Tongue and lip ties, also known as Tethered Oral Tissues (TOTS), could have a very large impact on our health and well-being.
A tongue tie occurs when the ligament between the underside of our tongue and the floor of the mouth does not dissolve naturally in utero. The tongue remains tethered down to the floor of the mouth, and this ligament can prevent the tongue from moving and functioning properly. Lip ties are a result of the same process, where the lip is tethered to the gums, restricting its movement as well.
A tethered lip or tongue can make nursing difficult for both baby and mom.
Cracked, creased, flattened or bleeding nipples
Poor breast drainage
Plugged ducts, mastitis
Feels like feeding the baby is a full-time job
Poor latch at breast or bottle
Falls asleep while feeding
Slides off the nipple
Reflux or spits up
Clicking or smacking noises
Gagging or choking when feeding
Gassy burps, toots
Poor weight gain
Long and frequent periods of feeding
Normally, the tongue rests on the roof of the mouth. The pressure exerted by the tongue on the palate helps to stimulate the growth of the mid-face. Proper tongue position helps to develop a flat, oval-shaped palate with the potential room for all the upper teeth in good alignment. A tongue that is tied cannot often reach the palate and exert these forces.
Since the roof of our mouth is the floor of our nose, a tongue that will help develop a wide, broad palate will help develop and support wide, broad nasal passages, sinuses, and upper airways.
We are meant to breathe through our noses. This allows the air to be filtered, warmed and humidified, and nitric oxide from our sinuses is added to help oxygenate our blood. A tongue-tie and low tongue resting position can lead to narrow/blocked nasal passages, which encourages mouth breathing and the loss of these mentioned benefits.
Mouth breathing does not allow the brain to experience the deepest levels of sleep; therefore, we awake unrefreshed. The quality of our sleep is affected.
In a normal, mature swallow pattern, the tongue moves upward and pushes the food/liquid against the palate, then backward to the throat. The movement is silent, and the muscles around the lips and face are relaxed. A tongue that is tethered or with low posture may compensate with a reverse-swallow, recruiting muscles of the face to help complete the swallow. We swallow approximately 1500 times per day! During the improper swallow, the lack of forces against the palate and the inward forces of the lips and cheeks will help create a narrow arch form.
Feeding issues can develop as the infant with a tongue-tie can lack the ability to coordinate the complex muscles and reflexes needed to form an efficient swallow.
If the tongue is restricted, it may have problems reaching the placements needed to produce sounds. Muscle coordination may be affected. The direction of airflow might be altered, and fluent speech may be difficult. Speech therapy may be required in these situations.
A thick restrictive lip-tie can cause a diastema (a gap between the front teeth). Not every diastema needs to be treated, though, and a functional evaluation should be completed. A lip-tie can trap milk or food between the teeth and lip, which can cause tooth decay. A lip-tie can also make it difficult or painful to brush the front teeth. Tooth grinding as a result of a tethered tongue/airway issue can occur. Gum recession can be seen when the strong muscles of the face and lips pull on the gum tissue over time.
Babies should be assessed at birth by a qualified practitioner for the presence of a tongue or lip-tie. Quite often, a lactation consultant (IBCLC) is the first to assess the child for any functional issues in breastfeeding. Dr. Caroline works with lactation consultants and is knowledgeable about anterior and posterior tongue ties, lip ties, the consequences of untreated ties for the future of the infant, and the post-release exercises needed. She will perform a thorough examination, answer any questions that the parents may have, explain any risks, benefits and treatment alternatives, including no treatment, and obtain informed consent prior to any treatment. Photos will be taken of the areas to be released.
Dr. Caroline uses a diode laser to release the lip and tongue ties.
Parents play a vital role in the post-surgical care of the area treated. Stretching exercises are demonstrated to the parents, and their commitment to follow through with the care is obtained prior to treatment being provided. Without doing these stretches, the risk of the tissues reattaching is high, and an additional release may be required. Follow-up checks are completed to assess healing.
Referral back to a lactation consultant for further support and retraining of the tissues after release or for bodywork to release tension in muscles of the head and neck may be recommended.
Dr. Caroline endeavours to provide compassionate care to the babies and meet the parents where they are in their journey. She would be happy to discuss any concerns you have about your infant’s oral care.