Tongue-tie (Ankyloglossia) and Lip-tie  (Lip Adhesion)

Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia.  Lip-tie is a condition where the upper lip cannot be curled or moved normally.

Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum. As we develop, this frenulum recedes and thins. The lingual (tongue) or labial (lip) frenulum is visible and easily felt if you look in the mirror under your tongue and lip. In some children, the frenulum is especially tight or fails to recede and may cause tongue/lip mobility problems.  

The tongue and lip are a very complex group of muscles and are important for all oral function. For this reason having tongue-tie can lead to nursing, eating,  dental, or speech problems, which may be serious in some individuals.

 

 

 

 

 

 

 

 

 

 

 

When Is Tongue and Lip- Tie a Problem That Needs Treatment?

- Infants

A new baby with a too tight tongue and/or lip frenulum  can have trouble sucking and may have poor weight gain. If they cannot make a good seal on the nipple, they may swallow air causing gas and stomach problems.  Such feeding problems should be discussed with Dr. Sierra.  Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue and lip tie.  We can refer you to one of our many excellent lactation consultants for support before and after revision.

 

Although it is often overlooked, tongue and lip tie can be an underlying cause of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breast feeding altogether.

 

-In Toddlers and Older Children

Speech

While the tongue is remarkably able to compensate and many children have no speech impediments due to tongue-tie, others may. By the age of three, speech problems, especially articulation of the sounds - l, r, t, d, n, th, sh, and z may be noticeable. Evaluation may be needed if more than half of a three–year–old child’s speech is not understood outside of the family circle. Although there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common:

 

• V-shaped notch at the tip of the tongue

• Inability to stick out the tongue past the upper gums

• Inability to touch the roof of the mouth

• Difficulty moving the tongue from side to side

 

As a simple test, caregivers or parents might ask themselves if the child can lick an ice cream cone or lollipop without much difficulty. If they cannot, then it may be time to consult Dr. Sierra or another specialist in tongue/lip tie.

 

Dental 

For older children with tongue-tie, appearance can be affected by persistent dental problems such as a gap between the top or bottom two front teeth. The frenum can also pull against the gingiva (gums) on the front or back of the teeth causing recession.  In addition to the esthetic problem, this can lead to sensitivity and pain.

The tight lip frenum may trap food, plaque, and bacteria against the teeth.  This is a major factor in Early Childhood Caries (nursing/bottle cavities).  

 

Tongue-tie & Lip-tie Revision 

Tongue-tie and Lip-tie revision is a simple procedure and there are normally no complications. The procedure may be performed as early as the day of birth.  The revision can be performed in our office or in the hospital room/nursery before discharge .  Dr. Sierra uses a LASER to perform the revision.  A creme to numb the area can be applied for the baby's comfort.  The laser gently removes the frenum tissue with virtually no bleeding.  Stitches are usually not required. The baby is allowed to nurse or feed immediately after the procedure!

 

While frenulectomy is relatively simple, it can yield big results. Parents should consider that this procedure often yields more benefit than is obvious by restoring ease of speech and self-esteem.