Pediatric Frenectomy

At Expedition Pediatric Dentistry, we are committed to working with parents to help support healthy development and growth in patients of all ages. Issues with tethered oral tissues (lip-tie and tongue-tie) are a common problem experienced in patients of all ages. We're proud to provide comprehensive care and guidance designed to help parents make well-informed treatment decisions on behalf of their children with tethered oral tissues.

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What Are Lip-Tie and Tongue-Ties?

Rope-like connective tissues called frenula (singular: frenulum) that tether one body part to another are located throughout the body. Inside the mouth, we have:

a lingual frenulum that connects the underside of the tongue to the floor of the mouth,

two labial frenula that connect the upper and lower lips to the gum tissues (between the two upper and two lower front teeth),

and buccal frenula (found inside the cheeks) that connect the cheeks to the gums.

About 5-10% of infants are born with frenal abnormalities known as tethered oral tissues (TOTs), where the lingual frenulum or labial frenulum is abnormally tight, thick, or short.

Tethered oral tissue conditions are specifically called lip-tie (abnormal labial frenulum) and tongue-tie (abnormal lingual frenulum). A lip-tie is also sometimes referred to as a tied maxillary frenum, and a tongue-tie is commonly referred to as ankyloglossia.
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Signs and Symptoms of Lip-tie and Tongue-Tie in Infants and Children

Several signs and symptoms can reveal an issue with tethered oral tissues. These indications are slightly different in infants and children.

Signs and Symptoms in Infants

Difficulty latching onto a bottle or the breast

Frequently detaching from the nipple

Falling asleep while nursing or exhibiting exhaustion after feeding

Prolonged feeding sessions

Clicking sounds while feeding

Trouble breathing while nursing

Inability to hold a pacifier in the mouth

Poor weight gain

Symptoms of colic or reflux (noisy breathing, lip blisters, and gas pain)

Poor sleep quality

Open-mouthed breathing

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Additionally, nursing mothers might experience breast inflammation, decreased milk supply, and sore or cracked nipples. Signs and Symptoms in Children

Difficulty pronouncing certain sounds such as D, L, N, R, SH, T, TH, and Z)

Delayed speech

Soft speaking or mumbling

Reduced vocabulary

Difficulty eating solid foods and swallowing

Picky appetite or aversion to certain foods/textures

Frequent, easy choking or gagging

Sleep troubles (apnea, snoring, restlessness, frequent waking, and bed-wetting)

Mouth breathing

Crooked or crowded teeth

Irregular gap between the front teeth

Forward head and neck posture

The tongue appears heart-shaped or notched when sticking out

If your child is old enough to follow instructions, you can ask them to lift their tongue, stick out their tongue, and move it from side to side. A child with a tongue-tie will have trouble lifting the tongue as far as the upper teeth, extending it beyond the lower lip, and moving it to either side.

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Developmental Problems Caused by Tethered Oral Tissues (Lip-Ties and Tongue-Ties)

Lip-tie and tongue-tie restrict oral movement, and this can result in a whole host of problems in both infants and children.

For example, lip-tie and tongue-tie often result in the following developmental concerns:

Difficulty latching, feeding, and eating (nursing, bottle, or solid foods)

Altered airway development

Trouble sleeping

Muscle tension

Migraine headaches

Speech development challenges

Reduced vocabulary development

Lower confidence communicating

Abnormal tooth eruption

Tooth alignment problems

Abnormal jawbone development

Gum recession

Oral hygiene challenges (inability to clean the teeth with the tongue)

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‍How Are Tethered Oral Tissues Diagnosed?

Children and infants get diagnosed with lip-tie and tongue-tie in a variety of ways. Sometimes parents notice signs and symptoms and bring these concerns to the child's pediatrician or a pediatric dentist. Other times, an IBCLC (international board-certified lactation consultant) or speech-language pathologist will suggest that an infant or child might have lip-tie or tongue-tie and recommend that you see a pediatric dentist or pediatrician.

Our pediatric dentist, Dr. Miller, thoroughly examines and evaluates every patient for signs of lip-tie and tongue-tie during an initial appointment and consultation. During this examination, she talks with parents and older patients about any symptoms they have noticed. She then evaluates the structure, function, and range of motion of the patient's oral tissues to determine if any abnormalities are present.

While tethered oral tissues can cause significant problems for infants and children that can impact them for the rest of their lives, there are thankfully treatments that can release the oral tissues in order to enable normal development through a less restricted range of motion.

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Lip-Tie and Tongue-Tie Treatments

The options for treating tethered oral tissues in infants and children include:

Labial Frenectomy

A labial frenectomy is a simple oral surgical procedure designed to entirely remove a labial frenulum.

Lingual Frenectomy

A lingual frenectomy is a simple oral surgical procedure designed to entirely remove a lingual frenulum.

Labial or Lingual Frenotomy

A labial or lingual frenotomy is a simple oral surgical procedure designed to sever and release an abnormal frenulum.

Myofunctional Therapy

Myofunctional therapy includes stretches, exercises, and postures designed to strengthen the muscles of the face and mouth to encourage and support proper development. When in use and at rest, orofacial musculature contributes to determining the development and growth of bones and teeth; strengthening, stretching, and building oral and facial musculature through myofunctional therapy helps to support healthy development.

Myofunctional therapy is often used in conjunction with frenectomy or frenotomy, especially when the procedure is performed after infancy. This therapy and at-home practice can help a child correct abnormalities with respect to the musculature and function of their oral structures to improve speech, ease eating and breathing, and promote healthy growth.

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Which Treatment Is Right for Your Child?

The treatment or combination of treatments that is right for your child will largely depend on their age and unique anatomy. We can typically diagnose and treat a patient in a single appointment, and we will be sure to discuss all of your options before moving forward.

Frenectomy Treatment Expectations: How Does the Frenectomy Procedure Work?

Frenectomy (removing the frenulum) is the most commonly recommended treatment. If your infant or child needs a frenectomy, we will walk you through every step of the process and be sure to answer all of your questions before the procedure takes place.

Patient Comfort

We take extreme precautions to ensure that all oral surgeries are safe and comfortable for our patients using a variety of age and dose-appropriate approaches to anesthetics. The anesthetic and pain medication your child receives will depend on their age and size.

If your child experiences dental anxiety or is nervous about the procedure, we do provide options for sedation dentistry. Depending on your child's age and appointment scheduling, we might recommend either light sedation with nitrous oxide (laughing gas) or moderate sedation with oral medication.

Surgical Process

A variety of instruments can be used to perform frenectomies such as scissors, a scalpel, electrocautery devices, and lasers. All of these tools achieve the same results, but, at Expedition Pediatric Dentistry, we use oral surgical lasers because of their many benefits such as precision, reduced bleeding, reduced pain and inflammation, and reduced risk of infection.

Aftercare and Recovery

Your child's recovery process will also vary depending on their age, and we will be sure to provide you with thorough instructions before sending you home.

For infants, we recommend nursing or feeding immediately after the appointment for comfort. Any apparent pain or discomfort during recovery can be addressed with skin-to-skin contact and other soothing techniques in addition to appropriate doses of acetaminophen. For infants over six months, appropriate doses of infant ibuprofen can be used.

Feeding in infants can sometimes temporarily worsen because infants need to learn new feeding techniques using their newly unrestricted oral anatomy. Meeting with a lactation consultant or pediatrician can help you and your infant through this adjustment period.

Older children typically recover within a few days. Any pain or discomfort can be addressed with children's acetaminophen or ibuprofen. We recommend avoiding hot, spicy, or highly acidic foods and drinks for a few days.

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Expedition Pediatric Dentistry: Supporting Healthy Oral Development with Frenectomies in Bellevue, WA

At Expedition Pediatric Dentistry, Dr. Miller and the team are here to support you and your child. Dr. Miller has the training, experience, and advanced technology needed to diagnose and treat tethered oral tissues with frenectomies in Bellevue, WA. For more information or to request a consultation for your little one, we welcome you to contact our office.

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Frenectomies