Frequently Asked Questions

Questions about treatment considerations

What Are the Symptoms of Lip Tie/Tongue Tie in newborns and babies?

There are a variety of symptoms associated with lip tie and tongue tie that may present at different milestones of life.

At birth, babies with lip tie and tongue tie may have difficulty with latching at the breast, sustaining a latch, and nursing efficiently. Nursing-parent often reports significant discomfort, nipple damage, and milk supply concerns due to inefficient drainage of the breast. Many babies struggle to maintain a seal with their lips and tongue on both the breast and bottle nipple and dribbling of milk, and pulling off to gasp or cough during feeds is fairly common. Air Induced Reflux leading to excessive fussiness, arching, low intake, frequent small feeds or copious amounts of spit up are noted by parents of babies with restrictive oral ties. Some babies may have difficulty with transitioning to solid table foods or purees as they cough and gag on textured foods.

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Does My Baby Need a Frenectomy?

Whenever we are considering a surgical procedure for an infant, we take into account both the necessity and optimal timing of treatment in order to help our baby get the best possible post-procedure outcome. If tethered oral tissues (TOTs) are negatively impacting feeding, speech, sleep and/or oral development, Waterlaser treatment may be beneficial in conjunction with therapeutic interventions both before and after the Waterlaser procedure.

Can Tongue-tie or Lip-tie Resolve Itself?
Tongue-tie and lip-tie do not ‘resolve’ themselves. Sometimes, trauma to the tissues can occur, like a fall, which can change the appearance and impact of the tethered tissue on the surrounding oral structures, but as a philosophy, we do not think of physical trauma to the site as ‘resolution.’ In many cases, if the ties are not treated surgically, children are able to find ways of compensating around the ties in order to do “well enough” with eating/speaking, etc., but the compensations are usually developed in the absence of proper oral motor function, and laser lip and tongue tie revision are often needed in order to help establish proper oral motor function at some point during the course of development. 
If my child has a lip-tie does that mean they will have a tongue-tie?
The statistical likelihood of having additional tethered oral tissues increases with the presence of one tether in the mouth. Lip-tie and tongue-tie frequently co-occur, and if we know one is present, we want to make sure we do not miss any others like a tongue- tie, lower lip-tie and buccal or cheek ties.
What are buccal ties?
Buccal ties, or often referred to as ‘cheek ties’ are bands of connective tissue inside the upper lip/cheek area near the canines (corners of the lips). When there is a prominent upper lip tie, there is a possibility of buccal ties being present inside the mouth.
Can you share some research articles about lip and tongue ties?

Tethered oral tissues have an impact on multiple systems in our body. It is a very active field of study in many specialties. While there are many resources now available on open source search engines, here are links to the two organizations that are dedicated to tethered

https://tonguetieprofessionals.org/research/

https://icapprofessionals.com/public-resources/articles/

What additional evaluations/therapies may be recommended and/or required pre/post-procedure, and why?
Truly collaborative and team-oriented care is a cornerstone of our record high rate of long term successful outcomes. 

Our doctors want to make sure that our families have an established support system for baby and mom with a feeding specialist like an IBCLC or feeding therapist to help prepare for the procedure. This ensures functional improvement with feeding after the procedure. 

Based on clinical findings, doctors may also make referrals to bodywork providers such as infant massage, craniosacral therapy (CST), physical therapy, occupational therapy or chiropractic care for overall wellness both before and after the procedure. In many cases, referrals may be recommended while in other cases such supportive care may be required prior to providing the frenectomy procedure. The clinical team provides detailed and stepwise guidance for our parents so that we can get our babies treated quickly and effectively in the right sequence!

 

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How can we find the best provider for my baby’s tongue tie frenectomy?

Not every frenectomy provider has the experience, skill, and knowledge to treat tethered oral tissues. It is crucial to find an experienced provider that is able to consider the full picture of the symptoms and connect the dots from signs and symptoms to proper diagnosis and thorough (complete) procedure to get the best experience and successful long term outcomes. When searching, you can take some steps to find a good fit.

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Is there a difference between the treatment approaches and outcomes for different types of laser?

Waterlase is one of the only dental lasers that is biocompatible, protective of all tissues, that can be used for treating hard tissues such as teeth and bony structures, as well as soft tissues like gums, lips, tongue, and more.

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If lasers are the best way to perform frenectomies, why don’t more practitioners use them?

Questions about procedure day

What can I do to prepare for my baby’s frenectomy?

Dr. Rishita Jaju reviews the 5 steps to prepare for the most effective and smooth experience during your baby’s Tongue and Lip-tie Laser Frenectomy procedure.

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What will happen during my consultation appointment?

During your consultation appointment, whether it is in person or virtual, the Smile Wonders Team and Doctor(s) will review the entire procedure process with you.The doctor(s) will perform a detailed exam of the baby’s mouth and body. They will discuss their clinical impressions of function and anatomy findings including tongue, lips, buccal/cheeks, jaw size/shape/position and their impact on function. They will screen for any neck or body tension or concerns with asymmetry.

The doctor(s) will also review current symptoms and future considerations. This is the best time to discuss the benefits, risks, aftercare, any other medical concerns and optimal timing for procedure with your doctors in detail. The doctor(s) will also consider how to best support your baby’s feeding and overall wellbeing by coordinating support with other providers like feeding specialists and body workers.

What will happen during my procedure appointment?
During your procedure appointment, the goal is to focus on the treatment and aftercare so that you feel prepared for the recovery process. The Doctor will review the treatment plan, complete the treatment, and then our Team will walk you through the aftercare instructions and you will be able to feed and comfort your baby shortly afterwards!
Is the surgery painful? How is the baby's pain managed during the procedure? Do you give anesthetic during surgery?

Waterlaser virtually eliminates the need for scalpel, sutures, or anesthetic in infant frenectomy cases. The newborns we treat can feed immediately after the procedure for comfort.

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How does laser surgery compare with use of blades in tongue/lip tie surgery?

Thanks to the great advances in laser technology, the most technologically-savvy and up-to-date healthcare providers are educated on the laser’s properties and know why they are highly favorable in soft tissue procedures. The laser’s ability to coagulate as it releases tissue allows better healing of the surgical site. Lasers virtually eliminate the need for scalpel or sutures, in most frenectomy cases.

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Will there be pain after the surgery? What can I do to help with comfort-management after the procedure while at home?

We will give you written instructions on pain management with age/weight appropriate dosing of Infant Tylenol. We recommend using your usual methods of soothing your baby, including swaddling/shushing/snuggles, etc. but when your baby is not easily soothed or discomfort seems to be impacting the quality of feedings, use of Infant Tylenol is also recommended. 

Can I be present in the room while my child is having the procedure?

Dr Rishita Jaju has been doing this procedure for over 13 years, and she has found that the safest way to do this procedure is without parents in the room. During the procedure, the Doctor and Assistant need to have their entire attention focused on your baby, and having parents in the room makes that very difficult to do!

You can expect to be away from your baby for about 5-10 minutes, and we take care of your baby like they are our own!

Aftercare Questions

How soon after the procedure can I feed/nurse my baby?

We encourage you to feed your baby right after the procedure. We typically like to show you the surgical sites and demonstrate exercises prior to the feed so that your baby is soothed immediately afterwards by feeding. 

What are recommended wound-care exercises & stretches?
At the bottom of our Infant Frenectomy page, there is a three part video that goes over our recommended active wound care and aftercare exercises. You can find those here, but we review it with you in person on the day of the procedure as well!
What is the importance of wound care and is it really necessary?
The wound stretches are very important to managing the healing and ensuring the formation of healthy new connective tissue. We all have connective tissues in our body, but they are considered ‘ties’ when they are restricting the full range of motion. The body’s natural healing tendency is to heal quickly and heal back to the way things were before. When we do these wound stretches we help the body heal through secondary intention and encourage the sites to remain where we left them surgically. These exercises help to make sure the healing tissue remains soft and supple as new connective tissue forms so that we resolve the tie!
Are there any restrictions on activity or travel after surgery?
In the week after the procedure, we want to make sure that your little one is able to focus on healing. There can be some soreness, fussiness, and impacts to the quality of feeds. So, lots of rest and comfort management are a must! We recommend avoiding travel, big activities and exposure to anything that would overwhelm your baby’s healing process like vaccines or additional germs at the pediatrician’s office.
Is a follow-up visit necessary?
At Smile Wonders, our team goes out of our way to ensure families feel well supported before, during and after the procedure. Follow up visits help to make sure the healing process is going well, but they also help with getting good optimal healing outcomes as we continue to coordinate with your baby’s other care providers. Seeing babies at specific intervals during the healing allows us to actively manage the healing and prevent the possibility of reattachment of the healing tissue. The follow up visits are an integral part of our care and one of the important ways that we ensure excellent long term outcomes.
How common is reattachment?

The incidence of reattachment in our office is extremely low! Less than 1 percent.

This is possible mainly due to 2 important factors:

  1. Our doctors are highly skilled providers in the mid-Atlantic area and maintain a highest level of training in the use of Waterlaser. This ensures safe and thorough/complete release of the restrictive tissue.
  2. We focus on supporting the parents after the procedure by providing detailed site management exercises, staying in close contact with them (and their providers) via text/phone/email. The aftercare protocol is customized to the needs of each baby and family at the follow up visits that are a part of our service.
  3. The aftercare protocol is customized to the needs of each baby and family at the follow up visits that are a part of our service.
Is it normal to notice a frenulum again in my baby’s mouth after frenectomy?

After infant frenectomy, it is very common for a healthy new frenum to form. The goal is for the new frenum to maximize functional results of the procedure and have proper development of the mouth and face. The new frenum is less prominent as well as soft and supple to allow for a full range of motion for the tongue and lip.  

Toddler Questions

What are common symptoms in a toddler with tethered oral tissues?

When toddlers come to our office for Lip Tie/Tongue Tie concerns, they are often experiencing speech difficulties, problems with eating, such as issues with chewing or swallowing, or managing textured foods, inability to move the tongue and lip well for good oral hygiene, and sleep disturbances like snoring, waking frequently, or gasping for air.

You can read more here.

What are the behavioral effects of prolonged tethered oral structures?

Children who grow into adults without having their tongue tie treated often experience a range of oral myofunctional symptoms, including:

  • Speech issues
  • Mouth breathing
  • Jaw pain, clenching, and grinding
  • Headaches
  • Head, neck, and shoulder tension
  • Forward head posture
  • Snoring, sleep disordered breathing, Upper Airway Resistance Syndrome (UARS), and sleep apnea
  • Increased risk of cavities and gum disease
  • Slower orthodontic treatment
  • Orthodontic relapse

You can read more here.

Financial Questions

Is it covered by my insurance?

Smile Wonders does not participate with insurance companies, but we do try our best to help you take advantage of any out of network benefits that your plan allows. As a courtesy to our patients, we will submit your electronic Dental Claim for you if you prefer.

We will also provide you with a Letter of Medical Necessity so that you will have everything you need to submit a claim to your Medical Insurance if you find that you have better coverage through your Medical Insurance.

We have provided codes and instructions on our website for you here towards the bottom of the page.