Hello I’m Dr Emily Hahn and I’m one of the pediatric dentists here
at St Louis Children’s Hospital. And I’m Maithilee Menezes. I’m one of the
pediatric ear nose and throat surgeons here at St Louis Children’s Hospital.
What brings us here today is that Dr Menezes and I work together frequently
and one question that we get asked often is what should I do about my baby's lip tie tongue tie and
how do I address this. Do I need to do anything? So first we should probably address what is a
tongue tie? So what is a tongue tie? So, a tongue tie refers to having a little bit of an extra
amount of tissue at the bottom of the tongue. To define that a little bit better think of it this
way, this is your tongue this is the bottom of your mouth on the inside, the lingual frenulum,
tongue, frenulum helps tether that down. Sometimes there can be a little bit of excess tissue so to
speak that tethers it up near here. The first question is when do we intervene when we are told
that our child has a lip tie? Or we're concerned that our child has some sort of lip or tongue tie
or something just isn't right. The most common is with breastfeeding and then later on in life where
there's a question of like well I my pediatrician or others noted that there was a tongue tie
and other concerns have been raised such as sleep apnea or speech challenges or other things. So,
with breastfeeding there's different things that we have and that we assess when a child comes in
and some of those things include what's the mom's experience been like. Has it been really painful,
have there been challenges such as clogged ducts or um how is the child doing, how is the transfer
going, how is mom's production for breast milk itself? When we take all of that into account,
that becomes our key factors in thinking about this and then of course we look at anatomy.
So what are the contraindications? Because as a surgeon that was one of the first questions
I asked when I delved into the research. What is the anatomy and how is the child doing from
an airway standpoint? And so, for example like if there's the jaw and it's a little bit further back
and the tongue seems to be tethered and the tongue tie helps pull that forward that's to our benefit.
She brings up a good point that's why there is some tethering there and that's something I think
we should actually make clear. Some tethering is actually a good thing. It holds things in place.
So breastfeeding is really the primary indication for us to consider doing a tongue tie release.
Dr Emily, are there other things that we might think about like with a tongue tie or a lip tie?
Yes. As a dentist I always am going to be considering oral hygiene and what's the risk as
to getting dental care which is the most common childhood disease. And so, if a tongue is limited
to where they can't lick their teeth, that's something that I’m concerned with. And if
there's a hygiene issue where we're getting plaque and these start of decay or cavities
along the gum line, that's an indication. With the lip tie, if we pull that lip up and we get
blanching which means the tissue gets white and we can't clean that area, that's another indication.
But quite honestly beyond that, dentally speaking, there's not a lot of indications to do that.
And then just to kind of round this out too, there's a couple of other things that people
often ask about for like tongue tie. Will it cause sleep apnea? The answer is there is absolutely no
definitive literature so I’m going to basically say no. There has not been any association with
sleep apnea itself. The next one that often comes up is, is this going to cause speech challenges?
And for that the information in the literature is kind of mixed. It's certainly something
that we'll be continuing to pay attention to as speech develops and that is where, for example,
a speech therapist later on is going to be very important. Again, you can hear that theme, we
think that it takes a village to raise a child and we do firmly believe in that and that's what we're
here to do here at children's, is to work together to provide whatever support you guys may need.