Diagnosis and treatment: New studies and information on what constitutes an abnormal lingual attachment, recommended treatment and the consequences of not treating an attachment are starting to change the way we look at newborns and children in dentistry. In the past, traditional medical teaching has been that a tongue tie is of little relevance, will have no adverse effect and can be ignored. The facts do not support that belief any longer. It will NOT stretch with use, which was a common myth that was often repeated. The reality is that a tongue-tieinterferes with normal tongue mobility and that affects the growth of the palate and the soft palate. Dental crowding, poor tongue position, mouth breathing and facial growth are affected. This can exert a harmful effect on many aspects of life and has been linked to sleep disorder breathing. This can change the overall quality of life over a lifetime. It is relatively common in newborns (3%) and represents a significant proportion of breastfeeding problems. It is the most misdiagnosed and overlooked congenital abnormality observed in children.
What to look:
The Academy of Breastfeeding Medicine suggests the following be used when evaluating whether a newborn requires a revision of the frenu. Symptoms of both the mother and the child as well as a physical exam are required to properly diagnosis the restriction and the need to revise.
- No latch
- Un-sustained latchh
- Slides off nipple
- Prolonged feeds
- Unsatisfied after prolonged feeds
- Falls asleep on breast
- Gumming or chewing on the nipple
- Poor weight gain
- Unable to hold pacifier
- Creased or blanched nipples after feeding; flattened
- Cracked bruised or blistered nippless
- Bleeding nipples
- Severe pain with latch
- Incomplete breast drainage
- Infected nipples
- Plugged ducts
- Mastitis and nipple thrush
This refers to a tooth or teeth (primary or permanent) that have become "fused" to the bone, preventing it or them from moving "down" with the bone as the jaws grow. This process can affect any teeth in the mouth, but it is more common on primary first molars and teeth that have suffered trauma (typically the incisors). Treatment can vary depending on the degree of severity of the ankylosis (how "sunken into the gums" a tooth may appear). The degree of severity usually will vary depending on how early the process started, and as a general rule, the earlier it starts, the more severe the ankylosis becomes with age. Several considerations must be taken before any treatment is provided, and your dentist will discuss all the risks and benefits of each treatment option.
Treatment Of The Infant Tongue-Tie
Treatment of the tongue-tie in neonates in my office is accomplished using a Erbium type (Er,Cr:YSGG ) Laser know as a Waterlase. The infant is swaddled to control unwanted movements, wears protective infant laser glasses and the frenum is released. In most cases, 2-8mm of freedom is adequate to allow for improvement and comfortable nursing. Additional revision may be needed at a later time if further problems arise.
After treatment is completed, children are encouraged to begin nursing and mothers have reported immediate relief of pain, extended nursing and improved infant sleeping.
Older children should be checked prior to initiating extensive and often expensive speech therapy. Trying to train the tongue to go into positions it is unable to reach only leads to frustration in a child. Revising the tongue will assist in correcting many speech abnormalities.
Treatment in an older child requires a little numbing prior to laser revision. Children’s Tylenol or Motrin usually relieves any discomfort after treatment. The laser is a much kinder method of revision, unlike electrosurgery and the scalpel. There is little damage to adjacent tissue when using the laser which results in quicker healing and less post-operative discomfort. After treatment care is as important as the revision. Exercises need to be done 5-6 times a day to prevent reattachment of the tissue. Avoid acidic or spicy foods such as apple juice, spaghetti sauce, or tacos. Post-operative follow-up appointments are necessary in one week. A complete list will be reviewed at your appointment and questions can be answered at that time.