Tongue Ties and Lip Ties

What is a frenectomy or frenotomy?

At Stellar Kids Dentistry, we use a soft tissue laser for a precise incision of the restricted frenum. The laser permits a relatively painless surgical procedure with minimal postoperative discomfort and bleeding. Babies can resume breastfeeding immediately after the procedure. We always work directly with physicians and lactation consultants to achieve an optimal outcome. They determine the degree of functional impairment which allows us to plan and perform the frenectomy procedure.

How To Prepare For The Procedure

We always try to provide treatment as soon as possible after your consultation appointment, usually on the same day. Time is of the essence. The sooner your baby’s lip and/or tongue tie is released, the more likely they will eventually breastfeed successfully.

Pain relief
We recommend you give your child acetaminophen (Tylenol) 30 minutes prior to the procedure. This way, any possible post-op discomfort is prevented, and you can focus on caring for your child. Use the dropper in the manufacturer’s packaging and ensure the bottle of Tylenol is 160mg/5mL dosage. (Not the concentrated form).

You may also use whatever works for your family or use nothing at all. We’ll be placing a topical numbing medicine during the procedure, so not everyone needs a medication beforehand.

Stretching and Strengthening Exercises
Babies requiring tethered tissue release often have weak or disorganized sucking patterns. Prior to your appointment, it’s valuable to start exercises to build confidence and dexterity for the important work coming up. This will help speed recovery and ensure the ties do not reattach. Aim for 4x/day leading up to the day of your procedure. We recommend you work directly with your lactation consultant for specific exercises. However, here are some good suggestions:

• Let your child suck your finger and apply gentle pressure to their palate. Once your baby starts to suck on your finger, just press down with the back of your nail into their tongue. This usually interrupts the sucking motion while your baby pushes back against you. Listen for a seal break and then put your finger back up into the palate to re-stimulate sucking. Repeat as tolerated.
• Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
• Slowly rub their lower gumline from side to side and your baby’s tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
• With one index finger inside the baby’s cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.

How To Prepare For The Procedure

We always try to provide treatment as soon as possible after your consultation appointment, usually on the same day. Time is of the essence. The sooner your baby’s lip and/or tongue tie is released, the more likely they will eventually breastfeed successfully.

Pain relief
We recommend you give your child acetaminophen (Tylenol) 30 minutes prior to the procedure. This way, any possible post-op discomfort is prevented, and you can focus on caring for your child. Use the dropper in the manufacturer’s packaging and ensure the bottle of Tylenol is 160mg/5mL dosage. (Not the concentrated form).

You may also use whatever works for your family or use nothing at all. We’ll be placing a topical numbing medicine during the procedure, so not everyone needs a medication beforehand.

Stretching and Strengthening Exercises
Babies requiring tethered tissue release often have weak or disorganized sucking patterns. Prior to your appointment, it’s valuable to start exercises to build confidence and dexterity for the important work coming up. This will help speed recovery and ensure the ties do not reattach. Aim for 4x/day leading up to the day of your procedure. We recommend you work directly with your lactation consultant for specific exercises. However, here are some good suggestions:

• Let your child suck your finger and apply gentle pressure to their palate. Once your baby starts to suck on your finger, just press down with the back of your nail into their tongue. This usually interrupts the sucking motion while your baby pushes back against you. Listen for a seal break and then put your finger back up into the palate to re-stimulate sucking. Repeat as tolerated.
• Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
• Slowly rub their lower gumline from side to side and your baby’s tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
• With one index finger inside the baby’s cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.

Aftercare

Now the hard work begins! The main postoperative risk of a frenectomy is reattachment of the lip/tongue tie. All surgical wounds tend to contract as they heal. A child’s mouth heals very quickly, and previously tethered tissues may close prematurely causing the previous issues and symptoms to return. The purpose is for the laser incision site to heal lengthwise in a vertical direction.

Please perform your exercises 6 times per day for the first 4 weeks. Over the next two weeks, you can taper off. Like any new skill, stretching and strengthening your child’s lip or tongue will be anxiety provoking and tricky. Know that it will get easier in time. We are here for you and only a phone call away! Stay calm and positive. Let your child feel this is playful and not stressful. Stretching exercises should be firm and gentle, not quick or forceful.

When performing the exercises, position yourself at 12 o’clock (i.e. directly behind your baby). Have your baby in your lap or on a table/bed.

Upper Lip Stretches
Place two fingers under their lip and gently pull up as high as it will go. Try to visualize you are rubbing their lip to their nose. Now, gently sweep side to side 6-8 times. Remember, the goal is to stretch the opposing surfaces of the lip and gum where the lip tie used to close them together.

Under the Tongue Stretches
Place two fingers under their tongue, ‘pick up’ the posterior (back) part of their tongue and lift towards the roof of your baby’s mouth. The key is firm pressure. Try to visualize the laser incision site as having a diamond shape. A tongue needs three separate stretching motions:

• Once you are under the tongue, pick up the back (posterior) part of the tongue as high as it will go towards the palate. Hold it there for 3 seconds, relax, and do it again 6-8 times. The goal is to completely lengthen the diamond so that you can visualize the area under their tongue.
• Place your finger in the middle of the diamond and do a gentle circular stretch for several seconds to dilate or open up the diamond.
• Turn your finger sideways and do a rolling pin motion to try and keep the diamond as deep as possible. Start at the fold “center” of the diamond and move to either side of the diamond top and bottom to loosen up the muscles of the tongue and floor of the mouth.

Call us right away if there is active bleeding, fever of more than 101.5, or if your baby is refusing to nurse or take a bottle.

Starting several days after the frenectomy, the wound area will develop a whitish ‘scab.’ It may appear yellow if your child had elevated bilirubin after birth. This is quite normal. Sometimes it will slough off on day 5-7 revealing tiny petechiae that can ooze a bit of blood. By day 14, the surgery site is mostly healed.

We are only a phone call away if you need any help and we welcome all questions and concerns. Your baby is relying on all of us for their wellbeing. We are here to support you!

Here is an excellent article on the team approach to improving the breastfeed experience.

It is essential that you follow-up with your lactation consultant or physician after the procedure. They will recognize compensations and coach you and your baby on the best pathway forward!