What is tongue tie release (frenectomy)?

Tongue tie (ankyloglossia) or lip tie is when the frenulum under the tongue or lip is too tight causing some unwanted restriction. Such restriction is usually first discovered during breastfeeding as babies can not latch on properly which can result in limited milk intake and aerophagia (excessive air swallowing) for babies. This also leads to pain during breastfeeding for the mom. Tongue and lip ties can also lead to long term issues such as dental decay, speech problems, digestive issues, diastema, early childhood caries, breathing problems (sleep apnea), and even trouble with playing wind instruments. Approximately 10% of the population has this condition. Most babies with a tongue tie also have a lip tie issue, and vice versa. We recommend releasing both at the same appointment. A simple procedure can be done with either scissors or laser to relieve the restriction (I prefer laser due to the cauterizing properties). The procedure itself usually does not take more than 30 seconds.

Does my baby need the procedure?

Breastfeeding should not be painful. If mom finds that is not the case, there is a good chance there is a tongue tie issue. Aerophagia (swallowing air which leads to gassy babies or stomach irritation) and trouble putting on weight can both be the result of tongue/lip tie issues. Not all tongue/lip ties cause breastfeeding issues and not all tongue/lip ties need to be released. If the baby is suspected to have tongue/lip tie issues, an examination/consultation would be recommended. The younger the babies are the easier it is to do the procedure and shorter time for babies to get used to his/her new tongue/lip motions. Babies older than 6 months may not be able to have the procedure done (weight and strength dependent) due to mobility.

How to prepare for and what to expect during the procedure?

If you are having breastfeeding issues and haven’t been seen by your midwives or a lactation consultant (IBCLC), we highly recommend you to have an assessment by them before the appointment with us. We ask moms to bring babies wrapped in a muslin blanket for the procedure. The procedure can be done with both scalpel/scissors or laser. We mostly use lasers for better fine control and less bleeding (most of the time there is no bleeding with a laser). Make sure you have infant Tylenol for possible discomfort after the procedure (and go by the dosage that is labeled on the bottle, which is based on babies’ weight). General anesthesia is almost never needed for the procedure. We ask parents to not be in the room during the procedure due to laser safety regulations (most of the time less than 5 minutes). The actual procedure is usually only around 30 seconds. Most of the time is spent getting everyone involved and the baby in the right position. We encourage moms to breastfeed right after the procedure to both calm the babies down and stretch the tongue/lip.

Recommended sucking exercises prior to the procedure?

It’s important to remember that you need to show your child that not everything that you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises. Starting these exercises from the moment you make your appointment can speed up your recovery after the procedure. The following exercises are simple and can be done to improve suck quality. Aim for 4 times a day leading up to the day of your procedure.

1. Slowly rub the lower gum line from side to side and the baby’s tongue will follow your finger. This will help strengthen the lateral movements of the tongue.

2. Let your baby suck on your finger by doing a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This will strengthen the tongue. This can also be done with a pacifier.

3. Let your child suck your finger and apply light pressure to the roof of the mouth. Once the baby starts to suck on your finger, just press down with the back of your nail into the tongue. This usually interrupts the sucking motion while the baby pushes back against you. Listen for a seal break (clicking sound) and then put your finger back up into the palate to re-stimulate sucking. Repeat if possible.

4. With one index finger inside the baby’s cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.

What to expect/do after the procedure?

Many moms experience immediate breastfeeding pain relief after the procedure. However, sometimes it will take a few days to a week or two for babies to get used to it (the younger the baby is, the quicker they get used to it). Stretching exercises to prevent re-attachment are very important. I will demonstrate how to do this during the appointment. Note that sometimes tongue tie is not the only issue that leads to breastfeeding problems; chiropractic treatment, massage, and CST (cranial sacral therapy) may also be needed. In some rare cases, there will be a bit of a rough patch where the baby’s feeding would get a bit worse. This usually is very limited to a day or two and should bounce right back.

How do you charge for the procedure and do you take insurance?

This procedure is under the scope of dentistry and is considered a surgical procedure. Most, if not all, private dental insurance covers surgical dental procedures. However, parents should always check with their own insurance provider or contact our receptionists to see what percentage of the fee will be covered. We follow the BCDA (BC dental association) fee guide and it does not make a difference if you refer yourself or if you are referred through your midwives/physician.

Research studies regarding frenectomy

• Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study

• Newborn Tongue-tie: Prevalence and Effect on Breast-Feeding

• Breastfeeding Improvement Following Tongue-Tie and Lip-Tie Release: A Prospective Cohort Study

• The Efficacy of Lingual Laser Frenectomy in Pediatric Obstructive Sleep Apnea Syndrome: A Randomized Double-Blinded and Controlled Clinical Study

Lecture by Dr. Chen regarding frenectomy

• Ankyloglossia in Infants, a lecture by Dr. James Chen for UBC Dentistry on Sept. 28th 2022

Patients’ experiences/stories

From mom Stephanie with Baby R:

I’m taking the time to sit down and write this because I am so very grateful for the work that Dr. Chen and the rest of the staff do to release oral ties for babies like my son.

Prior to Christmas, Baby R was nearly 4 months old, weighed less than 9 lbs, had constant spitting up, reflux controlled (barely) by a ppi, snored, had torticollis, cried anytime he was put on his back, woke hourly overnight, screamed in his car seat, and on December 24 he was given a diagnosis of Failure to Thrive. I’d had issues with pain and poor latch while starting to breastfeed and constant clogs. I was advised to put Robbie on formula to fix his problem. Our appointment with Dr. Chen was January 8, which I remember as the day everything changed. I was so nervous coming in. But the staff were so reassuring and Dr. Chen communicated clearly about the procedure and follow-up care. He was able to confirm the tongue tie and a lip tie. There was an immediate difference after the procedure when I was breastfeeding Baby R. The pain I experienced from the beginning was gone! Within the week I was able to stop pumping. Since January, Baby R has gone from being below the growth chart to being in the 10th percentile. He’s an active 10 month old who never sits still, but he’s still gaining weight faster than most babies his age which is allowing him to catch up. As an added bonus, he LOVES solids and has had an easy introduction to food thanks to having a properly functioning oral cavity.

Thank you again SO much for the work you do!

Sincerely,
Stephanie

From mom Katie with Baby H:

My Son baby H had both his lip and tongue tie revised back in October.

I know that he was older so it was a bit of a different experience and other than some discomfort for a few days after the procedure the healing after really went well.

I wanted to say thank you. The difference was huge! I have been able to wean myself off the breastfeeding medication to keep my supply up for baby H as he does it himself. He nurses like a champ now! Not only has this allowed him to keep the supply up himself but it has also continued to help with what was exhibiting as allergies (but was instead a milk production issue) for him. His intestinal inflammation, which was causing blood in his stool, is completely healed and he is no longer in constant pain.

I really appreciate the care you and the whole office gave to us.

Sincerely,
Katie