Tongue & Lip-Tie

Dr. Jessica Manske is a Board Certified pediatric dentist in Los Angeles, California. She has been certified on the BIOLASE® Epic diode laser, which uses infrared laser energy to treat tethered oral tissues with little to no local anesthesia and no scalpel or sutures, since 2018. She is now expanding her network of lactation consultants, Craniosacral therapists, physical therapists, chiropractors, speech therapists, myofunctional therapists, occupational therapists, cranial osteopaths and pediatricians to ensure that every patient receives the proper follow up and comprehensive care.

What Is a Frenectomy?
A frenectomy is a procedure that consists of releasing the frenum, a band of fibrous tissue, under the tongue or upper lip to allow for better range of motion. Children may be born with a combination of conditions called a tongue-tie (ankyloglossia) or a lip-tie, causing restrictions in movement that can cause difficulty with breastfeeding, and in some instances, other problems, like spacing between teeth, gum disease, speech and airway difficulties, and digestive issues. These issues can generally be corrected by a simple procedure done with our soft tissue Epic diode laser.

Laser Frenectomy – How Does It Work?
A soft tissue laser does NOT cut. It is more of a “vaporization” of tissue that occurs with infrared light energy. There is very little discomfort with the laser. There is almost no bleeding from the laser procedure. Lasers sterilize at touch and therefore have less risk of infection. The healing is very quick because the laser stimulates healing and regeneration of tissues.

How Can a Tongue-Tie Affect My Child?
Normal tongue function is important for multiple reasons. Among the many benefits, normal tongue function will allow a baby to latch adequately, breastfeed efficiently, promote normal speech development, make it possible for a child to self-cleanse the mouth during eating, allow adequate swallowing patterns, and allow for proper growth and development. Challenges that can occur with a tongue-tie:

  • Inability to latch
  • Inability to open mouth widely, affecting speech and eating habits
  • Inability to speak clearly when talking fast/loud/soft
  • Clicking jaws
  • Pain in jaws
  • Underdeveloped lower jaw
  • Snoring

How Can a Lip-Tie Affect My Child?
A lip-tie occurs when the upper lip remains attached to the upper gum. Challenges that can occur in children and infants with moderate to severe lip-ties:

  • Spacing between the upper front teeth — a large gap can form called a ‘diastema’
  • Difficulties with brushing and flossing
  • Repeated injury to the maxillary frenum because it is so low and prominent
  • Pain with breastfeeding
  • Inability to adequately move the maxillary lip upward during breastfeeding, affecting an infant’s latch and ability to create a good seal

Why Have the Tongue-Tie or Lip-Ties Released for My Baby?

  • To help make breastfeeding more successful
  • To help relieve the pain of breastfeeding and regain healthy nipples and breasts
  • To stimulate milk production by adequate stimulation
  • To help achieve satisfactory bonding between a mother and her baby
  • To ensure adequate feeding and growth of the baby
  • To avoid serious long-term issues with palatal development, teeth spacing, gum disease, speech impairments and social stigma

What Can I Expect Before the Procedure?
Most of the time, we can do the surgery on the same day as the assessment. Do not nurse or feed your child 45 minutes before the procedure. Due to laser safety restrictions, parents are not in the room for the surgery. The procedure itself takes less than a minute, and you will only be away from your child for about 5 minutes. For babies under 1 year of age, only topical numbing gel is applied to the treatment areas, and for 1 year and older, we use topical numbing gel plus local anesthetic. Your child will be awake during the procedure.

What Can I Expect After the Laser Frenectomy Is Done?
The numbness will wear off about 30-45 minutes after the procedure. We recommend you wait until you get home to breastfeed, but please feel free to do so at that time. Breastfeeding after the procedure is encouraged, as breast milk contains amazing healing properties and the simple act of breastfeeding will reassure and soothe the baby. Do not be alarmed if latching is difficult at first. Some babies do well right away, but some need time to adjust. Be prepared for some fussiness and discomfort for a few days. That is to say, breastfeeding may get worse before it gets better. This is not the sign of an unsuccessful revision. Your baby has newfound mobility of the lip and tongue, and he/she may need some time to re-learn how to use the oral musculature. We recommend you be thorough with the prescribed post-treatment exercises and to work with the lactation consultant, and possibly a bodyworker (cranial sacral therapist, pediatric chiropractor, etc.), to increase the chances of success.

Starting a few days after the procedure, the wound(s) will look gooey and white or yellow in appearance. This is a completely normal way the mouth heals. Below is a video explanation of the exam, treatment, and post-operative care.
Note: the video says to do the stretches 3 times a day, but we recommend 6 times a day with no more than 4 hours between stretches, done for 4 weeks to allow the best chance for optimal results.
Dr. Kotlow: Assessment, laser surgery and post-surgery active wound care

Pain Management Before and After the Procedure
Your child may not need any pain medication at all, but the following are options.
Infants under 6 months – Infant Tylenol. Consult with a pediatrician and follow dosage directions. Give after the procedure as needed.
6 months and older – Tylenol or Motrin (Ibuprofen). You may give this 1 hour before the procedure and then after the procedure as needed.
Arnica 30x – 10 tabs dissolved In a few tablespoons of breast milk, delivered by a dropper
Rescue Remedy – Frozen breast milk can be soothing to rub on the wounds after the procedure.

Call our office for any of the following:

  • Uncontrolled bleeding
  • Fever over 101.5 degrees
  • Signs of possible Infection

We look forward to seeing you and your child! If you have any questions regarding frenectomies in Los Angeles, California, or would like to schedule an appointment with our pediatric dentist, call our office at 424-322-4780.