Tongue and Lip Ties
General Information
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Everyone has a lip and tongue frenum, but only those that restrict normal movement and/or cause symptoms are considered “tied”. The following symptoms may indicate the presence of a tongue or lip tie, but a full in-person assessment is required to diagnose. Many symptoms can also have other causes, so it is important to have a complete functional exam.
Possible symptoms for breastfeeding parents
-cracked, blistered or bleeding nipples
-pinched or “lip stick” shaped nipples after nursing
-plugged ducts or mastitis
-pain or discomfort while nursing
-baby slips off during feeding
-thrush
-low milk supply
Possible symptoms for baby
-reflux or colic
-difficulty latching
-gumming or chewing nipples or bottles
-gassiness
-poor weight gain
-clicking while nursing
-excessively long nursing sessions
Possible symptoms in children or adults
-difficulty pronouncing L, T, D, N, Sh, Th, or S
-inability to touch tongue to roof of the mouth
-problems moving tongue side to side or clearing food from the teeth
-snoring or sleep disturbances
-dental problems- cavities, recession, gaps
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All breastfeeding infants/children should be seen by a qualified International Board Certified Lactation Consultant (IBCLC) prior to the release procedure. Non-breastfeeding babies/children and all adults should be seen by either an IBCLC, qualified Speech Language Pathologist (SLP), feeding specialist or Oral Myofunctional Therapist (OMT) prior to release. Please ask your provider to send a report to us prior to your appointment date. cdccinfo@comcast.net
For your convenience, we are pleased to offer Myofunctional Therapy in-person in our office and virtually with Cindy, our Certified Orofacial Myologist.
Most patients begin oral exercises given to them by their IBCLC/SLP/OMT prior to being seen in our office and most patients require bodywork from a skilled provider (Chiropractor, CST, PT, OT) to address tensions throughout their system both before and after release.
Please bring any pain management remedies you plan to use to your appointment. These may include homeopathy, Tylenol, Ibuprofen, or other remedies. Please discuss your plan for pain management with your primary care providers prior to your appointment with us. We ask that infants refrain from feeding for 1 hour prior to their appointment.
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A tongue/lip tie release is called a “frenectomy”. The release itself is a simple procedure performed in-office without the need for general anesthesia (being put to sleep). Some toddlers or children with some special needs may require the use of sedation which is not available in this office. We can provide these children with a referral when needed. We do offer laughing gas (nitrous oxide) for children over age 4 years.
Unfortunately, parents or visitors are not allowed in the room during the procedure due to office safety regulations, but babies are typically only separated from caregivers for 3-5 minutes or less.
Babies are swaddled and stabilized in our dental chair by an assistant to minimize movement during the procedure. Older children may receive an injection of local anesthetic.
A LASER is used to complete the release procedure which takes about 10-20 seconds or less per site. Babies do cry during the procedure, but they are typically soothed very quickly afterward.
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Babies are returned to their family to feed or soothe immediately following treatment and are welcome to stay as long as needed. Dr. Wehmeyer will assist with initial feeding/nursing and soothing.
Post-procedure wound care is very important for patients of all ages to help prevent the sticky edges of the wound from reattaching back to where they started. Please read and follow wound care instructions from Dr. Wehmeyer and other providers carefully. In addition, Dr. Wehmeyer and your IBCLC or OMT may recommend specific oral exercises to help your child gain proper function.
Dr. Wehmeyer generally sees patients back for 1 or 2 follow-up visits to check on wound healing and improvement in function. These can sometimes be completed via Zoom.
Careful follow-up with your IBCLC, bodyworker, OMT and/or other referring providers is critical to success.
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Puppet wound care demo: https://vimeo.com/518192415
Wound care (Ghaheri) http://www.drghaheri.com/aftercare/
Wound care (Newman) https://youtu.be/jCQ6xBAbbhA
Sleeping tongue lift: https://www.youtube.com/watch?v=ucmK28dZ3X4
Suck training exercises https://youtu.be/W4N7VoMn AND https://youtu.be/W4N7VoMn1C8 1C8
Information on bodywork https://youtu.be/ciTx4KkerWU
Why ties are more than just the procedure http://www.michalechatham.com/blog/tether-berg-or-tether-floe
Choosing a lactation consultant http://www.second9months.com/choosing-your-lactation-consultant/
Need for a team approach to ties http://www.drghaheri.com/blog/2014/3/13/it-takes-a-team-to-improve-breastfeeding-after-a-tongue-tie-procedure
Breast compressions https://breastfeeding.support/what-is-breast-compression/ and video at https://youtu.be/rS0QANEXezE
Help for a nursing strike https://rachelobrienibclc.com/blog/7-tips-for-ending-a-nursing-strike/
Weaning off a nipple shield https://rachelobrienibclc.com/blog/my-ten-step-process-for-weaning-from-the-nipple-shield/
Bottles for breastfed babies: https://www.rachelobrienibclc.com/blog/bottles-for-breastfed-babies-introducing-a-bottle-part-1/
Dealing with stress https://rachelobrienibclc.com/blog/stress-and-breastfeeding-protect-milk-supply/
“Flipple” exaggerated latch technique https://youtu.be/deKN3wJ17Mk
Asymmetric latch http://www.lactation-911.com/how-to-asymmetrical-latch/
Laid back nursing https://youtu.be/KYRg8DTbZCc
“Natural Breastfeeding” position https://youtu.be/diuGQhbjC6s
Myofunctional exercises
1. Breathing exercises https://youtu.be/65tlxqQ4A3A
2. Before and After frenectomy https://youtu.be/ouuIOo5F0aQ
Websites with more information
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Yes, patients should be actively working with an IBCLC, OMT, feeding specialist or SLP prior to and following frenectomy procedures. Bodywork is also recommended pre-and post-release.
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We treat patients from birth to adult with the exception of children between approximately 24-48 months. Children in this age range typically do not tolerate the procedure or the aftercare very cooperatively. In critical circumstances, we will treat children these ages, but this is assessed on a case-by-case basis. We are happy to give referrals for sedation or to delay treatment until the child is older if we are unable to treat the child in our office.
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We use a state of the art CO2 laser made by LightScalpel. This is a 10,600nm wavelength laser that is well suited to soft tissue procedures.
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We follow all federal and state guidelines for LASER safety including (but not limited to) requiring eyewear, suction, safety training, and restriction of personnel in the room.
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We use topical numbing jelly on infants when requested. We use local anesthetic (injected) on toddlers and older children. Please feel free to make requests regarding numbing.
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We do not use sutures on infants or toddlers. We do not generally use sutures for older children or adults but they may occasionally be indicated.
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We do not recommend “stretching” the wound, however, we do recommend “active wound management” as well as strengthening/training exercises. Please see our after-care handouts for more details.
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Wound care should be started 4 hours after your procedure and continues every 4 hours for the first week. It tapers off after that, according to a schedule we will provide.
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Thousands. We do this procedure multiple times a day, every day. Dr. Wehmeyer has been doing it since 2007 and is a gum specialist (periodontist) with 4 years of specialty training after graduating from dental school. She’s also an Internationally Board Certified Lactation Consultant. We often have patients travel several hours for appointments with Dr. Wehmeyer.
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Yes, Dr. Wehmeyer is a periodontist (specialist in gum surgery) as well as an IBCLC. She is continuously taking additional continuing education on this topic. She has taken in-person classes with Bobby Ghaheri, Larry Kotlow, Martin Kaplan, Lisa Lahey, Sharon Vallone, Bryna Sampey, Jennifer Tow, Jeff Rouse, Bob Convissar, Barry Raphael, Meghna Dassani and more. She also completed special training in LASERs from the Academy of Laser Dentistry.
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No-unfortunately our office safety policies do not allow parents or others to be in the room for infant frenectomies. However, the procedure takes only seconds, and children are typically returned to their parents within 3-5 minutes.
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Yes, we encourage breastfeeding or bottle feeding immediately after the procedure. Older children who are numb should not eat any solid foods until the anesthetic has worn off to avoid biting their tongue. Drinking and using straws is fine.
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Yes, however, I don’t recommend the use of pacifiers for more than a few minutes at a time since they encourage the tongue to rest on the floor of the mouth which can lead to reattachment and low tongue posture. Use it only for short periods and only when absolutely necessary.
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It depends! Some families see improvements immediately, but most families report that after the procedure it takes about a month of working with their IBCLC, myofunctional therapist, etc. to “habilitate” proper function.
FAQ
More Questions?
We are happy to answer additional questions. Please give us a call or contact us via email.
