Frenectomy | Board Certified Pediatric Dentist located in Bellevue/ West Nashville, Nashville, TN

Tongue-ties are normally straight forward to diagnose and fairly easy to treat. If the tongue is heart-shaped when the baby cries; there is an obviously tight frenulum underneath that runs from the floor of the mouth to an area close to the tip of the tongue. Tongue-ties can vary in severity and can include what we call “posterior tongue-tie” which is a lot more difficult to diagnose and recognize. The frenulum looks like it is non-existent so the first instinct is to believe that tongue-tie cannot be the issue. The tongue looks squared off with the floor of the mouth webbing/tenting the tongue. The edges of the tongue will form a cup when crying as it is unable to elevate. The tongue cannot move side to side but instead twists side to side. The tongue struggles to extend out of the mouth while it’s open but is absolutely incapable of “sticking out” when wide open, which is the ideal position for breastfeeding. Treatment is ONLY recommended when here is inhibition of function for the child. Dr. Priya will consult and evaluate and determine if the procedure will benefit your child or not.

Mothers who try to breastfeed their tongue-tied baby suffer tremendously, both mentally and physically. Not only does she have to re-latch the baby multiple times during a feed and deal with feedings that last sometimes hours, but she also experiences damaged nipples, cracks, bruises, and pain during feeds. Her risks of breast infection increase and her milk supply can be greatly reduced due to the lack of stimulation from an inefficient latch.

The babies may be losing weight, get sleepy during feeds (as they work much harder than other babies to stay latched), and become extremely gassy and irritable making the parent’s experience even more frustrating. Lip-tied babies end up with blisters on their lips from trying so hard to stay latched. Babies tend to feed a lot more often because their inefficiency results in less intake of milk so hunger kicks in faster.

Why Have The Tongue-Tie And/Or Lip-Ties Released For My Baby?

- To help make breastfeeding more successful

- To help relieve the pain of breastfeeding and regain healthy nipples and breasts

- To stimulate milk production by adequate stimulation

- To help achieve satisfactory bonding between a mother and her baby

- To ensure adequate feeding and growth of the baby

- To avoid serious long term issues with palatal development, tooth spacing, dental caries, speech impairments, social stigma

What Can I Expect After The Laser Frenectomy Is Done?

Breastfeeding immediately after the procedure is fine as breast milk contains amazing healing properties and the simple act of breastfeeding will reassure and soothe the baby.

It is possible that latching will be a struggle at first. Do not be alarmed if latching is difficult at first. This initial stretching of the muscles is therapeutic for the baby after the procedure.

Posterior tongue-ties may require a few weeks of practice before seeing the benefits of the frenectomy. We recommend to be thorough with the prescribed post-treatment exercises and to work with the lactation consultant and possibly a bodyworker (cranial sacral therapist, pediatric chiropractor, etc.) to increase the chances of success.

Frenectomy Post Operative Care

Important Concepts To Understand About Oral Wound Healing

- If you have two raw wound surfaces in the mouth in close proximity, they will reattach. Hence, it is important to keep them stretched open.

- The main risk of a tongue or lip-tie release is that the mouth tends to heal so quickly that it may prematurely reattach causing a new limitation and/or the persistence or return of symptoms.

- Wounds tend to contract towards their center as healing occurs, hence the need to keep them dilated open. Healing wounds get tight in the 2nd and 3 rd weeks of healing, the time period when reattachment can occur. It is important to continue with exercises for the full 4 weeks post-release.

Active Wound Management – Stretching Exercises

- Proper Active Wound Management is key to achieving an optimum result.

- It is important to remember to stay relaxed, smiling, and positive.

- You should show your baby or child that not everything is going to be painful, be playful. - The exercises are not meant to be forceful or prolonged.

- Stretching exercises with quick and precise movements are best.

- A small amount of spotting or bleeding is common while doing the exercises, especially in the first few days.

- Frequency over force, if you do a targeting firm stretch frequently, you don’t have to reopen tissue that has reattached.

You may use Tylenol, Ibuprofen (if 6 months of age or older), or other homeopathic measures to help with discomfort. Starting a few days after the procedure, the wound(s) will look gooey white and/or yellow in appearance. This is a completely normal inflammatory response. The body’s natural way to make a band-aid. Full healing takes 10-14 days.

Upper Lip Stretches

- This is the easier of the 2 sites to stretch and if you are doing both lip and tongue, start with the lip.

- Place your finger under the lip, in the fold of the lip, and move it up as high as it will go, until you feel resistance. Hold for 5 seconds.

- Remember, the goal is to open the opposing surfaces of the lip and gum so they cannot stick together.

- Repeat per instructions given.

Under the Tongue Stretches

- The goal is to dilate the diamond open in the upward and downward directions aiming your force at the diamond fold.

- Up – Insert both index fingers into the mouth with fingertips touching and dive under the tongue, aiming for the diamond fold, and pick up the posterior part of the tongue and lift towards the roof of the mouth.

- Hold it there for 5 seconds, relax, and do it again. The goal is to completely unfold the diamond so that you can visualize the entire diamond.

- The fold of the diamond across the middle is the first place it will reattach.

- Down – Place one index finger in the floor of the mouth at the diamond fold and aim force toward the base of the neck and hold for 5 seconds.

- Repeat per instructions given.

What type of releases do we do?

We use an FDA approved diode laser that offers predictable, repeatable results, fast tissue release, and instant hemostasis. The precision of the laser and minimal postoperative pain make this laser my tool of choice for performing a laser frenectomy. In some instances due to the age of the patient or anatomy, traditional incisions are used.

Parents are not allowed in the room at the time of the procedure but the babies are immediately brought to the mother to latch post-operatively in our private nursing suite. We encourage your lactation consultant or supportive loved-ones to join you for this process (no other children please).

Payment is collected upfront prior to consultation and/or procedure. We gladly accept HSA cards, exact cash, or credit cards.