Lip and Tongue Ties: What You Need To Know

As a board-certified pediatric dentist, Dr. Kwak is trained to diagnose and treat lip & tongue ties and has actually taken additional course on this subject with personal interest. He and his wife experienced this as new parents when their daughter had a mild lip tie as a baby and his wife had trouble breastfeeding aftrer she was born.

With the recent renewed emphasis on breastfeeding, new moms feel pressured to successfully breastfeed and when it doesn't work, they naturally want to find out why and how to fix it. Often, lip and tongue ties are blamed for an array of feeding and digestive issues on newborns, and it is a tempting to hear a "simple" procedure that can potentially make all the problems go away.

We don't currently perform frenotomy at our office at this time but we've had a lot of inquiries about it. While it is a popular prodecure, there is a lot of confusion and misunderstanding about lip and tongue restrictions even among health professionals, mainly because the research is ongoing and the findings are not very conclusive. However, one thing all the professionals agree on is we need more research! If you are a new parent considering frenotomy for your infant, Dr. Kwak wants you to consider these facts:

• Lip & tongue ties do exist in varying severity and they can sometimes cause problems in breastfeeding, bottle-feeding, reflux, speech, or tooth placement.
• A tie-release procedure performed by trained practitioners has little to no risk.
• Not all tongue and lip ties need to be treated, and even after a release procedure many babies will still need further therapy to restore proper tongue-function post-surgery.
• A study from 2017 shows there was an 834% increase in reported diagnoses of tongue tie in babies from 1997 to 2012 in the US, and an 866% increase in frenotomies during that time!

• A Cochrane review concluded that “surgical release of the tongue-tie does not consistently improve infant feeding but is likely to improve maternal nipple pain,” and also noted that “the quality of the evidence is very low to moderate because overall, only a small number of studies have looked at this condition, the total number of babies included in these studies was low and some studies could have been better designed.”

In short: a release procedure may be helpful, but the definitive evidence is lacking. It is not a "simple", fix-all solution and a tie release does NOT guarantee correction. Moreover, the drastic increase in tongue tie operations outpaces evidence, as studies suggest 50% of breastfeeding babies with tongue-tie will never encounter any problems.

Dr. Kwak recommends a comprehensive evaluation– from certified lactation consultants, speech therapists, chiropractors, occupational therapists, etc.– to identify specific functional deficits in your child before seeking a provider to perform a release procedure.