By James Lucas
Tongue and lips ties are sometimes diagnosed when parents are having difficulty teaching their newborn to breastfeed or bottle-feed. Although this can be stressful, babies can adapt and there is help available for parents and babies struggling with a tongue or lip-tie to help ensure their baby is feeding well and growing.
In recent times there has been an increasing trend for the procedure known as a tongue-tie release and lip-tie release. The question that has to be asked; is it necessary?
But what is a tongue-tie?
First, it’s important to understand the normal anatomy of the child’s mouth at birth, specifically the frenulum. There are two types of frenulum that are relevant for the most common types of tongue and lip-ties:
- The lingual frenulum is a narrow band of fibrous tissue that is located underneath the tongue and usually extends from the middle of the under surface of the tongue to the floor of the mouth.
- The lip frenulum extends from the lip to the ridge where the teeth will erupt. This can vary in shape and initially it will be near the top of the ridge, but with growth will position higher and is rarely between the teeth.
There are many different criteria and definitions for a tongue-tie, but the simplest description is where the tip of the tongue cannot be protruded beyond the lower incisor (front) teeth because of a short frenulum.
The reported occurrence of tongue-ties vary but the speech pathology department at The Royal Children’s Hospital consider it to be in the range of 1.7% – 4.8% of newborns.
The incidence of lip-tie is not reported but every child is born with an upper lip frenulum. Similarly the other frenulum at the sides of the mouth are also not reported, as they are normal and do not compromise feeding or growth for a newborn.
What are the consequences of tongue-tie?
Tongue-tie has been has associated with poor breast feeding and other feeding difficulties in young children. However, the Journal of Paediatrics and Child health report that of all children with a tongue-tie, only four out of 10 have associated feeding difficulties.
Although there are studies that show an improvement with feeding after surgery, these do not compare with the improvement seen in children who have had a good lactation consultant and no surgery over time.
There is no significant evidence that lip-tie release surgery will improve feeding.
How is surgery done?
The tongue or lip-tie can be cut with scissors, removed by laser therapy or surgically repositioned.
Are there complications?
Tongue-tie and lip-tie releases are not without complications.
First, bleeding from the floor of the mouth can occur, as it is very vascular. Children have been admitted to hospital with excessive bleeding particularly when open wounds are left.
Second, scarring can occur, particularly with laser therapy where an open wound remains and the post-operative sweeping process to reduce scarring, keeping the wound open by moving a finger across it, is inadequate. The tongue can heal with scarring, leaving it tethered to the floor of the mouth that can result in further complications.
Third, Oral Aversion can occur for some children, as the post-operative therapies can be painful. This can lead to them not wanting anything placed in their mouth, such as a toothbrush, which is known as oral aversion.
Many believe that leaving lip ties and tongue-ties will affect facial growth. There is no evidence to show this at all!
Remember it is not as simple as it seems. Consideration of tongue-tie procedures should occur only after consultation with your Paediatrician and a supportive lactation consultant and when non-surgical interventions have been explored.
Associate Professor James Lucas, Lucas Dental Care (www.lucasdentalcare.com.au) – Associate Professor James Lucas is one of the leading paediatric dental specialists in Australia. With extensive experience in dental trauma and treating children with a range of medical special needs, Dr Lucas has lectured in Australia and internationally to share his knowledge and expertise. Dr Lucas is also the Deputy Director of the Dental Department of the Royal Children’s Hospital, Clinical Associate Professor at the University of Melbourne and the President of the Australasian Academy of Paediatric Dentistry.