Dr. Horacek's (Uker) clinical interest in lip and tongue ties stems from her personal experience. Her son struggled with breastfeeding (and consequently, so did she), weight gain, fussiness, and poor, interrupted sleep. Despite being told by multiple professionals that her son “did not have a tongue or lip tie,” she had it revised when he was 10 days old. And everything changed! She is now committed to helping other families of infants, children, and even adults who struggle with consequences of lip and tongue ties find answers and relief.
What is a tongue tie?
A “tongue tie” is a congenital (present at birth) condition where the tongue is held down or “tied” into the floor of the mouth by a fibrous band of unnecessary tissue. It seems to run in families and is NOT diagnosed by sticking the tongue out as far as it can go. Tongue ties inhibit the tongue from lifting to the roof of the mouth, which is important for creating a seal for nasal breathing. A restricted tongue is also unable to swallow appropriately, cleanse the teeth from food particles or speak with clarity or without fatigue. A tongue tie can prevent the breastfeeding relationship between mother and child by causing unexplained, severe pain for the mother, inadequate milk removal from the breast, leaking milk, and significant air swallowing (and consequent infant “GERD”) but this also effects bottle fed babies too! If untreated, it can lead to speech difficulties, malocclusion, sleep apnea, unexplained decay, food texture intolerance, and chronic headaches, neck, and shoulder pain.
There are several types of tongue ties:
- Anterior Tongue Ties: Most obvious, usually present to the tip of the tongue.
- Posterior Tongue Ties: Hidden under mucous lining of tongue or floor of the mouth. Identified when tongue is lifted and palpated for restriction.
All anterior tongue ties have a posterior component. Removing the anterior component won't correct the dysfunction.
What is a lip tie?
Almost everyone has a small piece of tissue that attaches the lip to the ridge. Those, however, that are short and tight and restrict movement are those that need attention and would be defined as a “lip tie”. For breastfeeding efficiency and proper latch, the upper lip must flange for suction and milk withdrawal. If untreated, this can cause decay of the front of baby teeth, gaping between permanent teeth (normal in baby teeth) and problems with the recession of gum tissue in adulthood.
What can be done?
At our office, we perform a tongue tie and lip tie releases (called frenectomies) using a laser. They are quick procedures (less than 5 minutes) that can be done with minimal discomfort, without sedation. The laser allows instant cauterization, or wound closure, so discomfort post-op is minimized. Most describe tenderness of the neck and under the chin muscles and a mild “pizza burn” sensation.
What could happen if I don't treat it?
Common long-term complications:
- Delayed onset of speech
- Speech Therapy for lisping, mumbling, trouble with certain sounds
- Tired mouth or poor speech at the end of the day
- Higher risk of decay
- Difficulty swallowing or tolerating certain types of food
- Strong gag-reflex
- Headaches or chronic head, neck and back pain
- Mouth breathing/Difficulty breathing through your nose
- Sleep Apnea type problems: noisy breathing or snoring, chronically tired feeling upon waking
- Recurrent ear, nose and throat infections
- Clenching and Grinding
What are the risks with treatment?
There is a mild risk of bleeding with any surgical treatment in the mouth, however, this is minimized with use of laser. Please let the team at our office know if you or your child has any blood disorders. The biggest risk with treatment is that the site will reattach and need to be re-done.
What should I know before my or my child's appointment?
We prefer to do consultations and treatment the same day on infants. We can submit to both medical and dental insurances, so please bring copies of your insurance cards to your appointment. Unfortunately at this time we do not accept state insurance. For laser safety, during the procedure, you and your child will be separated. For breastfeeding moms, you will be encouraged to breastfeed afterward, however for aspiration risk, we prefer your infant to have an empty stomach prior to the procedure. Sometimes breastfeeding gets worse before it gets better...we strongly urge you to have an appointment scheduled with your lactation consultant post-procedure.
For adolescents or adults, we also recommend nothing to eat for several hours to allow us to use laughing gas (Nitrous Oxide). The most common complain post-procedure is muscle soreness under the chin, so having some Ibuprofen or Tylenol in your system can decrease the soreness. Take the dosage you would take for a headache. Consultations for lip ties can be done the same day as treatment. Tongues benefit from some simple stretches after age 5 to minimize discomfort post op.
Post Op: Tongue Tie
Feel free to look at the following links before your appointment or print off and fill out the infant health history to save time in the office.
Tongue Tie PaperworkMother-Infant Follow Up Form