Ankyloglossia or tongue-tie is a condition present at birth, which restricts the range of motion of the infant’s tongue. It occurs when a tight band of tissue called the lingual frenulum “ties” the bottom of the tongue’s tip to the floor of the mouth. It occurs more often in males than females and is believed to be genetic. Although relatively common (it is found in between 3 and 7 percent of the population), ankyloglossia is often misunderstood or overlooked in current dental and medical school training. Left untreated, it can cause mild to severe problems with breastfeeding and swallowing and may ultimately hinder normal speech development. Yet unless you or someone you know has been personally affected by the condition, you may not be aware of what to look for or where to turn to learn how to best address it, especially if you are a new parent.
Well-Being reached out to Catherine Sledge, DMD, of Carter Sledge Family Dentistry in Ridgeland about ankyloglossia and the innovative technology she uses to surgically treat the condition. According to Dr. Sledge, because tongue-tie is an issue that seems to have recently come to the forefront, there is not a lot of emphasis on it in current medical or dental training.
“There is a serious educational gap,” notes Dr. Sledge. “Those of us who treat the condition have had to seek out additional training, research, and professional support on our own. So the first step for a parent is to ask their provider specific questions to determine if they have the appropriate training. After a parent has found the right provider, the tongue- (and/or lip-) tie may be released using either a laser or scissors.”
One reason issues surrounding tongue-tie have recently received more attention is the increase in the number of women breastfeeding today. Before the days of commercially prepared formula, physicians and even midwives were trained to perform the simple procedure to clip the attached tissue. After the popularity of formula grew, more medical and dental schools eliminated the procedure from their curriculum because feeding problems were not as evident with bottle-feeding.
“The breastfeeding relationship can be extremely negatively affected if the child is tongue-tied or lip-tied,” Sledge explains. “In fact it can kill the relationship entirely, as tongue tie often leads to premature weaning. When a child is tongue-tied, the breastfeeding mother often experiences painful nursing sessions, cracked or bleeding nipples, increased stress and anxiety, and an increased risk of thrush, engorgement, and mastitis. Also associated with tongue tie is low weight gain in the infant, falling asleep repeatedly at the breast during nursing sessions, and aerophagia, or swallowing of excessive amounts of air, which is often misdiagnosed as colic or reflux.”
In addition to problems breastfeeding, research has begun to indicate that tongue and lip ties can cause other issues such as problems with speech development, jaw growth and development, airway development, and crowding of the lower teeth. Dr. Sledge recommends treating ankyloglossia soon after birth.
“When it comes to correcting the attachment, the earlier the better! The sooner the problem is corrected, the sooner the child’s orofacial musculature can begin to function normally,” she adds. “This allows for growth, development, and function to carry on without restriction.”
The surgical treatment for tongue-tie is a simple procedure called a frenotomy, which can be done in the hospital nursery or doctor’s office, using sterile scissors or a laser to snip the frenulum free. In her practice, Dr. Sledge uses laser technology to perform the procedure. “The use of a laser allows me to be more precise as a practitioner. It is a safe, effective way to treat the condition with the minimal amount of intervention. A laser essentially anesthetizes as it works, so there is no need for additional anesthesia, i.e., a shot, to be given. Without the confusion of anesthesia, it allows the baby to be back at the breast immediately after the procedure. Lasers also cauterize as they work, so there is no bleeding. This gives me a better field of vision, as well as making the procedure more comfortable for the child. It usually takes about sixty seconds.”
Dr. Sledge acknowledges that considering the procedure may be difficult for parents. “It can feel quite scary to hand over your tiny little baby for what may seem like an intimidating procedure. But parents need to know – this is a safe, simple, effective procedure that can have major short and long term positive effects for your child,” she concludes.
When tongue-tie has not been surgically treated immediately, parents should monitor their child’s development of speech and oral motor skills. If by 24 – 36 months there is an articulation problem, the child should be evaluated by a speech pathologist.
Susannah Silvia, MCD CCC SLP, Speech Language Pathologist and Clinical Director of Beyond Therapy for Kids, spoke to Well-Being about factors that should be considered by parents of an infant born with tongue-tie.
“The severity of anklyoglossis changes over time and is more severe the first year of life and most commonly affects feeding skills,” explains Silvia. “Over time, a child’s oral cavity grows allowing the lingual frenum to stretch lessening the impact on articulation skills. This is why surprisingly, children with ankyloglossia are often found to have no speech problems.”
“Whether the condition is treated soon after birth or considered later can depend on the severity of the attachment,” Silvia adds. “We use the Hazelbaker Assessment Tool for Lingual Frenulum Function. If an infant exhibits a score of a 0 or 1 on a scale of 0 – 3, we usually refer them to a pediatric dentist for the procedure. Typically a score of 3 may stretch and does not cause feeding or speech issues. However, surgery is best performed immediately after birth if there are feeding problems. The surgery is minimal and can be performed on a neonatal, outpatient or office basis.”
Susannah Silvia is not only a pediatric speech pathologist, she is also the mother of a child with ankyloglossia whose frenulum was clipped at 2 weeks old due to feeding issues.
“I had noticed my child was feeding just “ok” compared to my other two children,” Silvia notes. “Parents have great intuition about their children. If you have any concerns from the beginning, find the right neonatologist who can educate you on pediatric feeding and oral motor function. If your child is older, a pediatric dentist that specializes in ankloyglossia is the best route.”
Catherine Sledge, DMD, of Carter Sledge Dentistry in Ridgeland, received her DMD degree from the University of Mississippi Medical Center’s school of dentistry. She is a member of the American Dental Association, Mississippi Dental Association, Mississippi Association of Women Dentists, and the International Affiliation of Tongue-Tie Professionals (IATP). A top expert in treatment of ankyloglossia in the region, Dr. Sledge is one of the only doctors in Mississippi to use laser technology to treat the condition.
Susannah Silvia, MCD CCC SLP, Speech Language Pathologist, and Center Manager at Beyond Therapy in Ridgeland, received her BA in communication disorders from Louisiana State University and her Master’s in Communication Disorders from LSU Health Science Center. She has over 10 years of pediatric experience in a variety of communication disorders, and was one of Beyond Therapy’s first speech pathologists to treat babies in the community through MS Early Intervention Program, First Steps.