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.
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?
If my child has a lip-tie does that mean they will have a tongue-tie?
What are buccal ties?
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
What additional evaluations/therapies may be recommended and/or required pre/post-procedure, and why?
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!
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.
Is there a difference between the treatment approaches and outcomes for different types of laser?
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.
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?
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.
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.
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!
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?
What is the importance of wound care and is it really necessary?
Are there any restrictions on activity or travel after surgery?
Is a follow-up visit necessary?
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:
- 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.
- 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.
- 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.
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
- 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.
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.