Dr. heidi aaronson
1 Washington Street, Suite 306, Wellesley, MA 02481 781-431-9999
WHAT IS A TIE?
The medical term for the condition known as tongue-tie is ankyloglossia. It results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short and tight, causing the movement of the tongue to be restricted. Tongue-tie is congenital (present at birth) and hereditary (often more that one family member has the condition). It occurs relatively often: between 0.2% and 4% of babies are born with tight frenulums. In some cases, the frenulum recedes on its own during the first year, and causes no problems with feeding or speech development. A lot depends on the degree of the tongue-tie: if the points of attachment are on the very tip of the tongue and the top ridge of the bottom gum, feeding and speech are more likely to be affected than if the frenulum is attached further back.
A lip tie occurs when the frenulum that attaches the upper and/or lower lip to the gums on the upper jaw bone. Sometimes the frenulum can wrap all the way around the gums and attach on the palate. The degree of attachment does not always correlate with decreased function - the need for treatment is based solely on symptoms, not thickness of the frenulum or where it attaches.
A severe tie may cause a notch to form on the upper gum line. This is due to the tension from the frenum pulling on the bone. In a battle between muscle and bone, muscle will always win - in this case, the muscle is causing the jaw bone to pull upwards, which can affect the child's erupting teeth.
The term "Tethered Oral Tissues" (TOTs) refers to all types of ties - lingual (tongue), labial (lip), and buccal (cheek).
Tongue ties can lead to a wide range of dental issues. The tie may pull on the jaw bone, resulting in teeth shifting out of position, or it may prevent the teeth from closing together, causing a large gap between the front teeth.
Removing restrictions of the tongue and lips can allow the teeth to erupt in a more ideal alignment, which may help reduce the need for future orthodontic treatment.
When the tongue is unable to move freely, a child may have difficulty producing certain speech sounds. The most common letters affected are R, S, L, Z, D, CH, TH, and SH, but other sounds are also difficult. Furthermore, stringing multiple sounds together may also present a challenge.
There is no guarantee that a tongue tie will automatically create speech problems, just as there is no guarantee that a frenectomy will solve existing problems. There are, however, recent studies that show speech improvements after frenectomy.
In order to properly diagnose your child, a thorough examination is necessary. In some cases, there may be underlying issues in addition to the lip and tongue that may be restricting movement and limiting function. Dr. Aaronson will perform a comprehensive evaluation of the child's head and neck and, whenever possible, will speak with the child's IBCLC, bodyworker, or any other practitioner who may help provide insight that can aid in proper diagnosis.
There is no charge for this evaluation. If treatment is indicated, parents have the option to have their child treated the same day, or, if they prefer, they may schedule treatment for another day.
The treatment of choice for tethered oral tissues is called a frenectomy (or frenotomy), which is a minor surgical procedure that releases the tension on the frenum, allowing the tongue and lips to move freely.
While some providers use a scalpel or scissors, Dr. Aaronson uses a CO2 laser to quickly and nearly painlessly release the tethered tissue. The benefit of a laser is that it reduces postoperative swelling and bleeding by sealing off the lymphatic and blood vessels. Studies have also shown that patients treated with a CO2 laser have significantly less postoperative pain, both on day 1 and day 7, as compared to scalpel surgery, and patients who were treated with a laser require less pain medication after treatment than those who were treated with a scalpel. (Patel, et al., 2015)
A frenectomy takes less than a minute to complete. A topical anesthetic gel may be given to help reduce discomfort during the procedure. Local anesthesia (via injection into the frenum tissue) is also available if parents request it.
After treatment is complete, we encourage parents to feed their baby, either from the breast or bottle. The majority of breastfeeding mothers immediately notice an improvement in their baby's latch and the amount of pain in the breast and nipple. It is strongly recommended that all breastfeeding mothers follow up with their IBCLC as soon as possible after treatment to help the baby learn to effectively breastfeed with their newfound tongue and lip mobility.
New Generation Dental Center
1 Washington Street, Suite 306
Wellesley, MA 02481
DR. AARONSON'S HOURS
Tuesday: 8:00 am - 1:00 pm
Wednesday: 8:00 am - 6:00 pm
Thursday: 8:00 am - 1:00 pm
The office is open Monday through Thursday from 8:00 am until 6:00 pm