A wide, gummy smile is the hallmark of a happy infant. The amount of gum that appears when babies open their mouths is not just a cosmetic trait. Some infants are born with a lip tie that impacts not only their appearance, but also more importantly, their health.

What is a lip tie in an infant?

A lip tie in an infant is a condition that occurs when the frenum connects in a restrictive way, either tight near the tongue or lower than normal. The frenum is a band of tissue that attaches the upper lip to the gum at the midline of the upper gum. All of us are born with some degree of attachment. This is a normal part of anatomy. For babies born with an upper lip tie, however, this attachment can cause many different issues.

Dr. Lawrence Kotlow organizes ties and their severity by first organizing the tissue in the mouth into three zones and then placing them in four classes based on those zones.

• Zone 1: The soft tissue just under the nose that is moveable (also called the free gingival area)
• Zone 2: Soft tissue that is attached to the bone and has very little movement
• Zone 3: Tissue that includes the area between the teeth called the interdental papilla

The four different classes of lip ties depend on where the gum is attached to the lip and the severity of the attachment.

• Class I: A Class I lip tie inserts into Zone 1 in the mouth. Unless this tissue is very short or very tight, it does not generally inhibit movement of the lip.
• Class II: Class II ties occur when the tissue attaches to the bone in Zone II.
• Class III: Inserting into the area where maxillary central incisors will erupt, a Class III does not involve the entire upper gum but focuses on the center of the mouth
• Class IV: This final class involves the hard palate, with the frenum wrapping around the bone and the area where teeth will erupt as well.

Lip tie symptoms are evident from the very beginning but are often mistaken for common nursing difficulties.

How can a lip tie affect breastfeeding?

One of the most common lip ties symptoms is an inadequate latch when it comes to breastfeeding. Babies need to be able to create enough suction to take in enough breast tissue to nurse without fatigue. A lip tie can prevent this from happening.

Other common lip tie symptoms related to breastfeeding include:

• Sore, painful nipples: The inadequate latch will cause soreness for the mother, as the baby is not gathering the correct area or amount of the breast to nurse
• Blister or callous on baby’s upper lip: While not always a sign of this condition, a callous on the baby’s upper lip may indicate difficulty latching that could be due to lip tie

Can lip tie affect bottle-feeding?

In many cases, frustrated parents and hungry babies will turn to bottle-feeding when they experience challenges.

While bottles offer different nipples to address a difficulty latching, bottle-feeding can still be a struggle and present other challenges.

Can lip tie cause reflux?

This condition has a number of gastrointestinal effects including reflux. When the baby cannot latch on adequately, they take in more air during each feeding. This can result in:

• Reflux
• Excess gas
• Fussiness
• Colic

This extra air during feedings means that a baby will also request to feed more frequently. They are not getting enough nutrition at each feeding but feel full due to the air they take in. More feedings do not necessarily mean a lip tie is present, but it can be a sign.

Inadequate milk supply is another common symptom. If the baby does not completely drain the breast during feeding, the mother’s body will slow milk production to accommodate the baby’s needs.

What are the risks with baby lip tie?

The risks of untreated lip tie are not restricted to infancy. As babies develop into toddlers and children, there are risks that grow with them.

Can lip tie affect eating?

Untreated lip tie can affect a child’s ability to develop proper chewing and swallowing patterns, making finger foods and eating off a spoon difficult. The upper lip helps to move food to the back of the mouth for chewing and swallowing.

Children will compensate for a lip tie that prevents this by sucking in the cheeks to move food backwards. It can also cause children to become selective in what they will eat (because some foods are too challenging).

Can a lip tie affect speech?

Speech develops with all parts of the mouth – lips, teeth, and tongue – working together.

This condition can affect speech if it is causing the child to alter the way they open their mouth. Although speech is not as affected by a lip tie as it is by a tongue tie, compensations for it can have an impact.

Can untreated lip tie cause problems later in life?

In addition to breastfeeding issues, Dr. Kotlow (mentioned earlier) looked at the possibility for tooth decay related to lip tie.

He found a direct correlation between lip tie and cavity in erupting baby teeth. Baby teeth that are lost early to tooth decay can cause myriad problems for adult oral health, including an abscess that spreads into the adult teeth below the gum.

How can you treat infant lip tie?

The best way to treat an infant lip tie is as gently and with as little trauma as possible. AZ Dentist is a Phoenix area pediatric dentist that performs a laser surgery called a frenectomy to sever an infant’s lip tie. This is also known as a lip tie revision.

While the idea of surgery on your infant may be frightening, this procedure performs the surgery and seals the wound at the same time, offering faster healing times and less trauma for both parents and child.

If you are struggling with nursing and think your baby may have a lip tie, give us a call to schedule an exam today. We can help.