Rockville Pediatric Dental

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Tongue-Tie / Lip Tie

Serving Rockville, Bethesda, Potomac, Gaithersburg,
and Silver Spring Areas

What Are Tethered Oral Tissues?

All infants are born with soft tissues, called frena, under their tongue, upper lip, and in their cheeks. The soft tissue of the frenum is composed of a type of collagen that does not stretch over one’s lifetime. When these tissues cause difficulty for an infant with breastfeeding or cause a child to have speech or feeding issues, they are called tethered oral tissues. These tissues are further categorized into tongue ties, lip ties, or buccal ties depending on the location of the tissue. If the symptoms are not treated in infancy, sometimes the adverse effects of tethered oral tissues will impact an individual from infancy through adulthood.

Frenectomy diagram

What are some symptoms associated with tethered oral tissues?

• Impact on mom’s milk supply
• Severe pain with latch or inability to latch
• Failure of baby to thrive
• Sleep deprivation for mom
• Nipple pain, damage, bleeding, or blanching
• Mastitis, nipple thrush, blocked ducts
• Difficulty sucking a bottle or pacifier
• Reflux, colic, gas, bloating after feeding
• Early termination of breastfeeding
• Problems with introducing solids
• Poor bonding between baby and mother
• Depression or a sense of failure by mom

• Inability to chew age appropriate solid foods/slow eater
• Gagging, choking or vomiting foods
• Persisting food fads
• Difficulties with dental hygiene and increased dental problems
• Persistence of dribbling and drooling
• Delayed development of speech
• Deterioration in speech
• Behavioral problems
• Sleep disordered breathing
• Loss of self confidence because they feel and sound “different”
• Strong incorrect habits of compensation being acquired

• Inability to open the mouth widely affects speech and eating habits
• Difficulty talking even after moderate amounts of alcohol
• Clicking jaws/Pain in jaw
• Migraines and tension headaches
• Protrusion of lower jaws, inferior prognathism
• Multiple negative effects in work situations
• Negative effects in social situations, dining out, kissing, relationships
• Poor dental health, inflamed gums and increased need for fillings and extractions
• Sensitivity about personal appearance
• Emotional factors resulting in rising levels of stress, anxiety and depression
• Sleep disordered breathing
• Difficulty keeping a denture in place

• Poor swallowing and a risk of anterior open bite
• Mouth breathing and a propensity to allergies
• Open mouthed posture associated with an imbalance in skeletal structure
• Restricted dental arch development and facial development
• Recurrent orthodontic issues

smiling baby

Tethered Oral Tissues Treatment

The treatment of a tethered oral tissue is called a release. The release will remove the oral restrictions caused by tongue, lip, or buccal ties. After the release, the infant or child, with the help of their parents, will have to perform exercises or stretches for up to 3 weeks to ensure the tissues do not reattach. We want the result of the treatment to be that the tissues heal without the prior restrictions.

In our office, releases are performed with a LightScalpel CO2 laser. Although good releases can also be performed with scissors or other types of lasers, Dr. Horng uses a CO2 laser because it allows for the best post-release healing.

Collaborative Approach to Tethered Oral Tissues Treatment

In order for your infant or child to have the best results from their release procedure, we highly recommend they work with a lactation consultant or speech therapist prior to seeing us.  Although our team is skilled in performing the release, we rely on a team approach to ensure that your infant or child will have their oral function restored.  Many times a lactation consultant or speech therapist may want to work with your infant or child for some period of time prior to and after having a release.

The RPD difference

Dr. Horng understands the importance of evaluating and treating tethered oral tissues.  To this end, he and his team will work to schedule your infant or child in a timely manner.  Dr. Horng cares so much about helping infants and children with oral restrictions that he has helped teach a course on this topic since 2017.  He was also instrumental in helping the Pediatric Dental Division at the University of Maryland School of Dentistry incorporate evaluation and treatment of oral restrictions into the residency program.