Pediatric dentist, Dr. Richard Baxter shares expert advice about tongue-tie and lip-tie, two oral conditions that can cause problems particularly in breastfeeding babies.

According to research, around 1 in 10 babies are born with tongue-tie or lip-tie—but for those babies (and their parents), the conditions are life-changing.

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Dr. Richard Baxter
Shelby Pediatric Dentistry

We spoke with Richard Baxter, DMD, MS, of Shelby Pediatric Dentistry, about the conditions. Dr. Baxter performs more laser tongue-tie and lip-tie releases per day than any provider in Alabama, and often treats patients from other states and even other countries who travel to his office. He also lectures nationally and has created two online dental CE courses to help other dentists learn how to treat these conditions.

Along with his professional expertise, Dr. Baxter has personal experience with tongue-tie: He had the condition himself and only recently had it released. After the procedure, he could speak more easily and more quickly without tiring or experiencing neck and shoulder pain. In addition, his twin daughters had tongue-tie at birth and nursed much better after treatment.

“I just want more people to know that this can be a hidden reason why kids are having issues with nursing, feeding, and speech,” Dr. Baxter says. Keep reading for information about these conditions.

1. What Is Tongue-Tie?

Dr. Baxter: Tongue-tie is a tight piece of tissue under the tongue (a remnant from fetal development) that restricts normal tongue movement. Most people have a string of some kind under their tongue. To qualify as a tongue-tie it needs to be too thick, too tight, or too long and causing a functional problem of some kind.

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2. How Common Is Tongue-Tie?

Dr. Baxter: Tongue-tie is underdiagnosed and misdiagnosed, and it is common. Research articles from a decade ago would say 4 to 10 percent, but the actual number including posterior tongue-tie is likely higher, but no one knows for sure. Also, no one knows why the numbers of babies born with a restriction of the tongue is increasing.

3. What Is Lip-Tie?

Dr. Baxter: A lip-tie is an abnormally thick, tight, or long piece of tissue under the lip that can cause problems. Typically if you lift the lip up, and the frenum (lip-tie tissue) blanches or turns white, or exerts a traumatic force on the tissue, then it is likely a lip-tie. It also needs to be causing a functional issue for us to consider releasing it.

3. What Problems Does Tongue Tie Cause?

Dr. Baxter: The biggest issues with tongue-tie are with nursing, feeding, and speech. In babies, tongue-tie and lip-tie can cause several problems:

•    Poor weight gain
•    Reflux or spitting up often
•    Clicking noises while feeding
•    Choking or gagging
•    A shallow latch
•    Milk dribbling out of the mouth
•    Gassiness and fussiness

For breastfeeding mothers, tongue tie can cause a number of issues:

•    Painful nursing
•    Flattened, lipstick-shaped nipples
•    Bleeding, blistered nipples
•    Plugged ducts or Mastitis
•    Insufficient milk transfer

Part of the difficulty in diagnosing it lies in the fact that the presentation of each mother and baby dyad is different. Some moms have pain, some don’t. Some babies spit up, some don’t.

If there are many of these issues going on, it’s worth having the baby evaluated by a lactation consultant who is familiar with tongue-tie. Some issues may be resolved by lactation support, but in other cases, these positioning and latching techniques will not resolve the issue because there is an anatomical problem (the tongue and/or lip-tie).

Many babies with a tongue-tie also have a lip-tie because they often occur together and should recede together during fetal development.

4. How Do You Diagnose Tongue-Tie?

Dr. Baxter: It is diagnosed by a combination of both a clinical exam and a questionnaire about symptoms. During a clinical exam, we will assess the functional movements of the tongue and lip and determine if there is a restriction.

We will feel under the tongue, and often there is a tight string that feels like a speed bump or guitar string under the tongue. It sometimes is hidden under the floor of the mouth and is not an obvious string attached to the tip.

Many of the babies we see do not fit in the category of a “to-the-tip” tongue tie and all have a different appearance, either thick, thin, or variable length. In fact, the most painful nursing often comes from babies who are restricted with thick inelastic tissue that is hidden under the tongue and not easily seen, but it is easily felt if you know how it feels.

5. How Do You Treat Tongue-Tie?

Dr. Baxter: Some providers use scissors and a special retractor that holds the tongue to cut it. Sometimes this scissor release or “snip”/ ”clip” can help, but we often see babies who have been previously clipped and are still having issues because there is still tight tissue left that was not released.

We use a laser to get a full release of the tissue so it can function properly and give the child the most mobility. Our special CO2 laser takes away the tissue quickly (in about 10 seconds) with minimal to no bleeding, and less pain afterward. It is also safer because there are no sharp objects in the baby’s mouth. We strictly follow all laser safety protocols.

The laser looks like a small pen attached to a machine and we just “paint” over the surface of the tissue and it disappears. It is extremely precise, gently removing a layer of cells less than the width of a human hair at a time. It is the most advanced way to do the procedure.

We use a numbing jelly on the babies during the procedure. We do not use any sedation or general anesthesia to treat these babies. The babies typically calm down immediately after the procedure, are taken to their mother and put to breast right away. Most mothers notice an immediate difference in latch and often a reduction in pain, although the baby has to relearn proper muscle patterns to suck well, which can take a few weeks.

5. How Long Does It Take to Heal?

Dr. Baxter: The wound under the lip heals in two weeks, and it takes three weeks for healing under the tongue. The parents have to do exercises afterward to ensure it does not reattach. We teach the parents how to do the exercises, and have them do the first set of exercises in the office after the procedure.

The healing is such that at three or four weeks it’s typically hard to tell that anything was done. Scarring and swelling have been shown in studies to be less with the laser than with scissors or scalpel.

6. How Long Does It Take for Nursing to Improve?

Dr. Baxter: Most babies will feed better right away, but each baby is different. Often the babies will have to relearn how to suck properly, and this process can take a few weeks. We always recommend that nursing babies follow up with their lactation consultant regularly and if there are any issues to call us.

7. Do You Have Any Advice for Parents About Tongue-Tie?

Dr. Baxter: If you think your baby has a tongue-tie, do some research about the condition. We have some helpful resources on our website. Seek out a tongue-tie knowledgeable lactation consultant for help. So much has changed in the research that it is critical to stay up to date on the latest advances.

Parents often turn to Facebook groups, and there is an “Alabama Tongue and Lip-Tie Support Group” on Facebook. It’s a great place to connect with other parents who have been through this process with their child and can help you navigate this issue.