Understanding Tethered Oral Tissues
- Every child possesses oral connective tissue attachments known as frenums or frenulums. However, in some children, these attachments may be short, tight, or thick, limiting the function and mobility of the lip and/or tongue.
- When these limitations impact function, the frenae are referred to as symptomatic oral restrictions or tethered oral tissues.
- These oral restrictions are remnants of embryonic tissue that should have receded by the 12th week in utero.
- Tongue-tie (ankyloglossia) occurs when the attachment beneath the tongue and the floor of the mouth is tight enough to restrict normal tongue movement.
- Lip-tie refers to a tight attachment of the lip that prevents the upper lip from flanging outward normally.
What are the benefits of a frenectomy?
- A frenectomy, or release of a lip-tie or tongue-tie, can significantly enhance a child’s quality of life by improving breastfeeding, bottle-feeding, solid feeding, sleep, and speech. Release of tethered oral tissues can also optimize dental and orthodontic outcomes.
- The laser frenectomy procedure offers a gentle, quick, and straightforward outpatient solution that can be completed during the same visit as the initial assessment, if desired.
- This procedure carries minimal risk and offers significant potential benefits.
- Ultimately, we aim for our children to thrive, not merely survive.
How is it determined if a child may benefit from a frenectomy?
When considering treatment, symptoms and function take precedence over appearance. Assessment for treatment necessity involves evaluating symptoms rather than solely focusing on appearance.
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 are Involved in Diagnosis and Treatment?
While a frenectomy alone may not fully resolve symptoms, pre-op and post-op therapy with appropriate therapists is essential for optimal outcomes. At San Marcos Pediatric Dentistry, our pediatric dentists collaborate with allied healthcare professionals such as lactation consultants, feeding therapists, speech therapists, bodyworkers, and multifunctional therapists to ensure the best results for each child. We will recommend which services may be indicated for your child based on their individual needs.
Laser Frenectomy Treatment
What is a Frenectomy?
A frenectomy involves 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 laser.
Benefits of CO2 Laser (vs. Scissors)
- Little to no bleeding
- Quicker and less painful healing
- More precision, allowing 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 to Expect on the Day of Treatment
- Consultation with the pediatric dentist, ample 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 encouraged to feed immediately following treatment
- Hands-on demonstration of post-op exercises and stretches (to be done at home for 2-3 weeks)
After the Visit
- Tylenol or Advil dosages will be advised based on your child’s weight.
- Follow-up with lactation, feeding, speech, bodyworker, and/or myofunctional therapist
- 1-week follow-up at San Marcos Pediatric Dentistry to evaluate healing and effectiveness of stretches and exercises
