A tight upper lip frenum attachment may compromise lip flanging and may appear as a tight, tense upper lip during nursing or bottle feeding. This can result in a shallow latch during breastfeeding resulting in nipple pain for the mother and excessive air intake for the child. Additionally, the tight upper lip may trap milk, resulting in constant contact of the milk to the front teeth. This can result in decalcification and dental decay can develop when the milk is not cleaned off of these areas. This same issue can occur with bottle-feeding. If the frenum attaches close to the ridge or into the palate a future diastema (gap between the teeth) can also occur. A tight frenum is a risk for development of gum disease in the future. Sometimes a child’s smile is impacted by a tight lip frenum.
A tight lower tongue frenum attachment may restrict the mobility of the tongue and may or may not appear as a cupping or heart shaped tongue when the tongue is elevated. This can result in an inability to get the tongue under the nipple to create a suction to draw out milk. Long term, a tongue tie can result in speech problems, airway and palatal development issues and/or dental issues.
Symptoms and Assessment
Everyone has a frenum, but not every frenum is a “tie”. To know if a frenum is a problem, a physical and functional assessment must be completed. In breastfeeding families, both mother and baby must be assessed and you may be asked to demonstrate a breastfeeding session for assessment. Symptoms may include the following:
- Poor latch (breast or bottle)
- Leakage of milk from the mouth while eating
- Slides off nipple or falls asleep while attempting to latch
- Colic symptoms
- Reflux symptoms
- Poor weight gain
- Extended/continuous feedings
- Gumming or chewing of the nipple
- Unable to take a pacifier or bottle
- Thin smile/curled lip
- Creased, cracked, bruised or blistered nipples
- Bleeding nipples
- Incomplete breast drainage
- Infected nipples or breasts
- Plugged ducts
- Mastitis (inflammation of the breast)
- Nipple thrush
- Decay on baby teeth
Addressing a tight frenum is simple in children less than 12 months old. Older children and some very strong infants may require the use of sedation. The procedure itself takes less than a minute for each frenum. Dr. Fallahi uses a soft tissue scalpel or scissor that cuts the tissues resulting in some bleeding. We start by using a local anesthetic that is injected into the frenum. You will be allowed to snuggle your baby after the numbing procedure. After about 2 minutes for the numbing to take effect, the baby is swaddled and placed in our dental chair while being stabilized by an adult to minimize movement during the procedure. Then the frenectomy procedure is completed and cold coconut oil is placed on the site. The baby and mom are left in the room to nurse or soothe. Babies will cry during the procedure, but they are typically soothed almost immediately afterward.
The alternative to scalpel or scissor surgery is laser treatment, which is not offered at this office and would require a referral. The other alternative is to do no treatment. No treatment could result in some or all of the conditions listed under “Symptoms” above. Disadvantages (risks) are included in the “Risks of Procedure” below.
Post Op Instructions
Following the procedure breastfeeding and bottle feeding will have to be retrained, so may be difficult at first. Helpful supplies to have on hand include coconut oil and any post op pain management supplies approved by your physician including Tylenol or Ibuprofen. Keeping the lip and tongue mobile is important during the healing time. When nursing or using a bottle, make sure to position baby with a good latch every time. Complete the wound care described on the post-op care handout you are given every 4 hours for the directed amount of time. A white/yellow patch around the treated area is normal. This is how the mouth forms a “scab”. Keep the area mobile until all the white is replaced by pink tissue.
Risks of Procedure
While the majority of patients have an uneventful procedure and recovery, a few cases may be associated with complications, which may include:
- Reattachment of the frenum requiring additional surgical procedures
- Bleeding either at the time of the procedure or in the first 2 weeks after
- Damage to, or infection of the sublingual gland, which may require further surgery
- Temporary or permanent nerve damage
- Refusal to feed (nursing strike or bottle refusal)
- Impact on speech
- Lack of improvement
- Injury to the teeth, lip, gums, or tongue
- Alterations in child’s smile, including increased show of upper gums when smiling (for lip tie release)
- Swelling and inflammation, especially of upper lip