Common Childhood Ailments: Cutting Family Ties

So, my common childhood ailments series is going a little slower than expected (silly baby being born and everything), but here in our next installment I will be discussing something that I have been seeing more and more of lately: lip and tongue ties.

This is an issue that strikes close to home with my wife and I. Our oldest son Luke had both a lip and tongue tie that put his nursing relationship with my wife in jeopardy. He was unable to latch correctly and nurse effectively or efficiently.  It was very painful and frustrating for my wife, and Luke was constantly gassy, colicy, and hungry. When he was three weeks old we had his lip and tongue tie revised via a laser procedure (more on that in a moment), and his new nursing relationship with my wife was like night and day. It is amazing how much lives can be changed by such a little amount of tissue. During Luke’s diagnosis, I also realized that I had a tongue tie myself! So, when you read this, know that I have been there and have had to go through the family hardships that can be caused by lip and tongue tie issues.

The Basics

Let’s start by discussing what tongue and lip ties are.  A tongue and lip tie refers to thick or tight tissue that restricts normal movement of the tongue and lip respectively. There are different severities of lip and tongue ties, and there are basically two different tongue ties that are seen.  There are anterior tongue ties which keep children from being able to stick their tongue out of their mouth far enough or bring their tongue up into the palate (an essential motion for breast feeding). There is also a posterior, or subligual, tongue tie which does not necessarily restrict the motion of sticking the tongue out but can restrict the movement of bringing the tongue up into the palate.  The posterior tongue tie is the type of tie that I encounter the most and the one that is least recognized by most pediatricians, ENTs, dentists, and other medical practitioners. Below are some pictures (courtesy of Dr. Lawrence Kotlow) that better illustrate my descriptions and classifications:

Kotlow Lip Ties

Kotlow Tongue Tie

Symptoms

There are many symptoms that a baby and mother may experience as a result of lip and tongue ties. For the infant those symptoms may include: no latch or unsustaned latch, shallow latch, sliding off the breast, breaks latch seal, clicking or smacking sounds, gas, colic, reflux, prolonged feeding durations, lack of satisfaction after prolonged feeds, leaks milk, falls asleep on the breast, gumming or chewing on the nipple, poor weight gain or failure to thrive, and unable to hold pacifier.  For the mother symptoms may include: creased or blanched nipples after feeding, cracked nipples, bruised or blistered nipples, bleeding nipples, severe pain with latch, maternal exhaustion and depression, infected nipples, plugged ducts, mastitis and nipple thrush, and engorged or un-emptied breasts.

Potential Risks if Left Untreated

The restriction in normal motion of the tongue and lip can pose many problems to newborns, new mothers, older children, and adults alike.  I most commonly encounter these problems when I see babies and new mothers, but that does not mean that there are not issues that may occur later in life.  Some of the issues seen with children as they grow include gut and nutritional problems, colic, reflux, excessive drooling, gagging, swallowing difficulties, sleep apnea, speech problems, jaw and developmental abnormalities, and dental caries.  Some of the problems that may be encountered later in life include inability to open the mouth widely affecting speech and eating habits; inability to speak clearly when talking; clicking jaw; pain in jaws; migraine headaches; protrusion of the lower jaw; effects on social situations, eating out, kissing or relationships; dental health problems; snoring; and sleep apnea. (Information on symptoms and potential problems is taken from “Breastfeeding should be fun and enjoyable” by Dr. Lawrence Kotlow DDS.)

Other Associated Health Concerns 

There has been a lot of research and news recently about the underlying causes of and problems associated with lip and tongue ties.  Current research has shown that a specific gene mutation in the MTHFR gene is thought to be a cause for these issues. In our family, this made so much sense: not only did I have a tongue tie, but that same gene mutation was passed along to my children. The topic of gene mutations, and specifically MRHFR gene mutations, goes far beyond the scope of this post.  However, there have been numerous health concerns and problems associated with such a mutation.  If you or your child have a lip and/or tongue tie, I believe it would be a wise thing to investigate if this gene mutation is present and what can be done to prevent any further health concerns in the future.  More information on MTHFR gene mutations and the potential problems associated with these mutations can be found here.

Solving the Problem

The best way to correct a lip or tongue tie when you or your child has been diagnosed with one is with a laser revision procedure perfected by Dr. Lawrence Kotlow.  The laser procedure takes about two minutes to complete.  The laser releases and removes the excess tissue with little to no bleeding. By removing the tissue and sealing the area there is very low risk of infection and very low risk of the tie regrowing.  The risk of regrowth is even lower when the proper stretching exercises are done for about two weeks after the procedure.  This procedure, when done on infants requires little or no numbing agents.  Sensory input from these areas are not yet developed in babies.  Our son used a few drops of an anti-inflammatory homeopathic liquid.  Another option for having the ties revised is with a scissor cutting procedure, but when compared with scissor cutting procedures the laser is faster, safer, less painful, and has fewer incidents of regrowth of the tissue.  There really is no comparison between the two. However, if you do not have anyone in your area who currently performs the laser procedure (and travel is not an option) there are a few ENTs and dentists who will use snipping procedures on lip and tongue ties.  The trick is finding trained ENTs and dentists who will recognize the ties as an issue and correct them in an appropriate manner.  More links, pictures, and details on the laser procedure can be found here.

My Experience with the Procedure

When my son had to have his tongue and lip revised we were lucky enough to be in the Dallas/Fort Worth area of Texas.  There are two well-trained dentists there and we had one of them (Dr. Hugh Oser) perform the procedure.  However, when we moved back to Virginia there was no one in the state who performed the laser procedure. Knowing the problems that we have faced and that so many other babies and mothers have faced, my wife and I made it a priority to find a dentist who would be willing to get trained in the laser procedure that Dr. Kotlow has perfected. We’ve had more than a few people look at us like we were crazy when we brought up this procedure, but much sooner than anticipated we were very lucky to find Dr. Joan Anderson of Rocktown Family Dental Care in Harrisonburg, Virginia.  Having a new dentistry clinic and personal experience with Dr. Kotlow’s laser procedure, she was very willing and excited to learn this technique to help those affected by lip and tongue ties.

After being trained in the procedure this past summer, Dr. Anderson is currently performing the procedure on children and adults ages 6 and up in order to gain extreme proficiency with the procedure before beginning work on infants and young children. In order to help with her training and aid in her proficiency, I had Dr. Anderson revise my tongue tie a couple of months ago.

When I went in I was numbed with a shot (unlike babies, in adults this can be a very sensitive area, and an anesthetic is needed) so I never felt any pain during the procedure. With an adult, the tissue being revised is larger and thicker than an infant’s so the procedure took about three minutes instead of the one or two minutes with an infant. After the procedure Dr. Anderson showed me how to do the required stretches for two weeks, and then I was pretty much finished!  Dr. Anderson was very skilled with the laser and she did a wonderful job, as you can see below:

 

 

Dr. Andrew Dodge Tongue Tie Before

Dr. Andrew’s Tongue Tie (before)

Dr. Andrew Dodge Tongue Tie Immediately After

Dr. Andrew’s Tongue Tie (immediately after revision)

 

 

 

 

 

 

 

 

Following the procedure I had soreness for about four days.  The soreness did not prevent me from eating, drinking, or talking. I had the procedure done on a Wednesday afternoon.  Wednesday night I ate a normal dinner and was talking just fine, but I was pretty sore. By Thursday afternoon when I saw my first patients after my procedure, I was talking well without extra pain or soreness. Dr. Anderson recommended some over the counter anti-inflammatory medication (i.e. Tylenol/Advil), but I did a couple of anti-inflammatory supplements instead and did just fine with those. By day four the only pain I was having was with extreme motions like sticking my tongue out as far as I could or doing the stretches. By day six I had no pain with any motion and was completely back to normal.

Conversely, my sister-in-law had to have a lip tie revised in adulthood, and her procedure was performed with scissors. Her experience lasted about 15-20 minutes, included stitches, and the incision took about a week to heal after a day or two of minor swelling. Due to the need for stitches, however, scar tissue formed in the area, and she did note that it took from six to twelve months for the scar tissue to totally disappear. Given the choice, I would absolutely utilize the laser again for a lip or tongue tie revision on myself or any of my family members. In fact, my wife and I plan on traveling several hours out-of-state to have the procedure performed on our new baby in the next couple of months. While her tie is not as severe as her brother’s was, it is still having an effect on breastfeeding, and we do not want to have it cause problems later in life. If you or someone you know is considering having a lip or tongue tie revision, I could not recommend this procedure and Dr. Anderson more highly.

Is This Procedure Right for My Family?

If, after reading this post, you are questioning whether you or your child has a lip or tongue tie, feel free to contact us to learn more. Outside of my own family’s experience, I have seen many cases over the past three years , especially in young children and infants, and I’d love to help your family’s lives be changed for the better just as ours have.

 

Dr. Andrew About Dr. Andrew

Dr. Andrew Dodge lives in Staunton, Virginia, with his wife Nicole and their children Luke and Josie. Dr. Andrew is a graduate of Parker College of Chiropractic at Parker University in Dallas, Texas.

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