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The Tongue Tie- Tie Berg

The Tongue Tie- Tie Berg

Tongue Tie – The big scam I have almost every patient that I consult come back to tell this!!


What is a frenum ?
It is a small fold of mucous or fascia that secures or attaches an organ in the body to near
by tissues. In mouth it’s there labial, lingual and buccal. .
Does everyone have this ?
Yes .
Then what is a tongue/lip- tie or restriction?
When this frenum is short , thickened, attached too ahead or tight , it limits the range of
movement of lip or tongue. .

Tongue moves out so doesn’t have a tie ?
No , tongue has wide range of movements, like out/in , side to side and up / down. A tie
can restrict all or any of this movement. .

Children outgrow it / tongue tie corrects by itself?
No , studies have shown that the frenum is made of Type 1 collagen ( found in skeletal
tissues ) and dosent stretch or break. If so adults shouldn’t have ties. .

Tongue – tie should be corrected only if speech is affected?
Speech is the only obvious visible sign of the tongue tie. Tongue has other functions too
including , feeding, breathing, cleaning and acting as a scaffold for the jaws to grow. .

Many who had tongue ties are grown up and still dosent have issues?
If your are not seeing the cause of an issue , you will probably never know why it
happens . For example on the pic above , feeding is only the tip of the ice berg and the
restriction can cause many many issues. .
However say if a child has frequent cold and cough (URI) , the line of treatment is mainly
drugs related to symptoms. Many a times when there is no protocol or functional
assessment to see the role of tongue in this, we tend to overlook it. .
Yes a restriction dosent cause life threatening acute problems, most of the problems are
chronic thus it’s almost always overlooked or not diagnosed.
Next time you hear that everyone has a tie, no everyone has a frenum and to say if it’s a
tie needs evaluation. And everyone out grows it , a big NO !!!

THE TONGUE TIE RELEASE
The tongue’s resting posture up the palate in an infant post tongue tie release . At WE , we
call it N spot, the point the tip of the tongue rests while pronouncing the alphabet N. .

This position is necessary for the following reasons

  1. Optimisation of nasal breathing
  2. Proper Development of the upper and lower jaw
  3. Harmony of the face and neck muscles
  4. Proper chew and swallow
  5. Proper facial development
    Are few to mention. .
    It’s not just enough for the tip of the tongue to be up the palate, we want the entire tongue
    to be up to achieve the above mentioned benefits. .
    So how do we identify if the posterior part of the tongue is up too ?
  6. In breastfeeding infants , a posterior restriction is identified as issues in feeding , pain
    during latch , improper latch and long feeding time are fed to mention
  7. In older children, the opening of the mouth compromises when the tongue is sucked up
    the palate.
  8. They will have tendency to breathe through the mouth.
  9. Narrow jaws and crooked teeth.
    Does your child have a tongue that’s resting in proper position ?

PRE AND POST TONGUE TIE RELEASE
Tongue tie release in infant & children is not see and cut . Functional breastfeeding is
achieved after preparation of the child and optimisation of the time of release. .

WE follow a protocol that has stages before and after release to achieve the best possible
optimal outcome, for both the mother and child. Many a times it thought that tie release is
all that’s needed. Post operative care and protocols are important for the outcome. .
For the infant above, the pic was taken 2 weeks before the release , the child underwent
the pre treatment protocols . The pic on the right is immediately after the tie release. .

The mother was relieved out of pain instantly after the tie release and experienced good
breast drainage for the first time since birth. The child was able to feed in less than 20
minutes and had good sleep and of course we can’t take our eyes of the happy baby face
😃😃 ( on the same day as release )

Breastfeeding on demand after the tooth erupts can rotten it “few
medical professionals advice mothers stop breastfeeding for the
same. .TRUTH :NO
“Breastfeeding on demand after the tooth erupts can rotten it “few medical professionals
advice mothers stop breastfeeding for the same. .TRUTH :NO

Dental cavities/decay is an infectious communicable disease and has multiple risk factors
associated in its development few are

  1. Socioeconomic status
  2. Maternal nutrition
  3. Hygiene
  4. Oral restrictions
  5. Bacteria
  6. PH of saliva
  7. Tooth quality
  8. Diet
  9. Swallowing patterns
  10. Muscle strength
    are the very few of the many hundred reasons. .

Why is breastfeeding needed??
Uncompensated – Extended – Exclusive breastfeeding (minimum till 2 years of age WHO)
is an essential process to ensure an optimal craniofacial maxillomandibular growth. In
simple terms breast is the first functional appliance ( appliance used to straighten teeth
and develop proper airways).

So what can you do as young mothers?
Prenatal- ensure your Vitamin D levels are upto standards. There is a strong correlation on
maternal nutrition and children’s teeth quality.
Post natal – Exclusive Extended breastfeed till 2, visit a Preventive Pediatric Dentist for
anticipatory guidance ( preventive Councelling) as soon as the first tooth erupts ( ensure
they are breastfeeding friendly). Do not wait for symptoms to occur. .

Watch out for white spots on teeth from time to time ( see pic above), this is the earliest
stage of developing cavities and can be reversed with hygiene and preventive practices ,
without need for invasive procedures. .

Prevention is always less invasive and effective than cure . However if you are at a stage
beyond prevention and were told to stop breastfeeding…, PLEASE LOOK OUT FOR A
FUNCTION FOCUSED, BREASTFEEDING FRIENDLY PEDIATRIC DENTIST,
PEDIATRIC DENTIST WITH EXPERTISE IN THE ROLE OF MUSCLE FUNCTION ON
CRANIOFACIAL DISEASES (including cavities). Or in simple terms a professional who not
just treats symptoms of disease but also corrects and optimises the real causes.

Tongue Ties & Eating Problems
This is a picture of tongue and lip tie work in a toddler before and after , baby L visited few
months before with issues in chewing, eating and swallowing.

Children with tongue ties and lip ties may develop eating problems over the course of their
childhood. Many times I have parents come in for eating issues and haven’t had any
issues with breastfeeding or sometimes had issues and couldn’t get help. .

Unfortunately, many healthcare providers aren’t trained for this and do not check for ties.
Or, if they do, they don’t know what to do with them.

Once solids are introduced children have difficulties in chewing and swallowing due to
issues with tongue movements. The tongue should be able to move side to side
( lateralisation) and up the jaw and form a Bolus that is then swallowed. .
However with thin baby cereals this is not needed and often seen as messy , dribbles all
over with the child able to swallow only a bit of it. .
Lip ties can cause an open mouth posture , which makes swallow difficult. Also due to poor
control the food either gets stuck to the cheeks or even initiate gag. .
This makes the child learn that certain foods are difficult to eat and develop a negative
relationship. Also they only prefer liquid or semi-solids. .
So how to identify if it’s a tie related eating issues ?

  1. Child only eats specific textures of food.
  2. Child eats with open mouth
  3. Messy eating
  4. Gagging during eating
  5. Dribbles during eating
  6. Food stuck on the cheeks requires manual removal
  7. Swallowing only after drinking water
  8. Comfortable with liquid and semi-solid foods.
  9. In older children predominantly pouch in the cheeks make it soggy and swallow.
    What are mostly behavioural eating issues? .
  10. Child refusing to eat a particular food group , eg: vegetables
  11. Child throws non-preferred foods and sticks to preferred ones.
  12. Child has never been exposed to different textures of food, and are predominantly only
    on mashed foods.