Lip & Tongue Ties

Laser-Lip and Tongue-Tie Laser Revision

At Little Star Pediatric Dentistry, we are dedicated to treating infants, toddlers, children and even adults with tongue-ties, lip-ties, and other tethered oral tissues with the use of advanced laser surgery.

Dr. Najmeh Hannanvash is a Board Certified Pediatric Dentist in San Diego, CA. She specializes in this procedure and is a preferred provider in performing laser frenectomies. She works very closely with multiple Lactation Consultants, CranioSacral Therapists, Physical Therapists, Chiropractors, Speech Therapists, Myofunctional Therapists, Occupational Therapists, Cranial Ostheopaths, and Pediatricians to ensure that her patients receive a comprehensive, full-circle treatment. Dr. Najmeh is truly passionate about this field and has built a portion of her practice around having a facility for families to receive the best care possible. She has spent years studying this procedure, has lectured on the topic at several local forums, and is locally involved as a member of San Diego County Breastfeeding Coalition and various other professional organizations.

What is a Tongue Tie or Lip Tie?

A tongue-tie or lip-tie is more common than one would think. It’s often misdiagnosed, or under-diagnosed, and thus the reason why it is so often missed at an early stage in life. It is a mid-line defect of the frenum, resulting in an excessively “tight” or taut fibrous attachment limiting the range of motion of the tongue and the lip. These limitations in movement can cause significant breastfeeding difficulties in addition to other health problems. These health problems include decay, crowding, spacing, speech difficulties/delays, improper food clearance, digestive issues, heightened muscle tension, airway compromise, sleep apnea, tension headaches, clenching, grinding, muscle fatigue and overall skeletal and craniofacial development.

What Is A Frenectomy or Frenotomy?

A frenectomy or frenotomy refers to a corrective procedure done to release a tight frenum. When done with a laser, the terminology is essentially interchangeable.

How Does the Laser Work?

All procedures are performed with the use of a CO2 laser. This is a cold, non-touch laser which allows for gentle treatment and optimal healing of the tissue. The laser seals the blood vessels as it works so there is little to no bleeding (unlike with scissors which often require an additional medicament to stop the bleeding). No sutures are needed. Additionally, the laser is bactericidal and sterilizes the wound and surrounding tissue. Therefore the risk of infection is very minimal.

Please read the following three sections and complete the Patient Intake Forms prior to arrival for your appointment.

How To Prepare Before The Procedure?

What to Expect During the Procedure?

What to do After the Procedure?

How To Prepare Before The Procedure?

Please take some time to fill out all the necessary intake paperwork in your Patient Portal. This will expedite the process and allow us more time to focus on your child. Our goal is to focus on you and your child, and we would like the process to be simple as possible.

Read the information on this procedure in advance to prepare for your consultation. Come prepared to review this with Dr. Najmeh and bring any questions you might have in addition to what is described here.

Please DO NOT nurse/feed your infant 45 minutes before the procedure. We want your child to have digested the milk by the time of the procedure to limit the risk of throwing up at the time of the procedure. If these recommendations are not followed, same day treatment will not be an option.

Pain Management Preparation:

As a parent, you can best prepare your child for the procedure by having the proper medications ready to accommodate the procedure. The following is recommended:

  • OTC Pain Medication
    • For children under 6 months: Infant Tylenol
    • For children over 6 months: Ibuprofen (Motrin) or Tylenol
    • Administer 1 hour before the procedure. Use dosing recommendation on package and consult with your pediatrician.
  • Homeopathic Remedies
    • Rescue Remedy
    • Arnica: 30x or 200x (10 pellets dissolved in several tablespoons of breast milk and delivered via a dropper. Use 10 drops of the liquid every 60-90 minutes)
  • You also have the option to use nothing at all (although I do recommend having some analgesic on board beforehand)
  • Frozen breast milk to rub on the wound (the cold is soothing to the site. You do not need to bring this to the appointment).

Regardless of what is used in advance, basic numbing medicine will be used to make the procedure more comfortable. Additionally, the laser itself has some analgesic properties that will aid your child.

What to Expect During the Procedure?

Please come to the appointment with the Patient Intake Forms completed online in advance so that we can focus on your child from the beginning.

We will spend the first portion of the appointment consulting and discussing. In most situations, if treatment is recommended, it can be done at the same time as the consultation.

This procedure is a quick, in-office treatment. No general anesthesia is needed or recommended. During the procedure, due to laser safety regulations, parents are not in the room. The time away from baby will be about 5 minutes and the actual lasing part is 30-40 seconds.

  • For babies younger than 1 year of age, a topical numbing gel is applied to the treating areas.
  • For babies older than 1 year of age, a topical numbing gel, in addition to a local anesthetic injection, will be applied to the treating areas.
  • For children older than 2 years of age, we have a conscious oral sedative option using Versed (Midazolam) that will aid in relaxing and calming the patient. It is very safe to use and commonly used in dental and medical settings. The medication takes effect quickly and lasts for about 2 hours.

After the procedure is completed, your child is immediately brought back to your arms. Together we will review the procedure and detail our follow-up plan.

What to do After the Procedure?

There are four main components to having a successful revision:

  • Release of restrictive frenum (done in office with laser)
  • Post operative stretches
  • Follow up with your lactation consultant (IBCLC knowledgable in lip/tongue tie work)
  • Follow up with other necessary professionals/bodyworkers: CranioSacral Therapists, Physical Therapists, Chiropractors, Speech Therapists, Myofunctional Therapists, Occupational Therapists, Cranial Ostheopaths, etc.

If any one of these steps is not done properly, the revision may not have the same success.

Post Operative Stretches

The post-operative stretches are the most important component to a successful revision. These stretches are aimed at keeping the wound open and promoting attachment in a new, guided position.

When the frenum has been released, a cut or wound has been created. This wound will have a diamond-shaped appearance. This wound, as is natural, will want to heal very fast. Our goal is to keep this wound open and dilated, and guided to heal in a new, less-restrictive position.

Prior to stretching, wash your hands with soap and water. Do not use hand sanitizers as they have chemicals and alcohols that burn the wound.

I recommend doing the stretches from a 12 o’clock position, as you will be best able to visualize the wounds and proper lifts. Place your child on the bed or couch, and stand behind their head to perform the following exercises.

There are two different types of stretches that are done. You alternate between the two types of stretches, every 3-4 hours (6/day minimum) for a total of 4 weeks. Do not allow more than 4 hours to span without doing the stretches (including at night).

Stretch #1: Active Wound Management

  • I recommend doing the stretches from a 12 o’clock position, as you will be best able to visualize the wounds and proper lifts. Place your child on the bed or couch, and stand behind their head to perform the following exercises.
  • One is an active wound stretch that is demonstrated and recorded in office.
  • It’s important to get in the mouth, lift the lip/tongue and prevent premature reattachment. Think of it as needing to go in and air out the space that has not had that circulation for a few hours. The key to these stretches is not with regard to force or pressure, it’s about frequency, precision, elevation, and lift.
  • Each individual stretch is done for a count of three.
  • Upper Lip – this is the easier site to stretch and should be done first. Your child will likely become upset and cry during the stretch. Place your index fingers under the lip and move it as high as it will go (until you reach bone). You are now deep in the lip’s vestibule. Move your fingers in circular motion (like you are brushing the gums with your finger) On your way out, flip/flange the lip out.
  • Tongue – this is the harder site to stretch and should be done second. Your child likely is crying from the lip stretches and this will make lifting the tongue and visualizing the wound easier. Place your middle finger on the inside of the lower lip and use your index fingers to pushed the tongue back and lift up toward the palate. You are looking to manually open the mouth and elevate the tongue as high up as you can. This helps stretch the tongue from the floor of the mouth as wide as possible. You should be able to visualize the full diamond with this stretch. Using your dominant hand, place the pointer finger at the mid-line, and rub your finger up-and-down, in a rolling pin motion, three times.
  • The key to this stretch is making sure you are lifting the tongue upward and backward while doing the stretches. When properly lifted, you should be able to see the full diamond shape under the tongue.

Stretch #2: Sleeping Tongue Posture Hold

Pain Control

The following is recommended to aid in pain control and management:

  • OTC Pain Medication
    • For children under 6 months: Infant Tylenol
    • For children over 6 months: Ibuprofen (Motrin) or Tylenol
    • Administer 1 hour before the procedure. Use dosing recommendation on package and consult with your pediatrician.
  • Homeopathic Remedies
    • Rescue Remedy
    • Arnica: 30x or 200x (10 pellets dissolved in several tablespoons of breast milk and delivered via a dropper. Use 10 drops of the liquid every 60-90 minutes)
  • You also have the option to use nothing at all (although I do recommend having some analgesic on board beforehand)
  • Frozen breast milk to rub on the wound (the cold is soothing to the site. You do not need to bring this to the appointment)

Remember that the more comfortable your baby is, the more properly they will nurse. Be patient; use lots of skin-to-skin, co-sleeping, low lighting, singing, nursing in a warm bath, etc…

Re-Attachment

Every person has a frenum under the tongue and lip. A new frenum attachment after the revision is expected and does not mean that there is re-attachment. Re-attachment simply refers to the frenum attachment in the previous position that is still fully or partially restrictive. This is the main risk of a frenectomy procedure.

Tissue Healing

The tissue will go through various stages of healing and coloration for the next few weeks. From red, to yellow, to white, and finally to a normal salmon pink. These are the NORMAL stages of healing (much like the formation of a scab on your skin) and do not indicate that something is wrong or an infection has started. Please don’t be alarmed by the color changes or appearance.

Expectations

Be prepared for a few days of fussiness and discomfort as your baby adjusts to the new mobility and the wound goes through its various healing forms. Some babies take to the procedure immediately, and some take time to adjust. Both forms are fine and do not define a successful/unsuccessful revision. Generally, most babies take a few steps back before they are able to start moving forward. Meaning that breastfeeding might actually be harder initially until things begin to organize and the mechanics start working together properly. There is new mobility of the lip and tongue and your baby needs time to re-learn how to use them. Follow-up appointments will be instrumental in working this out.

Follow-Up Appointments

I prefer to see my patients about 1 week after the procedure to assess wound healing, re-attachment, daily stretches, and symptom changes. Further appointments can be scheduled on an as-needed basis. We will see each other for multiple appointments thereafter. It is important to commit to the follow-up visits to ensure proper healing and tissue formation.

It is VERY important to follow up with your lactation consultant after the revision for continued work. Now that the lip/tongue has optimized mobility, it is very important to re-learn and organize the movements. The same techniques that may have not worked before may be far more effective now that your baby has the appropriately functioning tools. Additionally, many babies will benefit from some Bodywork. This helps detect and release body tensions to aid in a more appropriate breastfeeding relationship. We can discuss the benefits of this during your appointment.

Call Our Office For Any Of The Following:

– Uncontrolled bleeding

– Fever > 101.5

– Signs of possible infection

The team at Little Star Pediatric Dentistry is trained to treat Lip and Tongue Ties with care and precision. Call today to schedule your child’s consultation.