What to Expect for Lip-Tie & Tongue-Tie

Having tools to pull from to ease the process of revision (and healing) for mother and baby is integral to optimal results of the procedure itself. We suggest having these on hand before your appointment. These are optional, however, when combined, we see the best results:

• Tylenol/Ibuprofen- please dose as directed by your pediatrician or Dr. Rowe
• Arnica Massage Gel (not for intraoral use; common brands are “Boiron” and “Hylands”, you can find these in most Target and Walgreen stores. Let us know if you need help finding these in your community
• Epsom Salt and/or Magnesium Oil- Dr. Rowe recommends Epsom salt baths after the procedure to promote skin-to-skin as well as the added anti-inflammatory properties found in Epsom Salt and Magnesium Oil. Babies are slippery, co-bathing is not easy, please ask for assistance from a loved one.
• A support person- We understand that this can be a lot of information to absorb in one day. Two sets of ears are better than one, as well as having a shoulder to lean on during the procedure.
• Turmeric – Turmeric has anti-inflammatory and anti-septic properties, using this in addition to other pain management techniques can be very helpful.
• Cool compress- for swelling and discomfort
• Turmeric and breastmilk/formula mixture frozen into shallow bits- 1/8 tsp of turmeric to 1 Oz of breastmilk/formula
• A baby carrier (woven wrap, soft structured carrier, Moby, etc.) for doing skin to skin contact for an extended period

We recommend that you bring with you, to the appointment:

A support person can make a big difference. There will be information to learn and experiences to process. It’s helpful to have someone with you who can help you remember all the information as well as be calm and present with your child. It’s ideal to have support through the evening of the procedure since many babies are fussy. Please also bring anything currently needed for feeding like milk, breast pump, bottles, or nipple shields. Please also consider your plan for the procedure. It is a very hard thing to see your child in pain, Dr. Rowe would welcome you to attend the surgery, however if it is too stressful/ traumatic to experience, we will be glad to accompany you in the reception area. We are here to help you, as the parent, feel as comfortable as possible and trust us to care for your child as if they are our own.

The day of the procedure:

We ask that you complete the paperwork at home, please bring this to speed up check-in. Our dental assistant will bring you into a treatment room from the reception area. We will ask you about what you have experienced thus far and welcome you to the practice. Kristyn, CLC will administer a functional assessment based on the Hazelbaker Assessment (HALFF). It is best to be done on children under 3 months, but we are able to modify this assessment to meet your child’s nursing or bottle-feeding habits. Tongue/lip ties are often misdiagnosed because function was not considered. Function has more to do with feeding than “sticking the tongue out, transferring normal amounts during feeds, or the lip flanging correctly”. This assessment is comprehensive in nature and helps us to correctly treat your child.

Dr. Rowe will then come into the room and introduce himself. He will review symptoms with you to create a baseline to achieve proper function. Dr. Rowe will go through all of the post-op exercises with you at this time. We like to make sure that our parents are completely informed of what they will be doing for their baby for the next few weeks. To ease this process, we go through post-op healing and wound management before the assessment. Once the assessment begins, emotions and vocal volumes tend to run high. Dr. Rowe wants to ensure that all of your questions are answered and that you are able to make an informed decision, so we do this beforehand. He will then complete an anatomical assessment. Since Dr. Rowe is a periodontist, dental health is very important to us. Function and anatomy are equally important to achieve a diagnosis. Dr. Rowe and Kristyn will review their assessments in order to calculate necessity. If the decision is made to move forward with a frenectomy, Pam, IBCLC, LPN, CST will then enter the room to do craniosacral therapy. In our experience, craniosacral therapy will help to alleviate any tension left over from birth or that has been built up from stress. The fascia in the body is lightly touched for 10-15 mins with a focus on the neck, jaw, head and mouth. This therapy given beforehand can lessen the severity of inflammation via enhancing blood flow, releasing physical restrictions and balancing the membranes at the core of the craniosacral system that may impair the function of the central nervous system.

Once this therapy is completed, Dr. Rowe will re-enter the treatment room. Your baby will be wrapped in a swaddle blanket for the procedure. The procedure takes about 2-3 minutes. We welcome our parents to remain in the treatment room during the procedure. However, moms that are struggling with letdown or are less than 5 months post-partum will be escorted across the hall to join Kristyn until your child’s frenectomy is complete. Once the procedure is complete, Dr. Rowe will bring your baby to you to nurse or bottle-feed. Kristyn will assist with the first latch after the procedure. In our breastfeeding patients, this latch can be critical for function to be corrected. Once the nursing session is over, your appointment is over. Overall, this appointment will take at least one hour.

Follow-Up:

We ask that our patients come for a one-week follow up. This appointment is important because of how healing varies in each patient. The risk for reattachment is always present after a frenectomy. We ask that you review your post-op healing video as needed when doing the post-op exercises as this plays an important role in preventing reattachment. Dr. Rowe will assess the wound and stretch as necessary. Please note that this can cause discomfort to your child. This appointment will be brief, 20-30 minutes.

We ask our patients to come back for a second follow up visit 6 weeks after the procedure. This appointment is also very brief. By this appointment, the wound should be healed or very close to it. Dr. Rowe does a quick look in the mouth and discusses again with you what you have been experiencing. If function has improved, we will release your child from our care. If not, we will ensure that we give you the name of someone to assist further. We will guide you through this process from beginning to end, no matter what.

Appointment 1 - Consultation

We are eager to meet your little one and that is what this appointments focus is. We do not render treatment on the same day of the procedure for any child older than 18 months. We do not want to cause unnecessary trauma to your child. During this appointment we are going to do a lot of talking. Dr. Rowe will sit down with you and discuss symptoms, what you have experienced as far as development and any pertinent family history. We then talk about sedation techniques and what options best suit your child. We will go over mental preparation for both parents and children. We recommend refraining from the words “pain, hurt, surgery, etc.” as these create a negative connotation surrounding the frenectomy. Dr. Rowe will give you exercises to practice at home in regard to the therapy if your SLP has not already.

We also establish supportive care in this appointment. When we are treating an older child there are a couple components that will be essential for an optimal outcome To find out more about that click here.

Appointment 2 - Procedure

As parents and caregivers, it is completely normal to fret about the day of a procedure for your child. It is normal. Dr. Rowe, as a father, has been in your footsteps and we want to ensure that this day is handled with the utmost grace and patience because each child deserves that.

For our consciously sedated patients, this therapy works the best when the child is able to remain calm. We ask that the child be familiar with a nose piece used for nitrous oxide via the speech therapy or practicing at home.

The procedure takes about 2-3 minutes to complete if we are able to work efficiently in your child’s mouth. We understand that seeing your child in discomfort can be very difficult to watch and we will accompany you in the reception area during the procedure. At Southern Roots Periodontics, we believe in a child’s right to consent, we will not do this procedure if they are not ready. This is another reason why therapy prior to a procedure is important. In a perfect world, your child should be familiar with intraoral work and will comply with treatment. Once the procedure has been completed, Dr. Rowe recommends seeing a therapist trained by the IAOM (International Association of Orofacial Myology) within 48 hours. This is not always possible due to rural areas and finances, we acknowledge this. Southern Roots Periodontics will make our best effort to ensure that you are informed about active and passive wound management to be able to bridge the gap.

Appointments 3 &4 - Follow-Up

We ask that our patients come for a one-week follow up. This appointment is important because of how healing varies in each patient. The risk for reattachment is always present after a frenectomy. We ask that you review your post-op healing video as needed when doing the post-op exercises as this plays an important role in preventing reattachment. Dr. Rowe will assess the wound and stretch as necessary. Please note that this can cause discomfort to your child. This appointment will be brief, 20-30 minutes.

We ask our patients to come back for a second follow up visit 6 weeks after the procedure. This appointment is also very brief. By this appointment, the wound should be healed or very close to it. Dr. Rowe does a quick look in the mouth and discusses again with you what you have been experiencing. If function has improved, we will release your child from our care. If not, we will ensure that we give you the name of someone to assist further. We will guide you through this process from beginning to end, no matter what.

Appointment 1 - Consultation

For your first appointment, the focus is to create a baseline for oral health and function. Dr. Rowe will go over your dental and medical history. During this appointment, we will take a myriad of measurements that reflect dental health and function. If you are not already working with a myofunctional therapist, we will find someone trained in your area to work with. If necessary, we will address sleep issues as well. If it is determined that you have a tongue tie, we will instruct you on post-op care as well at this appointment. Please have enough memory available for a 5-minute video.

Appointment 2 - Procedure

This procedure takes less than five minutes with minimal discomfort. We will administer a topical anesthetic preceding local anesthetic. We will ask you to wear safety goggles during the procedure. Once this has been completed, we will see you one and six weeks following the procedure.

Appointments 3 &4 - Follow-Up

For the first follow up appointment at one week, we will assess the wound for healing. Dr. Rowe will re-advise on frequency of aftercare exercises. If necessary, he will do a stretch to loosen up any reattachment that has developed. At the six-week follow up, full healing should have occurred. We will assess and refer as necessary if there are any issues persisting.

*If myofunctional therapy is in place, it is possible to have the procedure the same day as the consultation to save on time and travel expenses.