TONGUE-TIE

Dr. Kalkani is an experienced paediatric oral surgeon and accredited (Level 4) tongue-tiepractitioner. She has undergone further training in infant feeding, both breastfeeding and bottle.

Dr. Kalkani performs infant and paediatric frenotomy and frenectomy procedures using Laser Biolase Technology.

What is a tongue-tie?
The piece of tissue joining the underside of the tongue to the floor of the mouth is called the lingual frenulum. When this is short, thick or extends right to the tip of the tongue, it may be described as tongue-tie or ankyloglossia. Tongue-ties are observed in 2%-16% of babies.

They are congenital, meaning they are present at birth, and are believed to result from both genetic and environmental factors.

Tongue-ties are particularly important in neonates, as they cause reduced mobility of the tongue in the forward, upward and side direction and thus, have an effect on feeding.

While you may not always be able to spot a tongue-tie in your infant, there are signs and symptoms- which primarily occur during breastfeeding- that may indicate the presence of a lingual frenulum abnormality:

• Inability to fully open their mouth during breastfeeding
• Difficulty latching
• Frequent or long feeds
• Fussiness during breastfeeding
• Chewing or biting during breastfeeding
• Clicking noises and/ or dribbling during feeds
• Choking on milk
• Excessive reflux

Mothers can also experience pain during breastfeeding, low milk supply, exhaustion from frequent/constant feeding as well as distress from failing to establish breastfeeding.

Occasionally, bottle fed babies with feeding issues such as problems with dribbling large volumes of milk, excessive clicking on the teat, severe colic or reflux may need to be assessed for tongue-tie.

Tongue-tie division
Around 1 in 20 babies will need a division of their lingual frenulum to assist in resolving feeding difficulties. The decision on whether or not a tongue-tie is impacting on feeding and whether it is appropriate to offer to divide will be made after a detailed history and examination has been taken. It is strongly recommended that an assessment by a practitioner skilled in breastfeeding (lactation consultant/ midwife/ health visitor) has been carried out prior to your visit, including observation of feeding and positioning.

Tongue-tie division or frenotomy is a quick & simple surgical procedure that releases the lingual frenulum so that it no longer attaches tightly the tongue to the floor of the mouth. The procedure is conducted without anaesthesia or can be done with a topical anaesthetic.

Stitches are not usually necessary, and there are normally no complications and little bleeding or discomfort afterwards.

After the release, there will be a diamond-shaped wound under your child’s tongue and/or lip. It takes about 2 weeks for the wound to heal sometimes a bit longer.

Ties in older children
Tongue or lip ties can be associated with speech or orthodontic issues in older children.

When the tongue is unable to move freely, a child may have difficulty producing certain speech sounds. The most common letters affected are R, S, L, Z, D, CH, TH, and SH, but other sounds are also difficult. There is no guarantee that a tongue-tie will automatically create speech problems, just as there is no guarantee that a frenectomy will solve existing problems. Delayed speech is not a symptom of a tongue-tie. There are, however, recent studies that show speech improvements after frenectomy.

Working with a speech and language therapist is an important step towards helping your child learn to produce proper speech sounds, regardless of whether there are tongue restrictions or not.

Removing upper lip restrictions can allow the teeth to erupt in a more ideal alignment. This assessment takes place in older children and is usually done jointly with an orthodontist.