Tongue-ties Or Lip-ties

Tongue-Ties And Speech Problems

We frequently have children referred to our office from their speech therapists. Their primary concern is the inability for their patients to articulate their sounds due to a tongue-tie. Typically, speech therapy has been initiated, but with no significant improvement. Once it is realized that the tongue needs to be released, the results after the procedure are significant. Patients and speech therapists are amazed at the level of significant improvement after a tongue is released and a child is given the opportunity to fully realize the total mobility of a proper functioning tongue.

Infants With Nursing Problems

A new baby with a too tight tongue and/or lip frenum can have trouble sucking and may have poor weight gain. If they cannot make a good seal on the nipple, they may swallow air causing gas, colic, and reflux or spitting up. You may hear clicking noises when the baby is taking the breast or a bottle. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue and lip tie. It can also cause thrush, mastitis, nipple blanching, bleeding, or cracking in the mother and inability to hold a pacifier. The mother often reports it’s a “full time job” just to feed them because they are constantly hungry, not getting enough milk, and spitting up what they do get.

Although it is often overlooked or dismissed by other medical professionals, a tongue and lip-tie can very often be an underlying cause of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breastfeeding altogether. Very often, after releasing the tongue and/or lip, mothers report immediate relief of pain and a deeper latch. The symptoms of reflux and colic almost disappear and weight gain occurs rapidly. The sooner the tongue-tie is addressed the better the child will learn to use his or her tongue correctly.

Upper Lip-tie

Upper lip tie is when the upper lip is tethered to the upper gum. Though most infants have some degree of upper lip tie, when it becomes large and tight enough, it may prevent the upper lip from flaring out or curling up which is essential for breast-feeding in order to create an adequate seal with the breast. Also, some infants with upper lip tie will exhibit an upper lip crease with the skin turning pale in an attempt to flare up during breast-feeding.

If the upper lip tie is tight enough, an infant may have trouble feeding even from a bottle.


Tongue tie (otherwise known as ankyloglossia) is when the tip of the tongue is anchored to the floor of the mouth. Tongue tie may extend all the way to the tip or it may extend partially to the tip resulting in a partial tongue tie. There is also a condition called posterior tongue tie in which the tongue tie is hidden under the tongue lining.

Regardless whether dealing with a newborn or an, the treatment is the same. But when it comes to newborns, tongue tie can lead to feeding problems which can be quite distressing to both child and mother.

With tongue tie, the tip of the tongue is unable to help the infant draw the nipple into the mouth. It also prevents the tongue from being normally positioned between the nipple and lower gumline leading the infant to chew on the nipple. Ouch!

What To Expect During The Visit

In general, the procedure is very well-tolerated by children. We take every measure to ensure that pain and stress during the procedure is minimized.

General anesthesia is not utilized in the office and is almost never needed to perform the procedure.

The actual time of lasering is 1-2 minutes.

For babies under the age of 12 months, a topical numbing cream is applied to the area(s) that will be treated. This medication works very quickly.

For children 12 months of age or older, numbing cream is applied. In some instances, an injected local anesthetic may be applied for additional anesthesia.

Crying and fussing are common during and after the procedure. In older children, we have the option of giving an oral dose of Versed (midazolam), which is a relaxing medicine similar to Valium. It is very safe in children and begins working in 20-30 minutes. It helps alleviate separation anxiety in addition to providing an amnesia-like effect during the procedure. It lasts about 90-120 minutes.

You may breastfeed, bottle-feed, or soothe your baby in any manner you'd like following the procedure. You may stay as long as necessary.

Aftercare Stretch Exercises

The main risk of a frenectomy is that the mouth heals so quickly that it may prematurely reattach at either the tongue site or the lip site, causing a new limitation in mobility and the persistence or return of symptoms. The exercises are best done with the baby placed in your lap (or lying on a bed) with the feet going away from you.


A small amount of spotting or bleeding is common after the procedure, especially in the first few days. Because a laser is being used, bleeding is minimized. Wash your hands well prior to your stretches (gloves aren’t necessary). apply a small amount of the teething gel to your finger prior to your stretches. The area of the surgery will have a diamond shape. Initially it will be pink to red in color, but will eventually turn white.

Do one stretch on the evening of surgery. Then, skip ahead to the next morning (keep in mind that this is the only time that you should skip the overnight stretch).

Our recommendation is that stretches be done:
6x/day for the first 3 weeks, and then spending the 4th week quickly tapering from 6 to 5 to 4 to 3 to 2 to 1 per day before quitting completely at the end of the 4th week. We find it’s easiest for parents to do 5 of the stretches during their waking hours and one of those stretches in the middle of the night, taking care to not go more than 6 hours between stretches. Diaper changes are a good time to do the exercises.

Upper Lip Stretches

The Upper Lip is the easier of the 2 sites to stretch. If you must stretch both sites, We recommend that you start with the lip. Typically, babies don’t like either of the stretches and may cry, so starting with the lip allows you to get under the tongue easier once the baby starts to cry. For the upper lip, simply place your finger under the lip and move it up as high as it will go (until it bumps into resistance). Then gently sweep from side to side for 1-2 seconds. Remember, the main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they can’t stick together.

Tongue Stretches

The Tongue should be your next area to stretch. Insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Then use both index fingers to dive under the tongue and pick it up, towards the roof of baby’s mouth. Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the baby’s mouth). Hold it there for 1-2 seconds and then relax. Massage on either side of the diamond (outside the diamond) to loosen up the musculature of the remainder of the floor of mouth. You can use more pressure when doing these stretches because you aren’t in the wound at this point.

Post Frenectomy Exercises

New Patients and Emergency Appointements Welcome