Tongue Ties

Tethered Oral Tissues

1. What are tethered oral tissues? 

  • All babies (in fact, all people!) have tissue connecting their tongues to the floor of their mouths, as well as tissue connecting their lips to their gums.  In some instances, if the tissue is too tight, too short, or too thick, it can restrict the movement of the tongue and/or lips.  You may hear people referring to “tongue tie” or “oral restrictions” when discussing this condition.  The medical term is ankyloglossia.

2. Why is this important?

  • When babies feed at the breast, they use a combination of suction (think sucking through a straw) and compression (think breast massage) to remove the milk from the breast.  Babies need to do both in order to effectively breastfeed.  If the baby does not have the full range of the motion of the tongue and/or lips to do these movements, it can restrict the “massage” motion, causing breastfeeding difficulty for the baby and/or painful breastfeeding for the breastfeeding parent.  In addition to affecting breastfeeding, these restrictions can affect bottle feeding, and long term, the condition can affect speech, sleeping, eating, and dental healthand development, among other things. 

3. Signs and Symptoms:

  • Often (although not always) the first signs of tethered oral tissues appear soon after birth in the form of breastfeeding challenges.  Some common signs and symptoms are as follows:
    • For baby:
      • Poor/shallow/ineffective latch
      • Inability to sustain a deep latch
      • Pinching or “chomping” on the nipple
      • Long/frequent feedings
      • Issues with weight gain
      • Milk dribbling out of mouth when feeding at breast or bottle
      • Gassiness/fussiness/reflux
      • Clicking sounds when feeding
      • “Popping” on and off the breast when feeding
    • For breastfeeding parent:
      • Pain during latch
      • Low milk supply
      • Nipple/breast infections
      • Plugged ducts/ blebs/ mastitis

4. Diagnosis and treatment:

  • Your IBCLC can assess the function of the tongue and lips as they relate to breastfeeding and can assist with addressing feeding related difficulties due to tethered oral ties.  However, only a dentist or doctor can diagnose condition.
  • IBCLCs will often recommend skilled, breastfeeding friendly practitioners that diagnose and release the restricted tissues.  This release procedure is called frenotomy, and typically involves releasing the tethered oral tissues with a scalpel or laser.  After the procedure, the provider will provide wound care exercises, which typically involve sweeping a gloved finger under the tongue or lip to prevent re-attachment.
  • A follow up lactation consultation is recommended 3-4 days post procedure.  In this consultation, the IBCLC will assess feeding and the baby’s ability to effectively remove milk from the breast with the new range of motion that is allowed by the release.
  • An IBCLC may provide also suck training exercises to assist baby with the realization of the new range of motion.
  • Body work, such as craniosacral therapy, myofascial therapy, chiropractic work, speech therapy, and/or occupational therapy may also be necessary or helpful for the most effectiveness.

Gemma is a fantastic resource to help with many breastfeeding issues. As an IBCLC and with a long career in breastfeeding services, she has helped many mothers meet their breastfeeding goals. Her particular knowledge of oral restrictions has helped us treat and manage breastfeeding problems related to TOTS for the last five years. I highly recommend her for knowledge and expertise.

-Dr. Rachel Poulsen, DDS Princess City Dental - Mishawaka, IN