The Myofunctional Space

Tongue and Lip Tie Diagnosis and Treatment

Having a tongue tie and/or lip tie can increase the risks of having a number of functional issues, at any age. These issues can affect feeding, speech, jaw development, breathing and even posture, to name a few.

At The Myofunctional Space, we use Waterlase laser, which is essentially a beam of light surrounded by jets of cool water. The laser “ablates” the restrictive tissues by targeting the water molecules inside the cells and bursting them. In this way the tissue is then unable to hold together anymore and will release on its own. The laser feels like pins and needles across the skin. The lip and tongue wounds can remain numb for 2-3 hours after the procedure. A much gentler, cleaner, and more comfortable way.

Depending on the age of the patient, the oral tie release protocols differ between infants and toddlers, and older children and adults. Please see the FAQs section below to find out more of these protocols.

Nevertheless, safety is always a priority when it comes to performing any medical/dental procedure. Our dentists are always supported by other appropriate health practitioners in the evaluation and treatment processes of oral ties. Often the well-being of not only the patient, but also the family (parents) needs to be considered in the management of tongue tie and lip tie.

If you would like to book a tongue or lip tie consultation please see the contact page for instructions on what to do.

FAQs

What are the methods of releasing oral restrictions?

There are different methods of releasing these ties.

Snipping is still widely practiced by many practitioners, using scissors, scalpel, or even a long sharp fingernail. The downside of this method is the inability to know how deep to cut. If too shallow, then some restrictive fibres are left behind (incomplete release). If too deep, then high risk of adversely damaging hidden structures, such as blood vessels and/or nerves.

Using a dental laser is a safer method and tends to allow a more complete release. However, there are different types of dental lasers available. There are those that “cut”, and those that “burn”, which both can be quite traumatic and/or aggressive.

The Waterlase laser that we use, as mentioned above, works differently to other dental lasers.

We evaluate and manage oral ties for all age groups, from newborns to adults. Our youngest patient so far was 2 days old and our oldest was 74 years old. An initial thorough functional evaluation is always required to diagnose the presence or absence of oral ties. If there are ties that need to be released, we discuss the safest options to perform the release, according to each individual situation.

When assessing a baby, our in-house International Board Certified Lactation Consultant (IBCLC) or midwife is always present to evaluate the patient together with the dentist. The IBCLC or midwife gathers the patient’s functional history before the dentist physically evaluate the oral ties in the baby’s mouth. One of the parents and the dentist sit opposite each other with their knees touching together, and lay the baby down on their laps, with the head on the dentist’s. While the dentist examines inside the baby’s mouth, the parent holds the baby’s arms and body, and the IBCLC take photos of the oral ties and anything relevant to the examination.

The baby is swaddled securely on a reclined dental chair, in the procedure room. The International Board Certified Lactation Consultant (IBCLC) or midwife supports the baby’s head and body, while monitoring their well-being at all times. The dental assistant supports the baby’s jaws and holds a small suction to vacuum the water and saliva out from the patient’s mouth. The dentist performs the release of the oral ties gently and accurately with the Waterlase laser, while stabilizing the baby’s head.

Each oral tie takes around 10-20 seconds to release. Hence, the baby is only away from the parents for around 5 minutes. During this period, the parents are encouraged to remain as calm as possible, in order to be able to comfort and feed the baby immediately upon their return.

Releasing an oral tie usually takes around 10-20 seconds each, with the Waterlase laser. Additionally the laser has a numbing effect.

For infants and toddlers, no anaesthetic is used as this can be more dangerous to these young patients, especially the procedure takes only a very short period of time.

For older children and adults, local anaesthetic is recommended to provide a more comfortable and safer experience, and also to allow the ability to place sutures (stitches) for primary wound closure.

On the rare occasions, children may be non-compliant, leading to safety concerns to perform the procedure. In these situations, the option of performing the release under general anaesthetic is available, but by particular specialist paediatric dentist or Ear Nose Throat surgeons, who are appropriately skilled. Keeping in mind that general anaesthetic carries additional risks.

For infants and toddlers, wound stretches are necessary because placement of sutures (stitches) is usually impossible. With open wounds, the body usually naturally heals them back to their original conditions. However, this is not preferred, as this would mean the oral tie reforming. Hence, the wound stretches are required to guide the wounds to heal better than the originals, minimizing the risk of the tie reforming.

Wounds take around 4 weeks to heal, in which the stretches need to be performed every 4 hours in the first 3 weeks and every 8 hours in the fourth week after the release procedure.

How to perform the stretches is demonstrated by the treating dentist, prior to the procedure.

For older children and adults, safe enough for us to use local anaesthetic, sutures (stitches) are used to close the wound with primary intention. Wound stretches are not necessary when sutures have been used to close the wound. Nevertheless, these patients usually need to also undergo intensive orofacial myofunctional exercises before and after the release procedure.

Wound stretches are to minimize the risk of the tie reforming. Orofacial myofunctional (OM) exercises are to prepare the affected muscles to improve functions.

For older children and adults, OM exercises are indicated for a minimum of 4 weeks prior to the release procedure, and for a minimum of 4 weeks after the release procedure. These exercises are prescribed and instructed by an orofacial myologist, in order to form better neurological connections from the brain to the affected muscles, with the intention to retrain these muscles to improve their resting positions and functions.

Research indicate that it takes at least 2 months to change a habit. Thus, the total of at least 8 weeks of OM exercises.

The fee for the release procedure depends on the age group and what are involved. For infants and toddlers, the dentists look after the patients alongside our in-house International Board Certified Lactation Consultants (IBCLC) or midwives. For older children and adults, the dentists look after the patients alongside our orofacial myologists for exercises, and perform the procedures with local anaesthetic and sutures.

Please call our office to obtain a more accurate estimation of the fees, according to your particular situation.

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