Fit to Be Tied :: Dealing with Baby Tongue Tie

If you have had a baby recently or know someone who has, chances are you had a discussion with your lactation consultant or doctor about having your baby’s tongue or lip “clipped” because of a tie. This is typically known as an upper lip or tongue-tie removal; the medical term for this is a “maxillary frenectomy” when it involves the upper lip, or a “lingual frenectomy” when it involves the tongue.

This process involves the removal of a small muscle that connects the upper lip to the bone where the teeth come in or the removal of a similar muscle that connects the tongue to the lower jaw. These ties are often pointed to as the reason why babies are having difficulty breastfeeding, and they are also said to be linked to colic and reflux, along with a variety of other issues in newborns. Like many difficulties with infants, there are support groups for parents of tongue tied babies. The Tongue Tie Babies Support FB group has over 50,000 members and many states have their own groups including Tennessee.

This information is brought to you by East Tennessee Orthodontics of Oak Ridge.

Even though I have been practicing dentistry for over 10 years, it’s only been recently that I’ve been asked my opinion on infants having the upper lip-ties removed to help with breastfeeding. This seems to be because of the increasingly common trend towards removal in newborns these days. This may be recommended if the pediatrician or lactation consultant identifies an upper lip is not able to move like it should during breastfeeding and this muscle attachment is suspected to be the cause due to its thickness or low attachment position.

The more common procedure to aid in infant breastfeeding has to do with the removal of a similar muscle attachment that connects the tongue to the lower jaw. Even shortly after birth the doctor will run his finger under the tongue to check for the position of this muscle and the amount of movement of the tongue. If the muscle attaches to too closely to the tip of the tongue, the movement can be restricted and not allow for normal feeding. This can also affect the ability to pronounce certain words clearly as the child begins to talk.

Both of these procedures are very minor surgeries with a laser being the preferred method of removal because the area heals quickly and there is a low risk of infection and bleeding. There are a few medical studies that have shown the positive effects removal can have on breastfeeding especially with tongue-tie removal. To my knowledge no studies have been done that just look at the benefits or risk of lip-tie removal only in infants.

I have been using a soft-tissue laser in my practice since the beginning and commonly use it for lip-ties and to remove excess tissue around teeth on adolescent and adult patients during orthodontic treatment. I have never done this procedure on infants, and I rarely see tongue-ties still present after age seven when it’s recommended that children see the orthodontist. 

When I do see upper lip-ties, my most common and preferred method for taking care of them is to watch and wait until the adult teeth come in. As I watch these adult teeth come in, the jaws grow vertically and these attachments, that once looked really high, are now in a normal position. Any space between the front teeth is closed due to the larger size of the erupting teeth. An upper lip-tie that once looked like it needed removal now doesn’t look so bad and isn’t causing any problems. When there is 3mm or more of space between the front teeth with or without a lip-tie, these spaces rarely close on their own but can be closed with braces or Invisalign treatment. If a lip-tie was present, removal and the resulting formation of scar tissue can help keep that space closed long term.

I’ve spoken with one of the experts in the field, Dr. Lawrence Kotlow who is a pediatric dentist in Albany, New York. He has written numerous articles in the field and even came up with the classification system for both upper lip and tongue-ties. He commonly performs these procedures on infants to aid in breastfeeding as well as other issues, and sees it making a big difference in the lives of both babies and mothers. He also prefers to remove upper lip-ties before the permanent teeth erupt and says he sees space closure happen as just the front two teeth come in. Here is a link to a very thorough guide that he has written about this subject. Dr. Kotlow’s views are somewhat controversial because of the lack of research and evidence in this area. The American Academy of Pediatric Dentists has however recently relaxed their policy about early frenectomies in their latest guidelines to pediatric oral surgery.

Since there are no long-term studies about early removal of these upper lip-ties (and they are becoming commonplace among new mothers), time will tell what the effects are in my practice as these kids grow up and have a need for orthodontic treatment.

Dr. Justin Trisler is the owner/orthodontist of East Tennessee Orthodontics in Oak Ridge, which he opened in August 2016. He graduated from Berry College in Rome, Georgia where he fell in love with the mountains. He then accepted the Army’s Health Professional Scholarship and went on to the University of Alabama in Birmingham for dental school and entered the Army immediately after graduation. He also completed an additional one-year Advanced General Dentistry program at Fort Carson before being sent to Germany. He was then selected to attend The University of Louisville for orthodontic training and during these two years of specialty training he also received his Master’s degree in Oral Biology. The Army then moved his family to Fort Hood, Texas where he severed as both an orthodontist and to teacher of orthodontics for the Uniformed Service University in their Two-year Advanced General Dentistry training program. He completed his time with the US Army after ten years to begin his private practice.

Dr. Trisler has been married to his wonderful wife Kelly for 12 years and they have three amazing children. His boys Landon and Judah are ten and seven and love sports, the outdoors, and of course video games. His daughter Selah, who is just turned three, enjoys trying to keep up with her brothers and Frozen. As a family they enjoy organized sports (where he helps coach when he can), mountain biking, hiking, watersports and snow skiing. They also enjoy being involved in church ministry. In their last church home in Texas, Grace Bible Church, he served as a deacon and both Kelly and Justin served as Children’s Ministry Directors before making East Tennessee their home.