I have received several referrals for lip tie frenectomies over the past few weeks. This is a procedure I do often for young infants who are struggling with breastfeeding. But, it’s far more uncommon after infancy. As a pediatric dentist who has been providing comprehensive orthodontics and lip/tongue tie management for several years, I wanted to offer my thoughts regarding lip ties and when to treat them. (https://tonguetieprofessionals.org/paul-kahlon/)
I have found that 95% of infants have lip ties, yet only 5% of teens still have a lip tie. The main reason is our primary teeth continue to erupt and later when our permanent teeth erupt fully, the location of the tie on the alveolar crest gradually moves apically relative to the upper incisors. Hence, class III and IVs will gradually become class I’s. Untreated the vast majority of lip ties ‘resolve’ over time.
Myth: tearing of a lip tie with trauma is ‘normal’.
This is fairly common, but I don’t endorse waiting for a lip tie to tear as good treatment.
Myth: a lip tie can contribute to caries.
Actually, there is some truth to this one. When a baby has a sensitive labial frenum, it’s very difficult for well-intentioned parents to brush the gingival margin properly. Hence, there is an increased risk of caries along the cervical margin. I personally don’t release lip ties prophylactically in babies with no decay or demineralization. Instead, I coach parents on diet and show them how to ‘sweep’ the toothbrush on either side of the tie and ‘flick’ the toothbrush to clean the palatal surfaces. When an infant has ECC on #D-G, that requires treatment, I will occasionally use my laser to release the labial tie to make OH easier afterward. It’s really case by case.
Myth: Lip ties ’cause’ a diastemas.
Have you noticed that children with a crowded dentition don’t have diastemas? In reality, when a child has generalized spacing and they also have a Class III / IV lip tie, it is more likely for the space between the central incisors to widen relative to the other spaces. Hence, it looks like the lip tie is ‘causing’ a gap, but actually, it’s only expressing the interproximal spacing more between the centrals.
- A predictor for a diastema with permanent dentition is whether parents have a gap. I usually ask this question. If they do (or had ortho to correct) then it’s more likely their child will too.
- One more point, when a toddler is using a pacifier, this will increase spacing in the incisor region. Pacifiers (and thumbs) procline upper incisors, splaying them apart.
- Finally, all laser-tissue releases can leave scar tissue. This scar tissue will prevent the diastema from closing orthodontically. Always best to treat after ortho.
Solution – Patience. Gradually stop using the pacifier. Wait until the eruption of the permanent canines. The diastema will close most of the time. If needed, complete ortho as needed and perform a frenectomy once the space is closed. We do a lot of orthodontics at Stellar Kids Dentistry (non-DSHS patients) and I can’t tell you the last time I had to correct a lip tie to prevent a diastema. It’s always a spacing issue (arch length/tooth size discrepancy)
Myth: A lip tie causes speech problems.
In reality, a tethered labial tie doesn’t bind the upper lip so tightly that a child can’t pronounce sounds and sound blends. To clarify, tongue ties can certainly affect speech, but lip ties rarely do. Many parents of younger children feel a lip tie is causing their child not to speak. But, most delays in speech development have origins in behavior or cognition. Check out the chart below. The majority of sounds don’t mature until a child is 6 or 7 years old!
Solution – In most cases, patience. If a parent of a younger child is very worried, refer to a speech pathologist. Only if the specialist diagnoses the tethered oral tissues as contributory would I move forward with a frenectomy.
I hope this helps clarify the common scenarios with lip ties.
Also, please see our website: https://www.stellarkids.com/services/tongue-and-lip-ties