New Jersey Family: Many lactation consultants have attributed problems with breastfeeding to tongue-tie. What is tongue-tie and how does it affect nursing?
Dentistry for Special People: We all have small folds of tissue called frenula (also referred to frenum or frenulum) that secure and support the motion of our lips, tongues and cheeks. When this frenum is too tight or restricts mobility it can affect the way we eat, speak, our dentition, our oral hygiene and even our posture and breathing. Tongue-tie is when the frenum under our tongue restricts efficient motion. In infants, this can affect breastfeeding as well as potentially lead to additional problems as we grow older.
NJF: As a result of tongue-tie, there has been a significant increase in frenectomies. Can you explain what this procedure is and what it does?
DSP: Tongue-ties have been around for thousands of years. Midwives would use a long fingernail (ouch) to release the Frenula in babies with Tethered Oral Tissues (TOTS). With the invention of infant formula, the number of babies that exclusively nursed, decreased significantly, so less babies had the procedure done. Over the last decade or so, the importance of nursing was again emphasized by the medical profession and consequently more babies started nursing. Since more babies were nursing, more babies were presenting with latch and other Tongue -tie related issues and thus, more babies are undergoing a procedure called a Frenectomy, where the oral restriction is released. The good news is that Fingernail release procedures by midwives have been replaced by trained healthcare professionals using state of the art tools such as CO2 Lasers, that provide a much kinder, gentler and more controlled procedure for the baby. In most cases the surgery is done in the office and takes only a few seconds to minutes to perform with minimal sides effects or risks.
NJF: What are the signs that a baby may need a frenectomy?
DSP: Signs and symptoms of oral restrictions in babies can include difficulty latching, shallow or weak latches, refusal to nurse, poor weight gain, colick, fussiness, gassy babies that may have signs that are confused with reflux, excessive pain and trauma to a mother’s nipples, lip or tongue blisters and many others. However, there may be other underlying issues that can mimic the same symptoms. Any baby exhibiting these signs and symptoms should have a physical and functional evaluation by a trained professional before undergoing a frenectomy procedure. A multi-disciplinary approach such as what we utilize in our office tends to get the best results. We work closely with pediatricians, IBCLC’s (International Board Certified Lactation Consultants), bodywork specialists such as Osteopaths and Chiropractors as well as our own “in-house” myofunctional /feeding therapist/speech language pathologist to ensure the best possible outcome for baby and mommy.
NJF: How can parents be sure that surgery is the right choice for their baby? What are the alternatives to a frenectomy?
DSP: An informed choice is always the best choice. An initial consult is required along with the establishment of other members of the treatment team such as an IBCLC and Bodywork specialist, before we initiate the procedure. We also strongly believe in post-operative stretching exercises that help minimize reattachment (scarring due to the body’s natural healing process) and go to great lengths to train the baby’s caregivers to get comfortable doing those exercises.
NJF: What are some reasons an older child may need a frenectomy? How common is this scenario vs. having the procedure done as a newborn?
DSP: Unfortunately, the medical literature has not quite caught up with providing the necessary evidence for a causative relationship between TOTS and problems that occur later in life such as speech issues, airway restriction, sleep disordered breathing including snoring and sleep apnea, difficulty transitioning to solid foods, picky eating, reflux , self-esteem, etc. But there is a growing volume of literature that indicates that there may be a relationship (correlation) between these signs and symptoms and oral tissue restrictions. If your child exhibits any of these, no matter what age, it’s important to rule out the presence of TOTS.
NJF: What is recovery typically like for a baby or child?
DSP: Most babies do well with minimal discomfort the first few hours after the procedure. After that, as normal healing starts to occur there is a day or two of fussiness during which it’s important to keep the baby comfortable and hydrated. Most babies recover completely after that, as if nothing ever happened; except now they can make the necessary movements with their tongue and lips and cheeks which allows them to efficiently create the correct suck and swallow pattern for proper nursing. Older children tend to have a few more days of soreness that is usually alleviated with over the counter analgesics such as Tylenol.
NJF: What do you think is the biggest misconception about a frenectomy?
DSP: That it is a new “fad” that doctors use to make money off of.
Dr. Zuhair Sayany of Dentistry for Special People with locations in Cherry Hill and Turnersville has practiced pediatric dentistry since 1993 and stays up to date on the latest advances in dentistry by maintaining active membership in numerous professional organizations such as the American Dental Association and the New Jersey Academy of Pediatric Dentistry. Dr. Sayany graduated from the University of Pennsylvania School of Dental Medicine. He completed his residency in pediatric dentistry at the Children’s Hospital of Pittsburgh in 1993.
He is a past president of the New Jersey Academy of Pediatric Dentistry and has taught as an assistant professor at the University of Pennsylvania School of Dental Medicine. Dr. Sayany served as program director of the fellows training program in pediatric dentistry at the Children’s Hospital of Philadelphia before joining Dentistry for Special People in 2002. He is also a board-certified Diplomate of the American Board of Pediatric Dentistry and a fellow of the American Academy of Pediatric Dentistry.
In addition to treating infants with TOTs, Dentistry for Special People is also a pediatric dental practice that treats healthy children with routine dental needs as well as medically and behaviorally complex children who may need care in a hospital setting.
Dr. Sayany is married with two children who share his passion for Philadelphia sports teams. The family also has two dogs, Suri and Trixie, who are rescues.