During our Well Baby Check-up and infant examination, we examine the baby's mouth for tight oral tissue also known as a tongue tie, lip tie and/or buccal tie. If we identify a tie, we will ask follow up questions relating to the function. If it is determined that a revision should be considered, we encourage parents to see a specialist, such as a pediatric dentist, for the revision.
Our doctors at NLC provide pre and post frenectomy care by working on the tight muscles of the face, reestablishing proper sucking patterns, monitor healing with stretches, craniosacral therapy (CST) and gentle chiropractic adjustments.
We feel that checking for tight oral tissue is important because it can be the cause of many problems and frustrations.
Infant problems include but are not limited to difficulty latching, painful breastfeeding, decrease in milk supply, colic, reflux, and gas. Other warning signs include clicking noises, poor latch, poor seal, upper lip tucked under, extended feeding times, milk tongue, lip blisters, sensitive gag reflex, constantly wanting to be held, crying when laid on their back, and picky with bottle or pacifiers.
If left untreated, issues can still progress and manifest in toddlers as picky eaters and/or behavioral problems/eating. If the tongue is restricted, it cannot move properly to clear and manipulate food in the mouth. A great example is the appearance of pushing food out when introducing purees and parents feel like they are constantly scooping food from around the mouth. Therefore, these kids will prefer foods that devolve easily such as white bread, fries, chicken nuggets and other soft foods while avoiding textured foods and proteins. Other warning signs include food still left on the spoon (lip is unable to clear the spoon), gagging, coughing, choking, not attempting to self feed, continued used of suckle pattern, unable to use a straw or open cup, dental problems such as cavities, food left between the teeth and cheek, grazing, one side chewing and poor weight gain.
If the ties are remain untreated, children may have difficulty with speech since the tongue and lips cannot move to the proper positions to create certain sounds. Most difficult sounds are K, G, NG, SH, CH, TH, T, D, N, L, R, S and Z.
And lastly, in children and adults, some common problems include TMJ disorders, frequent headaches, migraines, braces, palate expansion, chronic dental issues, and chronic neck pain.
Your provider should give you post care instructions that include home oral stretches, body work, CST and/or chiropractic care. Constant and correct stretches are to prevent reattachment of the tissue during healing. Dr. Sai, Dr. Sam and Dr. Suzy will examine and stretch the tissue at each visit to help parents with this important piece. The stretches should not take long and although the baby may appear to have discomfort in the beginning, the stretches do become easier over time. The following video for stretches is from Dr. Baxter at Alabama Tongue Tie Center at https://tonguetieal.com
Did you know that at 20 weeks gestation, the fetus starts to develop a sucking pattern? So if a oral tie is present, poor suck patterns develop 20 weeks prior to birth. Compensation come from the chin, lips and cheeks rather than the tongue. Think about if you were weight lifting wrong for 20 weeks, you would probably have imbalances that would take a while to correct. The same is true post revision. Because of this, it can take 6-8 weeks to properly strengthen the tongue and relax the cheek and lips with proper post-frenectomy care. In the beginning, there are few great feeds and more poor one. Over time, there are more great feeds and the occasional poor ones. In the post revision visits, our doctors work on releasing tight facial muscles, proper bio-mechanics and stimulation/reteaching of the posterior tongue in the suck pattern. They also address any other imbalances or subluxation that they find with CST and gentle adjusting.
Performing a gentle facial massage to your baby before feedings can decrease facial tension to the baby and pain to mom. Pressure should be the same as checking the ripeness of an avocado or tomato.
To avoid oral aversion, playing with baby's face, rubbing the gums or simple suck exercises are great to do in between stretches. It is to reassure baby that not every time you go into the mouth will be painful.
For the upper lip, simply place your finger under the lip and move it up as high as it will go (until it bumps into resistance). Then gently sweep from side to side for 1 second. Remember, the main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they can't stick together. You should not use force.
The Tongue should be your next area to stretch. Insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Put your thumbs on the baby’s forehead and your middle fingers on the chin (remember, you’re approaching from above like in the video below). Then use both index fingers to dive under the tongue and pick it up, towards the roof of baby's mouth. Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the baby's mouth). Hold it there for 1-2 seconds and then relax. With one finger propping up the tongue, place your other finger in the middle of the diamond and turn your finger sideways and use a lifting motion from low to high, sweeping through the wound (only in the up direction). Lastly, Massage on either side of the floor of the mouth (outside the diamond) to loosen up the musculature.