Lip/Tongue-Tie
Solutions For Infants, Children, & Adults

Why does it hurt when I breastfeed my baby?

Many babies can be born with a combination of conditions. Tongue-tie (ankyloglossia) and/or lip-tie is/are one of the complications. These conditions can make breastfeeding difficult and painful.

What is a tongue-tie or lip-tie?

When the tissue attaching the tongue to the floor of the mouth during embryonic development does not disappear, the result is a tongue-tie. A lip-tie happens when the upper lip remains attached to the upper gum, making it difficult for a baby to latch.

FREQUENTLY ASKED QUESTIONS

When should I do my paperwork?

As soon as you receive it electronically. The earlier the better to allow us to prevent any surprises in terms of insurance verification, coverage, and what we need on our end. This also gives us the opportunity to prepare for your visit and discuss any specifics with your referring provider if necessary.

Do I need an IBCLC or any other provider?

Sometimes there may be underlying issues in addition to the lip and tongue that may be restricting movement and limiting function.

It’s strongly recommended that you have the proper team in place. Although, Dr. Hamlin and her team are amazing at what they do, they cannot provide the support and functional development that an IBCLC, Feeding and/or Nutritional therapist, Myofunctional Therapist, Craniosacral Therapist, Chiropractor or other body worker, Speech Therapist, Physical or Occupational Therapist can. Dr. Hamlin will most likely speak with your team or provider to discuss findings and recommendations for proper timing of release. You can download a list of our Co-Treatment Team here.

What ages do you do frenectomies on?

With referral, we see infants from birth to age 2 and kids ages 7 and up into adulthood. The oldest patient we have completed a frenectomy on was 87 years old. Children ages 2-6 are not guaranteed to be able to be seen in our practice since sedation is not offered.

Should I expect immediate results after the tongue/lip tie procedure (frenectomy)?

Not necessarily. You may notice an improvement immediately or may take time to see improved results. This is also why it is referred to as a breastfeeding journey. Everyone’s journey will look a little different and having a team in place that can guide you and potentially expedite the healing process is preferred.

What happens if we don’t release the tie and the restriction remains?

We cannot predict exactly what will happen as everyone is different and one’s ability to compensate will vary. Generally the following could potentially happen:

• Dental issues: Pulling on the attached jaw bone and gums which may affect how the teeth come out/erupt. Can lead to cavities when restricted tongue and lips affect our ability to properly maintain the bolus of food between the teeth and chew.
• Speech: Restricted tongue and lips affect our ability to pronounce or articulate certain words. R, S, L, Z, D, CH, TH, and SH are commonly affected but other sounds are also difficult. It is possible to not have a tie and have difficulty with speech- functional issues as well.

Can I feed my child right before the procedure?

Please don’t. We prefer that you feed your child immediately AFTER the procedure. Feeding before just increases the chance for spitting up during the procedure and possible aspiration of regurgitated milk.

Can I watch my infant’s tongue tie release procedure?
Can I be in the operatory while it is taking place?

No. We have created a nice home-like, lounge for you to relax while we complete the procedure. Your baby will not be away from you for very long. Please use this time to use the restroom, pick what you want to watch on Netflix, set up your follow up appointments or review active wound care instructions. We prefer to keep our laser treatment room clean and free of having multiple visitors. We want to keep our focus on your child and not worry about you potentially passing out or moving our equipment (in an effort to see what we are doing or comfort your child).

How long should we do the active wound care or after care instructions?

There isn’t a general answer for this as some heal quicker than others and we aren’t able to predict this. Healing occurs long after the physical appearance. This is because the functional aspect or oral motor development is ongoing even after the site has appeared to heal. Maintain follow ups with other providers on your team to determine next steps. Please expect anywhere between 3-5 weeks of aftercare depending on the releases performed.

How long should doing the stretches take?

It shouldn’t be longer than the time you use to brush your teeth, which can vary for most so not more than 2 minutes.

Are the active wound care instructions necessary?

Absolutely, without this we won’t recommend moving forward with the procedure. Doing the after care work isn’t particularly enjoyable, it may be hard at first for you to do but you’ll get better and will soon be done with it. It’s essentially wound care and exercise/stretches for a muscle that hasn’t been utilized at its full capacity. Dr. Hamlin knows first hand it isn’t fun but necessary for the success of the completed treatment.

What is used for the procedure?

Dr. Hamlin uses a non-contact CO2 laser to complete the minor surgical procedure called a frenectomy. For infants, the procedure includes going to the treatment room, swaddling, taking the post op images and bringing the baby back to the parents to feed.

Anesthesia for infants is not necessary or administered as the desire is for the baby to feed immediately after.

For adults and older children (more developed nerve endings), a topical or local anesthetic may be applied. Since the tongue itself is numb, please wait until the feeling of numbness goes away to eat.

Can I use orajel on my infant?

We do NOT recommend the use of oral numbing agents as this will inhibit the child from feeling when it’s time to nurse which is usually after stretches are completed. Swallowing the oragel/topical numbing agent also makes perception of swallowing difficult. Follow your child’s pediatricians dosing recommendations for Tylenol or Mortin. Arnica is a great alternative as well.

Will my child swallow their tongue?

No, human anatomy will not allow for that. Releasing the string of connective tissue doesn’t completely unattach the tongue from the floor of the mouth.

How do you evaluate?

Everyone's anatomy is unique, so there is no one size fits all appearance. We ask that the paperwork that is sent is filled out. It includes a questionnaire that we utilize to identify symptoms that could be related to tongue, lip, or buccal ties. At the consultation appointment, we discuss any functional issues or medical concerns. A full oral exam is completed to determine the degree of restriction. From there we discuss findings and develop a treatment plan.

Is this covered by insurance?

CUSP UNTETHERED, PLLC is NOT in network nor does it have any contracts with medical or dental insurances, therefore the responsible party will pay out of pocket before treatment is completed. We highly recommend calling your medical (not dental) insurance carrier prior to scheduling a reservation to check what requirements are needed for approval and possible reimbursement. Ankyloglossia and lip ties have been classified as a congenital medical condition NOT dental.  Any insurance related questions (reimbursement/coverage) will have to be answered by your insurance carrier as we are unable to answer. We will provide you with a completed health insurance claim form that you can submit to request possible reimbursement. Please note that filling out, mailing, or submitting the claim form online is the responsibility of the parent/patient and is not a guarantee that insurance plans will cover the procedure. We will provide you with the necessary form to make this as smooth as possible.

When is payment due?

Payment in full is due at the time the exam or procedure is performed. We will provide you with a health insurance form to submit to your carrier to request reimbursement, but this is not a guarantee, as every health plan is different and we are considered out of network with all health plans.

Do you charge to release buccal ties?

No. If the child needs any buccal or cheek ties released, Dr. H does not believe in charging an additional fee.  We also do not charge for any follow-up visits or procedures that need to be repeated for any reason in the first year, however, we like to keep our track record and prevent you and the patient from having to do the home care over or again. Compliance and seeing the co-treatment team is a must.

What if I have to cancel?

We totally understand that things happen. When this happens, we ask that a $50 deposit be paid to secure another appointment, this deposit will be applied towards the consultation fees or treatment (if consultation has already been done). This deposit is non-refundable if the appointment is canceled again with less than 24 hours' notice or if the patient does not show up for the appointment. Please note that the procedure is an investment in your or your child’s current and future health. We see issues with breastfeeding, bottle-feeding, eating solids, speaking, compensations, headaches, and tension as well as sleeping resolved after the procedure.

The providers we saw are giving me mixed answers, one sees a tie the other doesn't and says it's a fad. What do I do now because I feel like something isn't right?

This is unfortunately quite common. Ties can be tricky to diagnose properly. Training regarding this issue is lacking among various healthcare providers or professionals. It's not covered well in dental and medical schools and requires specialized continuing education and training. A provider must seek out additional training and continuing education to be up on the latest trends and diagnostic factors.

What if we refused the injected vitamin K shot for our baby?

If the vitamin K shot (can be named Phytonadine on paperwork) was not administered intramuscularly, we recommend waiting until after 6 months to have the procedure completed in our office. However, to proceed otherwise, we will need documentation if the procedure is to be completed. If the baby did not receive vitamin K by injection, please provide a letter from the child's current pediatrician or results of PTT test stating the baby is healthy and okay to receive treatment/clotting time indicated with the test.  Please note that when K is administered via oral route it is hard to determine how much the child has received especially if they are spitting up a lot or have reflux symptoms.  Your midwife may be able to guide you/monitor further regarding providing oral K.

‍