If your child is having trouble feeding, sleeping, or speaking clearly, a lip tie or tongue tie may be contributing to the issue. At San Marcos Pediatric Dentistry, we evaluate tethered oral tissues (also called oral restrictions) to determine whether a child’s lip or tongue mobility is limited enough to affect daily function.
What Are Tethered Oral Tissues?
Every child has connective tissue attachments in the mouth called frenums (or frenulums). In some cases, these attachments may be short, tight, or thick, which can limit the movement and function of the lip and/or tongue.
When these restrictions impact function, they are considered symptomatic oral restrictions, also known as tethered oral tissues. These restrictions are remnants of embryonic tissue that should have receded by the 12th week in utero.
What Is a Tongue Tie?
A tongue tie (ankyloglossia) occurs when the tissue connecting the tongue to the floor of the mouth is tight enough to restrict normal tongue movement. When the tongue cannot move properly, it can affect feeding, oral function, and development.
What Is a Lip Tie?
A lip tie refers to a tight attachment of the lip that prevents the upper lip from flanging outward normally. This limitation may contribute to feeding challenges and other functional concerns.
What Are the Benefits of a Frenectomy?
A frenectomy (also called a release of a lip tie or tongue tie) may significantly improve a child’s quality of life. Benefits may include improvements in:
- Breastfeeding
- Bottle-feeding
- Solid feeding
- Sleep
- Speech
Releasing tethered oral tissues can also help support dental and orthodontic outcomes.
At San Marcos Pediatric Dentistry, we offer laser frenectomy treatment, which is described as a gentle, quick outpatient procedure. If desired, it can be completed during the same visit as the initial assessment. This treatment carries minimal risk and may provide meaningful benefits. Our goal is for children to thrive, not merely survive.
How Do We Determine If a Child May Benefit From a Frenectomy?
When deciding whether treatment is appropriate, symptoms and function are more important than appearance. We evaluate how the restriction affects daily life rather than focusing solely on the appearance of the frenum.
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 May Be Involved in Diagnosis and Treatment?
A frenectomy alone may not fully resolve symptoms. For best outcomes, pre-op and post-op therapy with appropriate providers is essential.
San Marcos Pediatric Dentistry collaborates with allied healthcare professionals such as:
- Lactation consultants
- Feeding therapists
- Speech therapists
- Bodyworkers
- Myofunctional therapists
We will recommend which services may be helpful based on your child’s specific needs.
What Is a Frenectomy?
A frenectomy is the release or revision of a tongue tie or lip tie. At San Marcos Pediatric Dentistry, our pediatric dentists perform frenectomies using a state-of-the-art carbon dioxide (CO2) laser.
What Are the Benefits of a CO2 Laser Frenectomy vs. Scissors?
Benefits of CO2 laser treatment include:
- Little to no bleeding
- Quicker and less painful healing
- More precision for a full release
- No sedation or general anesthesia needed
Note: anxious children may benefit from laughing gas
No sutures needed
Note: sutures may be placed under the tongue for cooperative older children and teens
What Should Parents Expect on the Day of Treatment?
On the day of treatment, you can expect:
- Consultation with the pediatric dentist and time for questions
- Pre- and post-op intraoral photographs
- Infants are swaddled during treatment
- Application of numbing jelly
- Patient eye protection
- Quick treatment time
- Breastfeeding and bottle-feeding infants are encouraged to feed immediately after treatment
- Hands-on demonstration of post-op stretches/exercises to do at home for 2–3 weeks
What Happens After the Visit?
After the procedure:
Tylenol or Advil dosages will be advised based on your child’s weight
- Follow-up with lactation, feeding, speech, bodyworker, and/or myofunctional therapist as recommended
- 1-week follow-up at San Marcos Pediatric Dentistry to evaluate healing and the effectiveness of exercises and stretches
Frequently Asked Questions
Parents often have many questions when learning about lip ties and tongue ties. Below are answers to common concerns to help you better understand oral restrictions, treatment options, and what to expect.
How Common Are Lip and Tongue Ties in Children?
Lip and tongue ties are more common than many parents realize. Some children have mild restrictions that never cause problems, while others have tighter attachments that affect feeding, sleep, speech, or oral development. An evaluation helps determine whether a tie is functionally significant.
Can a Tongue Tie or Lip Tie Improve on Its Own?
In some cases, mild restrictions may stretch or become less noticeable over time. However, when a tie is causing functional symptoms such as feeding difficulties, speech challenges, or airway concerns, it typically does not resolve on its own and may require intervention.
Does Every Lip or Tongue Tie Need to Be Released?
No. Treatment is based on function, not appearance. If a child has a lip or tongue tie that is not interfering with feeding, speech, sleep, or development, treatment may not be necessary. We only recommend frenectomy when symptoms and functional limitations are present.
How Long Does a Laser Frenectomy Take?
A laser frenectomy is a quick procedure, often completed in just a few minutes. Because the CO2 laser is precise and minimally invasive, treatment is typically well tolerated and performed in the office without general anesthesia.
Why Are Post-Procedure Exercises Important?
Stretching and movement exercises help prevent the tissue from reattaching as it heals. These exercises also encourage proper tongue and lip mobility, supporting better long-term outcomes. We provide hands-on instruction so parents feel confident performing them at home.
