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Tongue and Lip Ties in Infants and Children

When young mothers and fathers have a child, it’s love at first sight! Before your child is born, new parents usually have already had a peek at them at an ultrasound. You get to see a profile picture and maybe a view of their tiny toes and fingers! With the 3D technology of today, you may even get to see a closer, more detailed glimpse. One of the things that you may not be aware of until they are born, though, is when their tongue or lip is more tightly connected to the roof of their mouth or to their gums than it should be. It may be upsetting when you find that your child has any abnormality, but be assured, this is something that can be remedied quickly, sometimes even before you take your infant home!

Tongue-Tie

The thin strip of tissue that we see under the tongue (lingual frenulum) helps control its movement and is usually soft and manipulative. Typically, this strip of tissue is separated before birth. If this tissue band does not separate or is thickened or tight, it may tether the tip of the tongue to the floor of the mouth, and this condition is called ankyloglossia. When infants are born with this condition, it restricts the tongue's ability to move and can interfere with breastfeeding and bottle feeding (1, 2).

Signs and symptoms of tongue-tie include (1, 2):

  • A notched or heart-shaped appearance when trying to stick out their tongue
  • Trouble pushing the tongue out past the lower front teeth
  • Difficulty raising the tongue to touch the upper teeth or moving it from side to side

Why tongue-tie happens is generally unknown but can, in some instances, be associated with genetics. This condition can affect anyone but is more common in males than females and runs in families (1, 2).

If tongue-tie is not diagnosed early in an infant's life, it can affect a baby's oral development and how they eat, swallow, or speak. The baby may chew on the nipple if the mother is breastfeeding instead of using the tongue in the correct position over the lower gum when sucking. If the issue is not identified quickly, it can lead to poor nutrition in the infant. As they learn to make words and speak in sentences, tongue-tie can interfere with forming sounds of letters and words, especially with the sounds of “t, d, z, s, th, r,” and “l,” and facilitate difficulty with pronunciation. Oral hygiene can be difficult as the child grows because food and debris will be harder to remove from under the tongue. Poor brushing and cleaning of the teeth and mouth can lead to tooth decay and gum inflammation (1, 2).

Often ankyloglossia is noticed first upon examination of the pediatrician or the lactation consultant. On inspection of the underside of the tongue, it will be evident that it is connected to the floor of the mouth. Mothers may be the first to notice if there is an issue with latching on or if she has pain when breastfeeding (1, 2).

Treating Tongue-tie:

No one can prevent tongue-tie. Early diagnosis and treatment are vital to reversing this condition.

A frenectomy is a simple surgical procedure that can be done to release the band of tissue under the tongue. It can usually be done in the office or clinic for infants and is said to be painless. In this procedure, the lingual frenulum is cut, and the tongue is released from the floor of the mouth. Older children or adults may need general anesthesia before the procedure. Most infants, children, and adults recover completely after this minor procedure (1, 2).

Lip Tie

Lip tie is a condition where the thin strip of tissue behind the upper or bottom lip (or both) is thickened or tight and connected to the gums. The rigidity does not allow the lips to move away from the gums. Much like tongue-tie, this condition is most frequently seen at birth and can, in some cases, occur along with tongue-tie. Again, lip tie is believed to be genetic, the same as tongue-tie (3).

Signs and Symptoms:

Many of the signs and symptoms of lip-tie are the same as tongue-tie. Here are a few others found during breastfeeding, which may make it difficult for a lip-tied baby to be fed (3):

  • Difficulty during feeding because of poor "suck, swallow, breathe" patterns
  • Producing a clicking sound while nursing
  • Falling asleep often during breastfeeding
  • Extreme fatigue by nursing
  • Inability to take a pacifier
  • Slow weight gain
  • Colic

Feeding the infant with pumped breastmilk or formula from a bottle might make it easier for your child to get nourishment. They may have trouble eating from a spoon or even eating finger foods when they are older because their lip is not separated from their gums (3).

Lip tie is something that can be quickly determined and diagnosed by the infant's pediatrician or a lactation consultant. If the lip tie is not causing issues with breastfeeding for the infant or the mother, it may just need monitoring for any complications as the child grows. Spoon feeding and eating finger foods should be assessed to ensure the lip tie condition is not affecting the child’s lip movement (3).

If the child fails to thrive, the doctor may conclude that the state of the lip tie is one of the causes. They may suggest doing a frenectomy of the membrane connecting the lip to the gums. This procedure can be performed using a sterilized surgical scissor and causes the baby very little pain or discomfort (3).

Tongue and Lip Ties may cause difficulties, but are easily treated at any age.

As you can determine after reading the information above, tongue-tie and lip tie are very similar. They are usually discovered in newborns, either in the initial hospitalization following birth, or soon after. If not caught at birth, the infant may have difficulty breastfeeding, and the mother may have pain or find it very frustrating to continue breastfeeding (1, 2, 3).

Mothers of infants with tongue-tie or lip tie may experience the following when trying to breastfeed (1, 2, 3):

  • Pain during or after feedings
  • The feeling of engorgement even immediately following breastfeeding
  • Blocked milk ducts or mastitis
  • Fatigue because you are constantly nursing, and your infant never seems full

Tongue-tie or lip tie can cause many complications for infants, children, and adults. If an older child has speech difficulty, it may indicate that they are tongue-tied or lip tied. It can also impede the activities such as licking ice cream from a cone, licking the lips, kissing, or playing a wind instrument. Adults may find that the tongue-tie or lip tie they have been dealing with most of their lives is now causing more of an obstacle and may seek medical help (1, 2, 3).

Depending on the severity of the condition, it may be able to be monitored only if not causing issues with the use of the infant, child, or adult’s mouth. It also can be treated by a pediatrician, primary care physician, or an oral surgeon with a minor procedure. The frenectomy procedure corrects these conditions by snipping the band to separate these structures. The process can be done in the hospital or doctor’s office without needing anesthesia, and the infant usually has no pain (1, 2, 3).

Any condition that needs to be addressed in your newborn or your child at any age can cause some anxiety. Tongue-tie and lip tie can cause this stress, but be assured that they are circumstances that can be easily managed and corrected (1, 2, 3). Our dental associates can answer any questions you may have regarding these conditions. Contact our staff at Jungle Roots for assistance!

At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.

Call Us - (480) 759-1119

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