Tethered Oral Tissue

Tongue-ties, also known as tethered oral tissues, can result in a variety of oral and facial problems. For children who have tethered oral tissues, a frenectomy to release the tongue or lip may be recommended. 

Tongue-ties and lip ties are conditions that can restrict the movement of the tongue or upper lip. It occurs when the frenulum is short or connected in such a way that it is restrictive, causing a number of problems for children as they grow and develop. For example, the short frenulum of the tongue keeps the tongue anchored, causing problems for a child or infant such as eating/feeding (breastfeeding and solids), airway development, sleep, tension, migraines, and speaking. The short frenulum of the lip keeps the lip close to the gums and can keep new teeth from erupting correctly, causing more issues down the road with oral development.

The good news is that a frenectomy is a way for your pediatric dentist to correct these types of problems permanently. With our focus on optimizing your child’s oral and facial growth, we will evaluate for tethered oral tissues and screen for dysfunction. If we identify obstacles to ideal function we will develop a plan that may include therapy and frenectomy.

Frenectomies at Expedition Pediatric Dentistry

A frenectomy is a procedure in which the bit of connective tissue that connects two surfaces in a child’s mouth, a frenulum, is removed. Sometimes the frenulum can be so short that it does not allow the child to move their tongue properly; this can prevent them from latching on during feeding. Also known by its medical name, ankyloglossia, tongue tie is quite common and affects upwards of 10% of all newborns. A short frenulum on the upper lip pulls the gum tissue upwards to cause a receding gum line. This condition, commonly known as a lip tie, can expose the roots of your child’s teeth.

A frenectomy frees the tissue, thereby allowing the tongue or other tissues to move freely. This simple procedure can have long-lasting benefits.

With a focus on optimizing your child’s oral and overall health, our pediatric dentist will evaluate your little one for tethered oral tissue and screen for any problems they may have.

A comprehensive team consists of the family, pediatrician, functional providers and release provider. This team is committed to supporting your child through the diagnosis, frenum revision, and recovery process.

In the majority of cases, simply performing a frenectomy does not instantly lead to improved function. It is essential to develop a team to walk you through this process and support your child.
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Frenectomy FAQ

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How will you know a frenectomy is needed?  

We will evaluate the structure and function of the tissue to determine if it is restricted. For infants we observe tissue movement and simulate the function of suckling to identify any restrictions caused by tethered oral tissues. For children we may notice tethered oral tissue at their first dental appointment and would provide a referral evaluation by a speech therapist or myofunctional therapist. If release of the tissues is likely to result in improvement in function, we will discuss next steps.

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What do you use to perform a frenectomy?  

There are a variety of instruments that can be used to perform a frenectomy including scalpel/scissors, electrocautery device, and lasers. While they can all achieve the same result, we find that the laser is our favorite. The laser removes tissue gently and helps to prevent bleeding. It is also very precise, allowing us to safely remove the restricting tissue without damaging adjacent structures.

‍Do I need a referral?  

Most of our infant patients are referred to our office by their lactation consultant, speech therapist, myofunctional therapist, or primary care provider but it is not required. We do recommend consultation with a lactation specialist, speech therapist, or myofunctional therapist prior to your consultation.

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What is an IBCLC?  

The most extensive training and highest level of certification a lactation consultant can obtain is to become an International Board-Certified Lactation Consultant. There is no other certification that comes close. The IBCLC requires extensive study of anatomy and physiology, child development and numerous other components for lactation management.

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How long is the procedure?  

The examination may take 20-40 minutes to discuss symptoms, evaluate function, demonstrate the stretching exercises, and answer all of your questions. The procedure itself is very brief and you will be reunited right after we are finished.

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Will the procedure be painful for my infant?  

Since our babies can’t tell us in words when they are hurting we have to take many precautions and monitor them carefully for cues to be sure they are comfortable. We utilize age and weight appropriate pain control techniques and encourage you to comfort your child by nursing immediately following the procedure. Crying and fussing are common during and after the procedure.

Some babies experience discomfort in the following days. Typically the first 24 to 48 hours are the most difficult. Comfort typically depends on your baby’s pain threshold and temperament.  We recommend acetaminophen every 4-6 hours for the first 3 days following the procedure. Skin to skin contact can also be very comforting. You may give weight appropriate doses of acetaminophen for pain control and if your child is over 6 months old ibuprofen can be safely used.

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How long will it take for feeding to improve?  

Releasing restricted tissue is typically just the first step toward improvement in feeding. When tethered oral tissues have prevented ideal feeding babies adapt to the restrictions and develop the best technique possible. It will take practice to learn to feed a new way and utilize their increased mobility.

It may get worse before it gets better. Upon occasion babies exhibit regression or refusal to feed in the first few days because their old way of feeding is now unsuccessful. Visiting with your lactation consultant following the release can help to develop this new skill. 

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How many appointments does it require?  

Often we can complete the evaluation and procedure on the same day. For follow-up evaluations you have the choice of an in office or virtual appointment. We will refer families who have not yet worked with a functional care provider, such as an IBCLC, to have an evaluation prior to performing the release.‍

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What is myofunctional therapy?  ‍

Myofunctional therapy includes exercises or postures to strengthen the muscles of the face and mouth. Growth of bones and teeth are determined by orofacial musculature both in use and at rest.

‍How long will the procedure take for my child?  

The procedure duration depends on the complexity of the tethered tissue and the cooperation of your child. If sedation is required there is additional time for the medication to work and wear off at the end. For most patients we would plan about an hour long appointment so that we have plenty of time to address any level of tie we encounter.

‍What if my child is nervous?  

For children who are nervous or fearful, sedation may be needed to properly complete the frenectomy. We have a variety of sedation options and can find something that will work for your child.

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Will the procedure be painful for my child?  

Pain management for children is typically achieved with ibuprofen. Children complain of pain most often in the mornings following their procedure. This is for two reasons. First, the tongue has not been moving as much in the night and the tissue is attempting to heal so it will feel tight and sore. Second, any ibuprofen will have worn off in the night, unless they have woken up to let you and you have administered another dose. Administering ibuprofen first thing in the morning and having something cold and soothing for breakfast can help to alleviate the pain.

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How Do I Know if My Child Needs a Frenectomy?

Your child may need a frenectomy if they:

• Have trouble latching, swallowing, or feeding
• Have difficulty pronouncing certain letter sounds such as “t,” “d,” “l” and “th”
• Breathe through their mouth instead of their nose
• Have misaligned teeth, gum recession, or gaps between teeth
• Have a tongue that appears heart-shaped or notched when they stick it out
• Have trouble sticking their tongue out past their lower lip

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Where can I find a frenectomy near me?

Expedition Pediatric Dentistry offers frenectomies in Bellevue, WA. Dr. Megan Miller has the training, experience, and advanced technology needed to diagnose and treat tethered tissue with a frenectomy. For more information, contact Expedition Pediatric Dentistry today for a consultation of your little one.