Tongue/Lip Ties

Breastfeeding Problems and the Relationship to Tongue Ties

The day our first child was born, my wife and I were confronted with a lot of new experiences and unknowns. Although we always wanted the very best for our children, there were so many questions that we had, and we felt helpless a lot of the time. For example, in the first 6 months after our first child was born, it just seemed that he was so fussy and uncomfortable, and we wondered if this was due to being colic? However, being first time parents, we had no answer. I believe that with what I know now, these miserable months could have been prevented. I am a firm believer that a lot of the fussiness was correlated to having a tongue tie. Our son was not being able to ingest milk correctly and swallowing too much air which caused him to be uncomfortable and gassy. My hope is to educate parents and make them aware of tongue/lip ties. Being educated about this issue may help to make parenthood less stressful and much more enjoyable.

One of the most common obstacles that occurs from the day a child is born is breastfeeding. There are so many mothers who struggle with breastfeeding and experience severe pain, mastitis, flattened/infected nipples, poor latch, etc. There are babies that are put on reflux medications, told they were lactose intolerant, told that things were fine as long as weight gain was okay. The truth is that a lot of problems associated with breastfeeding can be correlated to a lip or tongue tie.

The one time of our lives where our tongue is most important to us, is as infants. It is the “motor” that allows proper breastfeeding or bottle feeding. Effective and painless nursing requires the tongue to move in a wave-like motions, creating both a suction/negative pressure of the nipple against the roof of the mouth. If the tongue has restricted movement, breastfeeding at times is not possible and is extremely painful. A frenum/frenulum is a piece tissue that connects the bottom of the tongue to the floor of the mouth and although almost everyone has one, sometimes this is the culprit.

  • Your child should not have solid food for at least 2 hours prior to their appointment.
  • Please inform us of any change to your child’s health and/or medical condition.
  • Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
  • Let us know if your child is taking any medication on the day of the appointment.

What is a Frenectomy or Frenotomy?

These are procedures used to correct a congenital condition in which the lingual (tongue) or labial (upper lip) frenulum is too tight, causing restrictions in movement that can cause significant difficulty with breastfeeding, and in some instances, other health problems like dental decay, spacing, speech difficulties and digestive issues. When it affects the lingual frenulum, this condition is commonly called a tongue tie (the medical term in ankyloglossia).

There are a lot of doctors and dentists that don't believe in the procedure, from pediatricians to ENTS. However, unless they have performed the procedure, performed it correctly, had an IBCLC along for the journey, witnessed the positive results, I think it’s a dogmatic approach to say this procedure doesn't work. I am confident enough to not care about the doubters and non-believers because my intent is to expose this issue so that mothers can research this and have an option to pursue it if they are struggling with breastfeeding. For those wanting more information on this topic I would encourage you to visit the websites and read the blogs of Larry Kotlow DDS (pediatric dentist) and Bobby Ghareri MD (ENT), both of who I have the pleasure of meeting. I have been to both of their offices and have had the privilege to see Dr. Ghaheri perform these procedures firsthand. The most influential part of my observation was listening to consults between Dr. Ghaheri and parents. It was the same conversation over and over again. I also continuously heard how pediatricians and others did not recommend this procedure, but hearing the parents testimony firsthand who have come back on the post ops, made me a believer of the procedure. Both Dr. Kotlow and Ghaheri would not being doing 30-40 of these procedures a week if this was a "fad" especially because most parents are pursuing this procedure against their pediatrician's wishes.

My goal is to be a resource for people. I have seen and watched and learned from the best. Hearing the terms "fad" and trend" are common words to describe this tongue tie procedure and until meeting Dr. Kotlow and Dr Ghaheri, I was made a firm believer. In my practice I see 85-105 patients daily, and I have absolutely no need to do this for financial or marketing purposes. The reason I’m doing this is because people in Hawaii need to know about this, so they have an option. I’ve been having excellent results, and it’s so gratifying seeing mothers and infants that are happy and appreciative after the procedure. Our office has the best CO2 hard and soft tissue laser machine which allows no stitches, little to no bleeding, and no thermal collateral damage (like the old lasers did).

My entire professional career has been to help the children on Oahu and my purpose is to expose this procedure and give parents and option to pursue it if desired. I believe in 5 years, this will be of norm or at least an accepted option. As a father, I understand what mothers and infants go through, and I want to be of help to mothers who aren't able to breastfeed their children. I am animate that unless a mother is under care of a lactation consultant or is unwilling to do the post operative stretches, that I would not recommend this procedure.

To get more information out there about this subject, we are in the process of creating a facebook page which will serve as an informative venue that allows parents to gain information about this as well as about other topics in pediatric dentistry.

Issues can arise from a tongue or lip tie:

Infant Symptoms

  • Clicking and swallowing air while nursing (aerophagia)
  • Reflux/colic/crying episodes
  • Can only sleep when held upright
  • Poor weight gain
  • Unable to hold onto a pacifier
  • Falling asleep while attempting to nurse
  • Prolonged breastfeeding
  • Short, shallow, unsustained latch
  • Sliding off the nipple
  • Nursing/lip blisters

Mothers Symptoms

  • Flattened, blistered, bleeding nipples
  • Moderate to severe pain when infant attempts to achieve a latch
  • Infected nipples/plugged ducts
  • Engorged or unemptied breasts
  • Premature reduction of breast milk supply
  • Depression, mother frustration due to the lack of infant-mother connection

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