Infant Tongue Tie Clinic FAQs
These are common questions which are asked by our patient´s parents in relation to tongue and lip ties
Infant Tongue Tie Clinic FAQs
 

1. Is there a difference between “tongue tie”, “tongue tether”, “oral restriction”, or “ankyloglossia”?

All the above are interchangeable terms which related to the lingual frenum causing restriction of movement in the tongue.  This refers to the condition where the tongue is restricted and do not function as good as it could be.

 

2. If my child has a lip-tie, will they 100% have a tongue tie?

Tongue and lip ties are the result of a failure of cell death (apoptosis) along the midline of the head and neck at 12 weeks in-utero following the development of the tongue and lips in-utero. This failure of apoptosis almost always affects both the lip and tongue. This does not mean that both will always need treatment. It is our experience that for breastfeeding infants, the lip usually contributes to the presenting symptoms. For older children, a more severe lip ties will result in spacing in between the 2 upper front teeth. 

 

3. What happens if we do not treat the lip or tongue tie? What are the life-long implications?

In infancy: breastfeeding difficulties are common, as well as colic and reflux. 

In childhood: speech difficulties, poor jaw growth /dental crowding and fussy eating are common. 

In adulthood: head and neck tension, snoring and sleep apnoea may be related

 

4. I think my child has a tongue tie. Is treatment always necessary?

To make a proper diagnosis, a proper functional history (discussion of any symptoms your child has had) is essential. Also, a functional assessment (observing the tongue during function), as well as palpation assessment, feeling under the tongue is necessary.

Many health professionals are not aware of the implications of not treating a tie. Often, the thought process is that providing the baby can put weight on (with difficult breast feeding, bottle feeding) then there is no point in treating. The problem is that normal tongue function is super important throughout life, and particularly during growth. The tongue drives the growth of the mid face and jaws, so a tied tongue will usually result in a narrow and small jaw with dental crowding later. Furthermore, the tongue affects overall body posture, especially head and neck. It’s important in speech, swallowing and talking as well. So, if there is a tongue tied, ideally it would be treated as soon as possible to attempt to limit the chances of severe dental crowding, lack of jaw growth and other future problems.

 

5. Is laser different to using blades such as scissors in tongue tie surgery?

The most important factor in the success of any surgery is always going to be the operator. The operator must have done the necessary training to ensure competence and must have had plenty of experience to give a better chance of success. Dr Le is trained by The Tongue Tie Institute, has performed numerous tongue and lips tie release for infants, children and adults.

In relation to laser vs scissors:

A laser “ablates” (vaporises) the tissue. It does not cut or crush the tissue like scissors. It also seals nerve endings to reduce immediate post-op pain and helps to coagulate to reduce bleeding. A laser is extremely accurate. In the hands of an experienced operator like Dr Le, laser gets the job done with minimal trauma to adjacent tissues.

 

6. What will happen at my appointment for my infant?

• Preparation for your consultation 

We will send you some important documents with lots of information to prepare you for your consultation. We assume that you are already seen a lactation consultant, and / or  a body worker (chiropractor / osteopath / physiotherapist).  

 

• The consultation 

A through consultation is essential for effective diagnosis and for educating parents in how to best care for the infants in the post-operative period. Usually this consultation will be a joint consultation with our dentist and your lactation consultant.

 

• The procedure 

Laser tongue and lip tie surgery is quick and effective. Throughout the procedure our dedicated staff will be there to sooth and talk to your child. Immediately post-operatively your lactation consultant should be there to assist with the feeding and after-care. Skin-skin contact is provided for as much of the process as possible. You will have as much time as you like to feed and soothe your baby. We have a dedicated, relaxed room you can use if you wish to stay longer than your normal appointment time.

 

• The 1-week review 

Our protocol involves you returning to our clinic 1 week later for a free review appointment. This helps to ensure that everything is going according to plan

 

7. Is anaesthetic used for infants?

Consistent with the approach endorsed by the Australian Dental Association, the application of anaesthetic will depend on the age of the patient and nature of the procedure. Due to potential complications associated with injectable anaesthetic, these are not used in very young children. In addition, the effect of anaesthetic prevents effective breastfeeding immediately after the procedure which is important for healing, for settling and comforting the child post-surgery, and to enable the breastfeeding latch. In slightly older, non-breastfeeding children, a strong topical anaesthetic gel may be applied. For many young children, the taste of the anaesthetic and the feeling of being numb from the anaesthetic is more disconcerting than the feeling of the laser release. Parents who wish to, may give an age appropriate analgesic like Panadol to their child about an hour before surgery.  The preparations containing ibuprofen (like Nurofen or Advil) and aspirin should not be used.

 

8. Will there be pain after surgery?

Most of our little patients settle within a minute or two after the procedure during the post-op feed. Most babies leave the clinic either asleep, or very calm after having been fed. The babies do not appear to be in any pain at that time. Later on, normal inflammation happens as a part of healing and so we will advise you of your options for pain relief.

These can include:

• Baby Panadol providing the baby is over 4 weeks old and is the correct weight (for the dose)

• Homeopathic remedies such as “drops” which contain Arnica and other herbs

• Frozen breast milk, grated into icicles and applied to the mouth

• Skin-to-skin contact

 

9. Can I be present in the room during surgery?

We would never stop you being there is that is your choice. However, for the following reasons we prefer that you remain in the consultation room:

• We like to focus on the baby and not be concerned for your emotional or physical wellbeing during surgery

• We like you to be as relaxed as possible after the procedure as you will be required to soothe and feed the baby

• We like to keep the number of people in the surgery to a minimum. This assists with sterility as well as safety

 

10. How long will the consultation and procedure take?

• The consultation is just under 30 minutes

• We will be with your baby in surgery for around 10 minutes

• Preparation (not surgery) takes approximately 5 minutes

• The surgery itself is approximately 3-5 minutes 

• The post-op feed and recovery takes around 20-30 minutes

• This is a total of approximately 1 hour and 10 minutes

 

11. My baby is not breastfeeding do I need to see a lactation consultant (LC)?

Most of our little patients already seen an LC before coming to see us.

Regardless of the feeding method, an LC who is experienced in working with infant tongue and lip ties is an essential part of the team. The LC is a “feeding expert” for infants and toddlers. Therefore, they can advise on how to feed most effectively with the breast, and the bottle alike. Furthermore, they can give you tips and tricks to limit of avoid the need for using the bottle (such as finger or syringe feeding). Moreover, they can assist with issues associated with eating solids.

Patients who do not keep in close contact with their “tongue tie LC” often do not get the best outcomes. Lactation consultant is there to guide you through the healing process and beyond.

 

12. Is this treatment covered under Medicare?

The consultation and procedure are both considered “dental treatment”, so they are not covered under Medicare. However, for private health insurance, the following item numbers are used:

• 014 (consultation)

• 391 (per frenectomy)

 

13. Are there any restrictions on travel or other activities after surgery?

There are minimal restrictions on travel or other activity after surgery. However, carers should bear in mind that our active wound management protocol requires stretches to be performed 6 hours after surgery and every 6 hours for 3 weeks post-treatment, then every 8 hours in the 4th week. In general, it is best to take things easy in the first couple of days post-surgery and we advise against swimming or other medical procedures (such as immunisations) for seven days after the procedure.

 

14. What about after care?

We routinely do the following 3 things in order to follow up and check things are going well.

In the event that you need further support, we encourage you to call our clinic, so we can advise of the best course of action. Usually, the best person to assess function is the LC which is why we encourage you to team up with an LC both before and after treatment.

• We will call you 1-2 days later so we can assist you in whatever way is necessary

• The 1-week review - our protocol involves you returning to our clinic 1 week later for a free review appointment. This helps to ensure that everything is going according to plan

• Continued phone checks - we encourage you to call your lactation consultant, or call our clinic whenever you need to.

 

15. Do I need to do any exercise for my child?
We recommended to do stretches for the area by applying repeated, gentle but firm pressure. Stretches should be done for 3 seconds, every 4 - 6 hourly, for 3 weeks. This then cut down to 2 times a day in 4th week and completely stop at the end of week 4 after laser release of the frenum restriction.
These exercises are important to minimizing the reattachment of the frenum to its original position. 
It is normal to see a diamond shape, whitish patch for up to 2 week from the release until the new skin fully heal.
 
 
The time it takes to see a noticeable change in functionality varies from patient to patient, from almost immediately to a few months following treatment. 
 
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