Tongue and Lip Ties

Years ago, reflux was the diagnosis that I was seeing on a daily basis in our office.  I am not sure if it was the advent of Zantac or Prilosec, but the vast majority of the babies we saw were on those medications and had been diagnosed with reflux. These days the new diagnosis is a lip and tongue tie.  We are seeing it all the time, and our own Doris Howie, RN IBCLC has become our resident expert!  Here is some information regarding both issues, with all credit to a lecture I attended by Marty Kaplan DDS and to the website of Dr. Fawn Rosenberg.  Both are doctors that we refer to for fix these issues.  Dr. Rosenberg’s website has great pictures that illustrate what I am describing below.  It can be accessed at:

Many people suffer from tongue-ties, or lip-ties, and they often occur together. It is a genetic abnormality that can range from very minimal in some cases to severe in others. The lingual frenum is a cord that stretches from under the tongue to the floor of the mouth. A tongue tie, or ankyloglossia, are terms used for a lingual frenum is short and restricts the movement of the tongue.  Sometimes it is long and thin and goes from the base to the tip of the tongue, and can cause the tongue to be heart shaped. Other times it is short and thick and anchors the tongue to the base of the mouth.

Some common signs of a tongue-tie are:

  • Difficulty moving tongue side to side or up and down

  • Inability to touch the roof of the mouth with tongue

  • Inability to stick out tongue

  • Presence of a notch at the tip of the tongue

The labial frenum is a piece of skin that connects a person’s upper lip to their gums. A lip-tie is when the labial frenum is too short or wide and restricts upper lip movement.

Some common signs of a lip-tie are:

  • Inability to flair upper lip

  • Slurred speech

  • Gap between upper teeth

Sometimes, we will see a baby who we notice immediately has either or both of these conditions, and yet, they are doing just fine.  The frenulum is a membrane that can stretched and often does, with no consequences for the mother or the baby. If the baby is gaining weight appropriately, is happy and not causing the mother any pain, I often won’t even mention it.

However, some babies with these conditions really struggle with breastfeeding, which is frustrating for both the mother and infant. Often, they do fine in the beginning, when the mother is engorged and the breast is full of milk.  But as the breast returns to a relatively normal state, these babies may be unable to latch properly, and slide off or chew on the nipple. They never seem satisfied, yet feeding times are prolonged and they are constantly falling asleep at the breast.  They babies exhibit poor weight gain, are often gassy or fussy, and eventually labeled colicky or “Failure To Thrive.”

The poor mom often suffers from excruciating pain when nursing. Many times she is told everything looks great from the outside, and that pain is normal and will go away eventually. This is particularly frustrating for women who deal with the pain 8-12 times per day, and have their heart set on nursing their baby.  One of my patients found this fantastic video online, that perfectly illustrated how she felt while nursing:

These women will often experience creased or flattened nipples after feeding, with bruises or blisters noted.  Breast drainage is often incomplete and plugged ducts are common. A decreased milk supply, mastitis, and thrush are often the result.

Tongue and lip-ties can be easily corrected. The procedure is called a frenectomy. It is also commonly known as a frenontomy or frenulectomy. Some doctors we refer to treat tongue-ties and lip-ties with FDA approved laser that is safe, effective, and minimally invasive. Using a laser for this procedure eliminates the need for needles, general anesthesia, stitches, or a costly hospital visit. When the procedure is done with a laser beam, there will be minimal bleeding, if any at all. Other doctors, usually ENTs, use a scissors to snip the frenulum.   Either way, it only takes a few minutes and the baby can nurse immediately afterwards.

If you are concerned that this might be an issue for you and your baby, talk to your pediatrician and ask for a referral to see a pediatric dentist, ENT, or one of us.  I would start with us, because often, we can help you nurse comfortably and nothing further needs to be done. My advice is to ask for Doris!   Rhode Island also has a pediatric dentist at Children’s Dentistry of Westerly and Wakefield who has recently been trained in these procedures.  Her name Dr. Anna Capalbo, and we have been very pleased with her honest assessment and repair for babies that need it. Whatever you do, just know that nursing with pain is not normal and it can be fixed. We are happy to help, or guide you to someone who can!