> Tongue-Tie

Tongue-Tie Surgery in New York and Philadelphia

What It Is

// TOTsDOC: Tongue-Tie Surgery

What is a tongue-tie?

Tongue-tie, also known as "ankyloglossia," is a condition present at birth that restricts the tongue's range of motion. With a tongue-tie, an unusually short, thick, or tight band of tissue (also called the lingual frenulum) tethers the bottom of the tongue's tip to the floor of the mouth. 

 

Tongue tie treatment procedures have been performed by doctors for a long time. However, most pediatricians across the U.S. do not commonly perform corrective procedures for tongue-ties. 

 

TOTsDoc is the first provider in the U.S. that offers tongue-tie treatment. We have developed a comprehensive, evidence-based and non-invasive program to treat tongue-ties.

We believe that tongue-tie can pose a major obstacle for healthy feeding and oral function.

> Did you know? =)

TOTsDOC is a leading provider of Tongue and Lip-Tie Surgery.

The Symptoms

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What are the symptoms of having a tongue-tie?

Tongue-tie can cause a number of problems with feeding, speech and sleep. 

Breastfeeding

Breastfeeding can be compromised and become unsustainable when the presence of a tongue-tie limits the tongue’s normal range of motion. An upper lip tie can limit the ability of the baby’s upper lip to form an adequate seal while breastfeeding. This can cause discomfort, difficult feedings, poor weight gain, and stress for parents, baby, and the whole family. Babies with tongue-tie aren't able to open their mouths wide enough to latch on to the breast properly.

 

During breastfeeding you may experience:  

  • Bleeding, cracked, scabbed nipples

  • Difficulty bonding with the baby

  • Frustration and anxiety associated with breastfeeding

  • Low milk supply

  • Mastitis (inflammation of the breast)

  • Nipple “flattening”/ whitish compression stripes

  • Plugged milk ducts

  • Severe nipple pain while breastfeeding

  • Thrush

  • Vasospasms

Your child may experience:

  • Clicking sounds on the breast

  • Difficulty latching and/or maintaining a deep latch

  • Frequent unlatching and re-latching

  • Frustration and/or breast refusal

  • Fussiness at breast and in between feedings

  • Gassiness

  • Leaking/dribbling on the breast

  • Persistent suck blisters

  • Poor weight gain

  • Spitting up frequently

  • Tucked upper/lower lip when on the breast

Bottlefeeding

Feeding your baby should be a wholesome and beautiful experience. We understand that there are many choices for bottle feeding available and at times the process can be difficult and frustrating. At times, the difficulty and discomfort a baby is experiencing during and after a feeding can be related to restriction in the tongue caused by a tongue tie. This can cause discomfort, difficult feedings, poor weight gain, and stress for parents, baby and the whole family. 

 

Your child may experience:

  • Bottom lip moving back and forth, on and off the nipple when feeding

  • Chewing/gumming the bottle nipple

  • Difficulty latching to the bottle

  • Dribbling while feeding

  • Falling asleep/fatigue during bottle feeds

  • Gagging when bottle nipple is presented

  • Gassiness, air intake, frequent spit ups

  • Needing to trial SEVERAL bottle systems to find one the child will take

  • Prolonged feeding times

  • Pulling away from the bottle frequently

  • Upper lip curling inwards when sealed on the bottle

Solid Foods

We understand that there are many choices for solids available and at times the process can be difficult and frustrating. We want to help you whether you are just starting the transition to solids, already on your way to stage 3 foods, or more. 

 

Your child may experience:

  • Avoiding certain foods

  • Difficulty with complex solids 

  • Difficulty with textured foods

  • Dipping foods excessively to moisten it

  • Excessive spillage of food from the mouth

  • Extremely small bites of food, and prolonged times to clear this

  • Gagging with purees/ spoon feeding

  • Needing to drink a liquid between bites to clear the food

  • Pocketing of foods in cheeks and/or the roof of the mouth

  • Prolonged mealtimes and frequent reminders to chew, to take another bite, to not pocket foods

  • Tongue thrusting when foods are presented

Speech

An undiagnosed or untreated tongue-tie may negatively affect speech. If your child is struggling with certain sounds and words and has been assessed by a speech therapist, we encourage you look further into the possibility of tongue-tie causing issues with speech. We believe that there can be several causes for speech problems and tongue-tie is just one of the possible reasons. 

 

Your child may experience:

  • Difficulty with sounds like L, T, D, N, SH, TH, R, or S

  • Lisps

  • Prolonged need for speech therapy with slow progress

  • Speech that sounds “slushy” or unclear

  • Unclear speech when sentences are longer, and conversations are more complex

Sleeping and Breathing

An undiagnosed or untreated tongue tie may negatively influence overall health and well-being, leading to an increased risk for physiologic alterations resulting in poor breathing and sleep quality. 

 

Your child may experience:

  • Breathing through the mouth instead

  • Daytime fatigue

  • Dry, cracked lips

  • Excessive drooling

  • Frequent sore throat

  • Gagging, coughing, or choking during feeding and/or sleeping

  • Obstructive or apneic periods during sleep

  • Persistent nasal congestion and sinus symptoms

  • Snoring

 

> Did you know? =)

The natural jaw movements and suck motions that take place during breastfeeding assist in creating optimal shape and function of the head, neck, mouth, and sinus cavities.

The Treatment

// TOTsDOC: Tongue-Tie Surgery

How to treat a tongue-tie?

At TOTsDOC, we use advanced dental technology to provide treatment that is safe, effective, and often painless. During tongue-tie procedures, our doctors use a CO2 laser (also known as a “cold laser”) to release the frenulum.
 
In comparison to the traditional use of a scalpel or “hot” laser, cold laser technology accelerates the healing process. The cold laser seals blood vessels so the patient experiences little to no bleeding. By using the cold laser, there is no need for sutures. The laser sterilizes the wound so the risk of infection is very minimal. With this technology, tongue-tie procedures can be completed safely and in a short period of time.

What is a Lightscalpel Co2 Laser?

The LightScalpel CO2 laser is a device that produces a concentrated beam of light. This laser beam vaporizes tissue, while sealing blood vessels at the same time.

What is Laser Surgery and how does it work?

Traditional surgery with a scalpel or scissors can bruise or crush tissue.  By using the LightScalpel CO2 laser (a light that interacts with the oral tissue), we can prevent trauma to the tissue while keeping a very narrow coagulation zone – almost the width of a human hair. The LightScalpel CO2 laser has the unique ability to vaporize or ‘erase’ tissue. The LightScalpel CO2 laser can be used to make incisions, as well as to remove unhealthy tissue. Our laser is so precise that it can selectively remove only a few cells at a time if needed. At the same time, it is powerful enough to remove the largest of tumors.
 

Are Lightscalpel Laser procedures safe?

The laser is as safe as other instruments. Your child will wear special protective glasses, just as you would to protect your eyes from sun exposure. Years of experience in medicine and oral surgery went into the design of the LightScalpel laser, which was made to provide superior care for our patients.

Is Laser Surgery appropriate for my child?

The LightScalpel CO2 laser can perform a wide variety of surgical procedures. Schedule a consultation with us to find out if your child is a candidate for laser surgery.

 

> Did you know? =)

TOTsDOC is a leading provider of Tongue and Lip-Tie Surgery and provides complimentary virtual consultations!

After Care

// TOTsDOC: Tongue-Tie Surgery

Why are post-surgery exercises key?

Post-surgery exercises are the key to the healing process.

 

Frenectomy wounds heal very quickly. Without proper post-surgery exercises, the new tissue can prematurely reattach at either the tongue or lip site, causing a new limitation in mobility and the return of tongue- or lip-tie symptoms.

Remember this: 

 

1) An open oral wound will contract towards the center of the wound as it is healing 
2) If two raw surfaces in the mouth are in close proximity, they will reattach

3) With every set of exercises, check for re-attachment by noting the size and shape of the white diamond

4) A small amount of bleeding and some crying is common after treatment and after exercises

 

Be consistent and don't be discouraged. Post treatment exercises are critical to ensure proper healing.

Exercises

 

Start when your baby is in a quiet alert state or early active alert state. Talk in a pleasant voice, smile, sing, laugh, and make eye contact with your baby so this is playful and reassuring for them.

Coming from behind, insert both index fingers into the mouth. First insert one in the mouth and then go towards the cheek to stretch out the mouth. This will make room for your other index finger. 

The tongue needs three separate stretching exercises:

 

  • First exercise: Once you are under the tongue, pick the tongue up as high as it will go towards the roof of the mouth. Hold the tongue in this position for a maximum of 2 seconds, and then relax the tongue.

  • Second exercise: With one finger propping up the tongue, place your other finger in the middle of the diamond, turn your finger sideways, and use a lifting motion from low-to-high. Keep the diamond as deep as possible. Use a lifting motion when you sweep through the diamond and separate the horizontal fold across that diamond. 

  • Third exercise: Gently massage outside of the diamond on either side to loosen up the remainder of the musculature on the floor of the mouth. As you massage, carefully apply gentle pressure around the areas surrounding the diamond.

 

Exercise Schedule

 

Avoid these exercises immediately before or after a feeding. The best time to perform post-op exercises on your child is immediately before or after a diaper change. 

  • Day 1: Perform the exercise during the evening

  • Week 1 - 3: Stretches should be done 5 times per day

  • Week 4: Taper exercises each day until quitting completely at the end of the fourth week. For example, day 1 of the fourth week, you will do 6 post-op exercises. Day 2 you will do 5 exercises. Day 4 you will do 4, and so on.

Checking for Re-Attachment

With every set of exercises, check for re-attachment by noting the size and shape of the white diamond.

  • The white diamond should remain the same size and shape: it should not get smaller or disappear

  • If you detect re-attachment, please call the office for further instruction. Some re-attachment is expected, but minimizing it with exercises is important for over-all improvement.

Pain Management

Proactive pain management is very important. Initially, your child’s mouth will be numb at the site of the procedure. This will last for approximately 2 hours. For most children, the first 72 hours are the hardest. The use of Tylenol or Ibuprofen based on your child’s age and weight will be helpful. Please call if your child is using Tylenol or Ibuprofen frequently past 3 days.

  • Tylenol​: Please refer to the Tylenol Dosing Chart given to you for the appropriate dose for your child. 

  • Ibuprofen (over 6 months of age): Please refer to the Ibuprofen dosing chart given to you for the appropriate dose for your child. 

Other Tips

The most important factor to recovery is consistency with these exercises. However, here are some tips that will help you succeed throughout the healing process:

  • Always wash your hands with soap before performing these exercises

  • Stretches are not meant to be forceful or prolonged

  • Be gentle, quick, and precise with your movements

  • Use a LED headlight to have plenty of vision into your baby's mouth 

  • Place your baby on a bed or in your lap, with their feet facing away from you

​If you have any other questions, please feel free to contact us.

 

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