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September 19, 2019

Pediatric Dentistry Focus: Tongue Tie and Lip Tie

By Dr. Frank Sierra

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 non­medical 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. Sometimes 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 tongue­tie can lead to nursing, eating, dental or speech problems.

Infants

A baby with a 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. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching should have their child evaluated for tongue and lip-tie. Although it is often overlooked, tongue and lip-tie can be underlying causeS of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breastfeeding altogether.

Speech

Speech impediments due to tongue­tie are possible.  By the age of 3, 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 3–year–old’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:

  • V­shaped 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

Dental

For older children with ties, persistent dental problems such as a gap between the front teeth can occur. The frenum can also pull against the gums causing recession. In addition to the esthetic problem, this can lead to sensitivity and pain. The tight lip frenulum may trap food and bacteria against the teeth. This is a major factor in Early Childhood Caries.

Treatment

Revision is a simple procedure and there are normally no complications. The procedure may be performed as early as the day of birth.

A laser is used to perform the revision. A cream to numb the area can be applied for comfort. The laser gently removes the frenulum tissue with virtually no bleeding. The baby is allowed to nurse or feed immediately after the procedure!


Frank Sierra, DMD is a board-certified pediatric dentist, practicing in the Tampa Bay Area for almost 30 years. He is a past president of the Florida Academy of Pediatric Dentistry and the Florida Cleft Palate-Craniofacial Association. He lectures nationally on many topics including diagnosis and treatment of tongue and lip tie. Families from the entire state come to Kids Smiles Pediatric Dentistry for their expertise and quality care.

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