Frenectomies for Tongue Ties and Lip Ties

A tongue-tie used to be thought of as something something that only affected babies and breast feeding. But modern medicine and dentists are finding that the problems associated with a tongue-tie can affect both children and adults of all ages. Releasing a tongue-tie is now an integral part of achieving optimal oral and dental health.

What is a Tongue Tie?

Being tongue tied isn’t just a figure of speech. It’s a very real medical condition that can affect oral and facial development, and have a range of other serious health consequences.

We all have a lingual frenulum (or frenum) under our tongue. If you lift your tongue and look in the mirror, you’ll see it. The frenum is the tissue that connects the tongue to the floor of the mouth. In some people, it’s tighter or thicker than it should be, and this can physically restrict the movement of the tongue.

A tongue tie can also be referred to as Ankyloglossia or Tethered Oral Tissue (TOT).

What is a Lip Tie?

A lip-tie is similar to a tongue tie, and the two are often seen together. With lip-ties, the small seams that we all have on the midline between our lips and gums are too short or thick, causing restricted lip movement. This can have a major impact on breastfeeding and speech, as well as dental development. Lip-ties are treated exactly the same way as a tongue tie; the tie is surgically released, and myofunctional therapy exercises are prescribed.

How to identify a Tongue Tie

Here are some examples of tongue ties

This is an example of a less obvious tongue tie. This type is most often missed by most doctors and dentists. The tongue looks “normal”, but the full range of motion is not possible.

This is an example of an “Eiffel tower” frenum, as it is often referred to. The frenum is in a fanned out shape where it attaches to the floor of the mouth.

This is an example of a severe tongue tie, indicated by the “heart shape” tip of tongue, and a frenum that is thicker in appearance.

How to Identify a Lip Tie

A tight upper lip frenum attachment may compromise full-lip flanging (releasing) and appear as tight, tense, upper lip during nursing.

Why Does a Tongue Tie Matter?

The position of the tongue is an important part of dental health. The tongue should rest in the top of the mouth, filling up the entire palate from front to back. When the tongue is resting in the correct position, it shapes the maxilla (upper jaw) and guides the growth of the face.

The tongue also provides an internal support system for the upper jaw. But if a person is tongue tied, their tongue may not be able reach the top of the mouth because it’s physically restricted. This causes the palate to develop smaller and narrower, and the teeth to grow in crooked. Also, the mandible (lower jaw) is often smaller and set back, and the airway is restricted.

Because of this, children who grow into adults without having their tongue tie treated often experience a range of oral myofunctional symptoms including:

  • Speech issues
  • Mouth breathing
  • Jaw pain, clenching, and grinding
  • Headaches
  • Head, neck, and shoulder tension
  • Forward head posture
  • Snoring, sleep disordered breathing, Upper Airway Resistance Syndrome (UARS), and sleep apnea
  • Increased risk of cavities and gum disease
  • Slower orthodontic treatment
  • Orthodontic relapse

Can a Tongue Tie Affect Breastfeeding

Breastfeeding is one of the first ways a tongue tie can be noticed. When mothers have trouble breastfeeding, a tongue tie can often be to blame. However, if babies are bottle fed, or meet weight gain and growth markers, the tongue tie can be missed or overlooked.

Just because a mother managed to breastfeed her baby doesn’t mean that tongue tie isn’t an issue. Many times, a nurse or lactation consultant will notice a tongue tie but not recommend a release because the baby is gaining weight. From a developmental perspective, the tongue tie still needs to be released so that proper oral growth and development can take place.

Can a Tongue Tie Affect Speech

A tongue tie can certainly affect a child’s speech but it doesn’t always. Sometimes doctors and dentists are reluctant to release a tongue tie if it’s not affecting speech. However, it comes down to much more than speech – growth and development of the jaws and teeth will be impacted by a tongue tie. The most common sounds that kids struggle with if they are tongue tied are “r” and “l”. If your child has these specific speech issues, the first thing I’d recommend would be to screen for a tongue

Many children have disordered breathing due to a tongue or lip tie which can result in craniofacial changes (high palate, long face) if the tie is left untreated. Most of the changes that result from disordered breathing cannot be reversed so we advise to perform the treatment as early as possible.

How is a Tongue Tie Treated?

In most cases, tongue ties are treated with a minor surgical procedure to release the tie. This procedure is called a frenectomy but is also known as a frenotomy or frenulectomy. The frenectomy is a simple procedure that only takes a few minutes. It’s usually done in-office by a dentist or ENT using a laser or scalpel without general anesthetic.

We recommend finding a specialist who’s very experienced at performing the procedure. If it’s not done correctly, or released enough, there’s a high chance the frenectomy will need to be done again.

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We use a Deka CO2 dental laser for our surgeries. The benefits of a CO2 laser inclue:

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