Dentists have traditionally been trained as experts of teeth and gums along with the options to treat disease and replace missing teeth. Thankfully this has been changing over the past couple decades, so the mouth is rightfully viewed as part of the full body. The mouth body connection is strong with many diseases of the mouth affecting the body and vice versa. One such connection is the tongue-tie in children.
A tongue-tie is a condition that dentists were rarely trained to observe or treat in the past, but this has been changing in recent years. A tongue-tie (also known as ankyloglossia) happens when a child’s tongue is anchored, by a fibrous membrane called the frenum, to the floor of the mouth. Signs of a tongue-tie can be a heart-shaped tongue when they try to stick it out, the inability to stick out the tongue past the lips, and the inability to touch the tongue to the roof of the mouth. Not all tongue-ties have these signs and some are quite subtle in presentation.
Tongue-ties in children can have significant impacts on breastfeeding. This is the most common reason to treat the tongue-tie. Other issues associated with a tongue-tie include speech issues, gum recession, and gaps between teeth.
Signs that there is an issue in an infant breastfeeding can include difficulty latching, loud sucking sounds, excessive gas, not gaining weight, decreased milk supply, mastitis, and pain for the mother while breastfeeding. This is not an exhaustive list but meant to give an idea of some of the more common issues.
As dentists, it isn’t our specialty to diagnose lactation issues and therefore if any of these issues are being experienced it is important to see a lactation specialist or pediatrician. Lactation specialists may try different techniques to correct the issues, but one increasingly common approach is to seek an evaluation and treatment of a tongue-tie. Some providers will also recommend treating lip-ties at the same time which are fibrous tissues limiting the movement of the lips. Only around 5-10% of children are tongue-tied and it is unclear what percentage of those require intervention.
Some general dentists and many pediatric dentists are now trained and equipped to treat tongue-ties using lasers that are effective in treating the ties minimal side effects. Traditional techniques with a blade or scissors are also effective and nearly as safe with few side effects. The procedure is called a frenectomy. Frenectomies are not always successful and require follow-up care and home exercises to prevent the tongue-tie from relapsing. Many moms have seen great improvement in their child thriving and improved breastfeeding.
Tongue-tie treatment is not without controversy. The treatment is estimated to only be needed in up to 10% of children and may be overprescribed in some areas. There is a lack of standard diagnosing and treatment protocols, therefore a wide range of opinions exist among lactation specialists, physicians, and dentists.
As a dentist my advice to parents with a tongue-tied child is that if it isn’t severe then there may or may not be a benefit to the procedure. If they choose to have the procedure it is very safe with minimal risks that may improve quality of life. If they choose not to have the procedure, then there is no reason to feel guilty because there isn’t medical consensus as to the validity and it is not a life-or-death issue.