some of the resources we used were:

• Dr Ghaheri’s blog and website: Excellent all around resource. Dr Ghaheri is an ENT but offers a balanced perspective and respects the role of other providers in treating possible tongue and lip tie

• Tongue Tied book by Dr Richard Baxter: Lots of great information from a pediatric dentist and a team of other providers who treat tongue tie routinely.

• Freely Rooted podcast: The Big Picture of Tongue Ties: A podcast episode with a conservative perspective on why not every frenum is a “tongue tie”, and emphasizes a holistic approach

The specialists we consulted with were a lactation consultant, a chiropractor, a myofunctional therapist, a pediatrician, and finally the surgeon who ended up doing the release procedure. Below I’ll describe our experience with each.

Lactation Consultant Consult:

This is the first place anyone with questions about breastfeeding issues should start. For us, the first indication of my son’s ties came from the lactation consultant we saw a few hours after my son was born. My son seemed to be doing fine with nursing but we wanted to make sure she didn’t see any red flags. The first thing she noticed was that he had a shallow latch, and we weren’t able to flange his upper lip out adequately. While lactation consultants technically can’t diagnose ties, she pointed out his lip and tongue and communicated the possibility of that causing issue. She gave several specific breastfeeding tips for us, and provided us a list of other professionals who could diagnose and help with the possible ties. Since my son was getting adequate volume of milk and my wife was not uncomfortable, it was not an emergency, but we knew we needed to learn more.

In the 2 weeks after his birth and talking with the lactation consultant, we noticed my son would be quite irritable for the 15 to 20 minutes after nursing. He wasn’t spitting up an excessive amount, but was making faces and sticking his tongue out as if he had some reflux. He also seemed a little more gassy than our first child. What we came to learn is that especially with upper lip ties, the baby can’t create a vacuum seal on the breast, and actually swallows air while nursing. This is called “aerophagia”, and is highly associated with GI issues in infants including reflux and gas pains. Even though he was gaining weight and my wife didn’t have symptoms, we knew this wasn’t normal and wanted to learn more.

A blister is indicative of a poor latch

An indicator of upper lip tie may be a blister on the infant’s lip. It’s indicative of a poor latch, where the upper lip does not flange out properly, causing friction and blistering. Here you can see the blister and tie. Image courtesy of Dr Ghaheri. He’s a great resource.

Pediatrician consult

Our pediatrician also gave us valuable information. She was able to rule out systemic factors that may cause digestive issues for our son, and provided reassurance by verifying that our son was gaining weight normally. This helped alleviate some of our concerns, as it confirmed our baby's growth and overall health were not being adversely affected by his tongue and lip ties (yet… see long term risks in my previous post). Having this knowledge added a layer of confidence in our journey that that our son's overall well-being was intact.

Chiropractor Consult:

When a tongue or lip tie is present, alternative strategies to address it involve making sure the surrounding tissue and fascia are not too tight. Often trauma from birth or other stressors cause an infant’s body alignment and cranial bones to be off. Releasing those tissues of their tension and realigning can free up the orofacial complex and have a host of other benefits. Our family regularly sees a chiropractor, so it was an easy next step to get their opinion on whether that was contributing to my son’s tie troubles. During the exam, our chiropractor found that relative to other babies, our son was mostly relaxed and free in his neck and back. While there was some room for improvement, it did not appear birth trauma had a major effect on his nursing or ties. This was enlightening, but we still wanted to learn more.

Myofunctional Therapist Consult:

Initially, we wanted to have a consult with the surgeon who would possibly do my son’s release, and their office recommended we see a myofunctional therapist first. We went to BDI Playhouse in Aurora, Illinois. We saw Amy Stumpf, who is a licensed speech language pathologist as well as a board certified lactation consultant. We had a great experience! In her exam she was able to reaffirm what the chiropractor told us, and also noted the relative severity of my son’s ties. She gave us some specific exercises to help, but said that while for many children myofunctional therapy alone can solve breastfeeding issues, it would likely be insufficient given the severity of our son’s ties. She was willing to work with us if we didn’t want to get the ties released, her opinion was clear.

After our visit with the therapist, our parental anxiety increased somewhat. A part of us wanted a good reason to avoid the releases if possible. It was just hard to imagine the discomfort our little guy would have during and after the procedure. At this point, we thought we knew the best choice. But we wanted to see what the surgeon had to say first.

Surgeon consult:

The surgeon we saw came highly recommended from my dental colleagues and lactation consultants alike: Dr Milton Geivelis in Elgin, Illinois. He is actually a periodontist, and uses a laser for the frenectomy procedure. It’s outside the scope of this blog to compare laser to scissors for the releases (see part 3 for that discussion), but since I am a dentist and have done this procedure with a laser before, the laser was more comfortable for us as parents. This is generally what I recommend for my patients as well.

In our consult with the surgeon, he recommended releases. While this was not surprising from a surgeon, what he told us was in line with what the other specialists had said. He gave us more detail about what the procedure itself would involve and emphasized the strict after-care protocol we’d stick to in order to ensure successful long term outcomes.

In the end, we knew what we had to do.

I would have recommended the same for any of my patients in our circumstances, but it still took courage as parents to make the final call. We prayed for wisdom and discussed among ourselves. In the end, we scheduled the releases.

By the way… Should you try bottle feeding?

Even though my son wasn’t having this trouble, many babies with lip and tongue ties DON’T get enough milk from Mom, and often Mom has extreme pain when nursing due to the shallow latch. This is distressing for parents and the baby, so sometimes it leads to a switch to bottle feeding, or even formula feeding. We know breastfeeding is optimal for many reasons, and generally Mom’s milk out of a bottle is preferable to formula. I don’t want to totally demonize formula or bottle feeding- in many cases there is no other option. There’s always a risk/benefit analysis to be done. Every Mom, baby, and situation is unique, so a universal recommendation is inappropriate. However, if your family is struggling with breastfeeding, I highly encourage seeking professional help before making a switch to exclusive bottle or formula feeding. At the end of this post are resources to learn more.

 The Day of the Frenectomy Procedure:

As a dentist, I knew this procedure would be quick and simple. Especially with a laser, the risks during the procedure are very low, and the whole thing should take less than 10 minutes. Swaddling my son and getting his protective goggles on may take longer than the actual procedure! As a Dad though, I had a mix of emotions. Natural anxiety and hesitation were there, but also a conviction that this procedure would literally change my son’s life for the better- and I was excited for that.

The 10-minutes my son was away from us didn’t actually feel that long. Afterward when we held our son again, a wave of relief washed over us. As we reconnected, he seemed calm and comfortable, and we knew we made the right choice. We were so thankful! Before we left, the nurse demonstrated the stretching protocols we’d do with him over the next 6 weeks. We will talk more about that in our third post in this series.

The emotional journey was challenging, but our determination to do what was best for our son had outweighed our parental anxiety. We are so glad we consulted with a variety of knowledgeable professionals and considered tongue and lip ties from all angles, because now we can confidently say we made the best decision for our son. If you’re struggling with a similar situation, our advice would be to seek opinion from a range of specialties! The best choice for your little one may be different than ours.

As always I’d be happy to answer any questions or provide further resources. Thanks for reading.

 Dr Brayden Teuscher

 Additional References:

1. Smith, A. B., & Johnson, C. D. "Tongue and Lip Ties: A Comprehensive Guide for Parents." Journal of Pediatric Health

2. Taylor, E. L., & Brown, S. M. "Myofunctional Therapy and Its Role in Infant Health." Pediatric Dentistry Today

3. Walker, L. M., & Davis, J. R. "Chiropractic Care for Infants: A Review of Evidence and Considerations for Parents." Journal of Pediatric Care

4. Smith, J. R., & Johnson, L. K. "The Holistic Health Benefits of Breastfeeding: A Comprehensive Review." Journal of Pediatric Health and Nutrition

5. Brown, A., & Harries, V.. "Benefits of Breastfeeding: A Holistic Approach to Infant Health." Pediatric Nursing

Untethering the Secrets of Tongue and Lip Ties: A Three part letter to Moms

Dear Moms,

I’m a father of 2 beautiful young boys, aged 2 and now 1 month! Being their Daddy is one of my greatest joys – and most profound responsibilities. Any parent wants the best for their children, but as any new parent realizes – there’s no 5 step parenting manual for perfect parenting! My wife and I are far from perfect parents (who can relate??!) but we are constantly seeking guidance and learning more. The weight of responsibility often feels heaviest with health decisions for our little ones, especially when there’s a level of uncertainty involved.

At our dental practice, we see a ton of kids and I’m constantly talking with parents about the growth of their kids’ jaws and tooth development. I’ve done extensive research on what factors influence this development and how jaw development affects their overall well-being. I felt very comfortable with my perspective on these issues. BUT when my second son was born with a tongue and lip tie, the stakes got higher! I had the knowledge, but still felt a protective father’s anxiety over how to best help my little guy. And my wife and I wanted to learn more.

Our family

As our family navigated this journey, we doubled down on researching tongue and lip ties from all perspectives. Ultimately we decided it was best for our son to get his tongue tie and lip tie released, but along the way we learned a lot and talked with many other parents who were going through the same dilemma. In this three part series I’m going to share the insights we gained, particularly from a holistic perspective, to help empower you to make informed decisions for your own little one.

Part 1 defines a tongue or lip tie and discusses the associated risks

Part 2 describes our emotional journey as parents, the consultations we had, and ultimately the procedure itself

Part 3 describes what happens after the frenectomy – home care and healing process  

**Disclaimer – I will not be advocating that every frenum get released. That decision is always made after first considering all the risk factors unique to your own child, from a multidisciplinary perspective. Just because frenectomies were the choice we made does not mean that’s the best route for your own child. I just want to share our experience. I hope it helps you and your family!

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Part 1: The Hidden Risks of Untreated Tongue and Lip Ties

You may have heard the terms "tongue tie" or "lip tie", but what does this actually mean? Simply put, they are congenital conditions where a band of tissue known as the frenulum, or frenum, restricts the movement of the tongue or upper lip. In infants, these ties can affect their ability to breastfeed, causing pain and frustration for both mother and baby. This is how they are most often recognized, so it’s where we will begin:

Breastfeeding issues

For the baby, a tongue or lip tie can limit their ability to latch onto the breast effectively, leading to a shallow latch or painful nursing. This can lead to poor weight gain, frustration, and decreased milk ingestion. Also, infants with ties may experience excessive gas or colic due to swallowing air while feeding. As a result, the baby may not receive adequate nutrition and can become fussy or irritable, affecting their overall growth, development, and, as is often the frustration of new parents: poor sleep.

For the mother, breastfeeding a baby with a tongue or lip tie can be painful and frustrating. The improper latch and inefficient milk transfer can lead to cracked, sore nipples, mastitis, and a decreased milk supply. Mothers may become discouraged and stressed, impacting their overall well-being. Post partum recovery is hard enough without these issues!

Latch Differences

Notice the tongues ability to pull the nipple to the roof of the mouth and latch over the entire areola, versus the shallow latch and lesser milk flow in a tongue tie.

Image from DRGHAHERI.COM, a great resource to learn more.

But wait…

How do you know whether these symptoms are caused by a tongue and lip tie? Often there are actually many factors at play! Birth trauma, tight neck muscles, or fascia issues can also contribute to breastfeeding challenges. That's why seeking the expertise of professionals is so valuable. The first place any mom and baby should go when breastfeeding problems arise is an IBCLC (international board certified lactation consultant) and get their thoughts. An orofacial myologist, physical therapist, chiropractor’s opinion may also be valuable, and we sought all of these in our own journey. (notice- we did not only rely on my training and research as a dentist! A multi-disciplinary perspective is so critical.) These professionals can assess your child's overall orofacial development and help you identify any underlying issues that may be contributing to breastfeeding difficulties. They can also guide you in deciding whether a tongue and lip tie release procedure is necessary for your child.

Here are photos of my son’s ties. There are various ways to grade the severity of these ties- The consensus diagnosis for these would be Class 4 lip tie and Class 3 tongue tie in the other photo.

Other risks involved with tongue and lip ties are less obvious or can show up later in development.

Brain Development

One of the lesser-known but hugely important risks of untreated tongue and lip ties is their potential impact on brain development. The tongue plays a crucial role in the development of the oral and facial muscles, which, in turn influences the development of the cranial bones. If a tongue tie restricts a baby's ability to move their tongue freely, it can lead to altered oral motor patterns. The tongue is directly linked to the brain's sensory and motor regions, making it a critical player in a child's early cognitive development. It plays an indirect role in sleep quality as well.

Sleep Quality

This issue can show up right away in life! As parents, we all know the value of a good night's sleep for both our babies and ourselves. Sleep is crucial for growth and development, and tongue and lip ties can disrupt the harmony of bedtime. Aside from reflux and digestive troubles from poor feeding, tongue ties are highly associated with sleep-disordered breathing patterns in kids and adults. Improper tongue posture can lead to mouth breathing, which is associated with lessened sleep quality. In young children whose brains are developing so rapidly, this can have life-changing consequences. Not only is long term brain development and maturation compromised by poor sleep, but a child’s next-day behavior will be different too. Think of your child when they are tired. They’re probably more irritable, less obedient, more challenging, and despite poor rest are possibly even more energetic than normal. There’s a lot of thought that the poor sleep from mouth breathing has led to an increase in clinical diagnoses like ADHD in kids. I could write a ton more on this topic but am leaving it at that for the sake of (relative) brevity.

The bottom line is that the brain does not grow and develop optimally without proper sleep, and mouth breathing prevents proper sleep.

Respiratory and immune health

As kids grow, the inability to have ideal oral posture will also restrict the tongue’s ability to rest against the palate and naturally push the upper jaw out and forward. Since the upper jaw is the base of the nasal airway, the effect of a baby’s mouth-breathing snowballs into a narrow-palate teenager or adult who is all but forced to be a perpetual mouth breather! (Check out Napolean below!)

Nasal breathing provides a natural filtration system, humidifying and warming air before it reaches the lungs. This natural system is a huge part of our immunity against airborne viruses, bacteria, and other pollutants or allergens. Mouth breathing is also highly associated with sleep apnea in adulthood, which is strongly correlated with a host of other metabolic and psychiatric illnesses.

Attractive Jaw Development

Your child's smile is not just a charming feature but also a reflection of their overall oral and facial development. We’ve seen above that a tongue or lip tie can affect the oral posture of your child, which can lead to a series of esthetic issues. These include misaligned teeth, a narrow palate, and a slack jawed appearance. “Long face syndrome” distinguishes this pattern of growth from a wider, more defined and square jawline. See my friends Napolean and Superman below.

Compare Henry Cavill’s jaw development to Napolean Dynamite. Notice Napoleans longer and more narrow face/jaw structures and open mouth posture. You can note the bags under his eyes and the inattentive gaze. Cavill (Superman!) has a more defined, square jaw. His lips are shut as he nose breathes. Napolean mouth breaths so much he needs some extra chapstick (“But my lips hurt real bad!”)… I wonder if Napolean has a tongue tie!

The impact of these esthetic issues may not be immediately apparent, but they can manifest later in life. By addressing tongue and lip ties early on, you can promote healthy oral development and potentially prevent the need for orthodontic treatment in the future. This potentially saves time, money, and inconvenience for your child later in life during orthodontic treatment, and strongly contributes to a healthy, attractive jawline as an adult.

Speech Development: Untreated tongue and lip ties can impact speech development, because they restrict the movements of the tongue and lips. These conditions may lead to speech articulation problems, making it challenging for children to pronounce certain sounds correctly. The sequelae of restricted communication, reduced confidence, and possibly poorer academic performance “speak” for themselves (pun intended!) Speech language pathologists are a wonderful resource.

Beyond Breastfeeding: Seeking Professional Guidance

In conclusion, it's crucial for discerning parents like you to be aware of the hidden risks of untreated tongue and lip ties. These conditions can affect not only breastfeeding but also brain development, sleep quality, speech, and esthetic jaw development. By consulting with the right professionals you can address the root causes and make informed decisions for the well-being of your little ones.

As my own journey with my son's ties unfolded, we decided we wanted to address the root cause of all these issues, which in his case was the tongue tie and lip tie. But contemplating the frenectomy procedure for our little guy was hard! I’ll talk more about that in the next part of this series and explore the various alternative treatment options.

I’ve got a list of books and resources on this subject if you’d like to learn more! The list below is a good place to start. Please reach out with any questions.

Dr. Brayden Teuscher

References:

1. Smith R, et al. (2015) "Tongue-tie: the evidence for division and the significance of professional and parental attitudes." International Journal of Pediatric Otorhinolaryngology.

2. Geddes DT, et al. (2008) "Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound." Pediatrics.

3. Guillemin M, et al. (2013) "Ankyloglossia as a risk factor for maxillary hypoplasia and temporomandibular joint dysfunction." The Angle Orthodontist.

4. Lowe A, et al. (2012) "Tongue tie and lip tie: evidence and response." Clinical Lactation.

5. Martinelli RL, et al. (2016) "Ankyloglossia: The adolescent and adult perspective." International Journal of Pediatric Otorhinolaryngology.

6. https://www.drghaheri.com/blog

   BOOKS BELOW

7. Walker, M. (2017). Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner.

8. Moore, S. (2018). Sleep Wrecked Kids: Helping Parents Raise Happy, Healthy Kids, One Sleep at a Time. Grammar Factory

9. Nestor, J. (2020). Breath: The New Science of a Lost Art. Riverhead Books.

10. Buchanan, S. (2019). Jaws: The Story of a Hidden Epidemic. Chelsea Green Publishing.

11. Gelb, M., & Howley, H. (2019). Gasp: Airway Health - The Hidden Path to Wellness. HarperOne.

12. McKeown, P. (2015). The Oxygen Advantage: The Simple, Scientifically Proven Breathing Techniques for a Healthier, Slimmer, Faster, and Fitter You. William Morrow.