What Is Tongue Tie? Lip Tie? Oral Restriction?

Infant oral restriction refers to any structure in the mouth that could be limiting normal range of motion, usually resulting in symptoms. This can include tongue and lip ties. Tongue tie, also known as ankyloglossia, occurs when the tissue between the undersurface of the tongue and the floor of the mouth, called the lingual frenulum, interferes with the normal movement of the tongue. Tongue tie restricts normal range of motion of the tongue and can adversely affect infant feeding, including breastfeeding and bottle feeding. Lip tie occurs when the tissue between the undersurface of the upper lip restricts normal range of motion resulting in symptoms adversely affecting infant feeding. When it comes to infant feeding, tongue tie and lip tie are associated with persistent pain with latch, slow or poor infant weight gain, reflux and low milk supply. Find photos of different presentations of lip and tongue ties here.


What Causes Tongue Tie?

Tongue Tie occurs when the frenulum, the tissue under the tongue that connects to the floor of the mouth, is short and fails to develop properly during gestation in the womb. It is an embryological remnant that failed to recede and results in poor tongue mobility. The exact cause of tongue tie is unknown, however, it is an autosomal dominant condition, more common in males and associated with a mutation in the TBX22 gene. There is ongoing research as to the cause of the gene mutation that is associated with tongue tie, including research theorizing MTHFR mutation may play a role, however no strong evidence has been found.

What is the Difference Between a Frenulum and Tongue Tie?

Everyone has a frenulum! A frenulum is simply a piece or fold of tissue that secures a mobile organ or muscle to the body. Just because you can see a frenulum under your baby's tongue or lip does not mean that they have tongue tie or lip tie. It could just be a normal, flexible frenulum. It is only tongue tie or lip tie if it restricts normal mobility resulting in symptoms. Below are photos of different frenula. In our office we use a few different tools to grade and type the frenulum. Grading or typing alone does not diagnose a tongue or lip tie.

 

A tongue or lip tie should only be diagnosed if it has all three components:

1. Appears short, tight or restrictive (usually using a standard grading or typing tool)

2. Limits normal function and mobility

3. Results in symptoms

Tongue or lip tie is clinically significant due to appearance, function and symptoms. That means that in addition to the appearance qualifying as tongue or lip tie, the function must also be impacted and the limited function results in symptoms. Symptoms vary depending on the age of the infant or child, method of feeding, severity of restriction and conservative therapy measures the family has been incorporating. 

 
 

Lingual Frenulum Type

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Maxillary Frenulum Type

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What are signs and symptoms of infant oral restriction?

Signs and symptoms of infant tongue and lip ties include:

- Difficulty nursing/ breastfeeding or bottle feeding

- Painful latch

- Sore nipples (often looking misshapen and flattened after baby unlatches)

- Infant reflux

- Slow infant weight gain

 

Additionally we see many babies with ties in our clinic that also have difficulty making and maintaining a seal while nursing at breast or bottle. These babies slip off the breast or bottle frequently, make noises while feeding that sound like smacking or clicking and get fussy through let down or if the flow of milk is too fast. They can leak milk while feeding and are not always satisfied after what seems like a full feeding. Over time we see these babies present with slow weight gain, despite feeding frequently as they appear to have difficulty getting the milk out while nursing.

 

 

What is the treatment for tongue and lip tie?

Treatment for tongue and lip tie is a minor surgical procedure called frenotomy or frenectomy. At our clinic we perform frenectomy using a CO2 laser. We have dedicated our practice to delivering the highest quality lactation, breastfeeding and postpartum care to our clients and community. This high standard care incorporates the latest technology to better meet your needs.

 

After completing hundreds of tongue and lip tie procedures using other modalities, our team has incorporated laser technique to provide release of infant oral restriction (tongue, lip etc.) in our office. This is called laser frenectomy where a highly focused CO2 laser beam vaporizes, cleanly and precisely, while sealing blood vessels at the same time. The laser frenectomy takes between 5 and 15 seconds to perform, babies and parents are in our laser room for 5 to 10 minutes. 

 

In the hands of our experienced provider, the CO2 cold laser provides a safe, precise and often bloodless procedure to release the restriction and babies feed immediately after. We provide comfort measures in office to reduce pain and make the experience positive for everyone involved. A Board Certified Lactation Consultant remains with you and baby after the procedure to help with latch and develop a feeding plan if needed. 

 

In addition to this advanced technique, we incorporate lactation, breastfeeding support and infant feeding support in every visit. We also provide evaluation and same day procedures as we know that appointments with a new baby can be challenging. We have close follow up with lactation support and infant oral functioning support in the days and weeks following the procedure.

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Before
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Immediately After Laser Frenectomy
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Before
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Immediately After Laser Frenectomy
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Copyright Pacific Wellness & Lactation

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Copyright Pacific Wellness & Lactation

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Copyright Pacific Wellness & Lactation

 
 

Aftercare

Supporting gentle and mobile healing.

Aftercare includes gentle exercises that are both in and outside of the infant's mouth. These are completed to encourage lots of tongue and lip movement during healing following frenectomy. We find that when babies move their tongues and lips more during the healing process, they heal with more flexibility and maximized mobility.

FRENECTOMY AFTERCARE

Start infant tongue and/or lip stretches 6 hours after the procedure:

Using gentle pressure, use a clean finger under your baby's tongue and/or lip and gently lift 4 times a day for 2 weeks or until we see you again. A white patch will develop where the frenectomy was performed, this is normal healing.

Use infant pain relievers according to provider given directions. The dosing for these are often based on the weight of your infant. If you have questions please call your provider.

TONGUE EXERCISES:

Mimicking/ Copy Cat - stick your tongue out at your baby when you enjoy face time. Or trace your baby’s bottom gums with your finger.

Gentle Massage - gently massage around your baby's mouth, lips and jaw. Then trace your clean finger along your baby's gums, their tongue will follow.

Tug of War - use a clean finger (if your baby uses a pacifier or bottle, ok to use these!) use gentle downward pressure on your baby's tongue while your baby sucks and pull out until you meet resistance, then release.

LIP EXERCISES:

Sweep - gently sweep your finger under your baby’s lip from side to side

 

Gentle Massage - gently massage around your baby's mouth, lips and jaw.

 

Lip Hold - Hold finger between upper cheek and upper gums for gentle stretch. 

 

Seek immediate care if your baby develops: 

Fever of  >100.4F

Bleeding that does not stop

Refusal to feed

*Videos of aftercare exercises coming soon...

In addition to using our clinical experience, we pride ourselves on using science based and evidence based practices and care techniques. For a list of our references please see our References Page.