When you bring a new baby home, one of the first concerns is making sure they are eating well. For some infants, a tight frenum of the tongue makes nursing difficult from the beginning. Good news, though: a tight frenum is easy to treat and can help make feeding time easier.
What causes a tight frenulum of the tongue?
Also known as ankyloglossia or tight lingual frenulum, a tight frenum occurs when the thin membrane that anchors the tongue to the floor of the mouth extends well past the base of the tongue towards the tip.
There are four main classes of tight lingual frenulum.
Class 1
This type indicates that the lingual frenulum attaches to the very tip of the tongue. When people refer to a tongue-tie, a Class 1 tongue-tie is most often what they mean.
Class 2
The lingual frenulum attaches just behind the tip of the tongue.
Class 3
Located closer to the base of the tongue, this type of tight frenum may not cause any difficulty in infancy at all. Because of this, it may not even be identified.
Class 4
This type occurs underneath the mucous membrane and must be felt to be diagnosed. This can make the tongue appear shorter and result in a misdiagnosis.
Tight frenulum of the tongue occurs in an estimated three to four percent of infants, with boys diagnosed more frequently. The cause is congenital, meaning it is present from birth. Other than genetics, there have not been any risk factors identified for a tight frenum. Some children are born with it, while most others are not.
What are the risks of a tight lingual frenulum?
The area where the frenum attaches can vary widely. In many cases, this variety does not cause a problem that needs intervention.
For some babies with a tight lingual frenulum, problems can occur almost immediately, including:
- Difficulty latching on: While most babies and mothers struggle with latching on at first, babies with a tight frenum may never quite get it right
- Cracked, bleeding, or sore nipples: Babies will suck harder to try to get more milk because they cannot get a proper seal on the nipple
- Excessive gas: The baby is sucking more air than milk as they nurse which can lead to gas
- Poor weight gain: Not enough milk means that the baby is not able to gain weight
- Fussiness: All babies fuss at one point or another, but babies who are hungry for lack of adequate nutrition and excessive gas may be even fussier
- Poor milk supply: Milk supply depends on demand, so if the baby is not able to drain the breast at a feeding, your supply may drop
These symptoms can be very frustrating for a hungry baby and tired mother. As the baby gets older, a tight frenum can cause more problems. These issues include the following.
Difficulty speaking
While many children who grow up with a tight lingual frenulum learn to adapt, some may have difficulty speaking clearly.
The tongue is primarily an instrument of speech, and without free movement this can impede communication.
Eating challenges
The tongue also helps to move food from one area of the mouth to the other to swallow.
Children with a tight frenum may develop an infantile swallowing reflex to help food move to the back of the mouth. In adulthood, this can result in an open bite deformity (also known as a malocclusion).
Poor oral hygiene
A tight lingual frenulum can make cleaning back teeth challenging, for infants and as children grow. This can contribute to early tooth decay that affects erupting permanent teeth.
What are tight frenum and tongue-tie treatments?
In the absence of feeding difficulties, many parents will choose to leave their child’s tight frenum untreated. While this may work in the short term, some children may need treatment in the future.
For both infants and children, a laser frenectomy is the procedure of choice for most pediatric dentists. Traditionally, a frenectomy is performed with a scalpel. Although the procedure is relatively quick, it is not pain-free and the risk of infection is high.
These days, infant dentists use a laser to safely sever the tight lingual frenulum and seal the wound at the same time. In some cases, they may use a numbing gel in the area to prevent pain. The entire procedure takes less than five minutes.
Infants who receive a laser frenectomy (also referred to as a tongue-tie revision) may be able to nurse properly immediately. Scheduling an appointment with a lactation consultant can help make this transition easier.
Recovery after a laser frenectomy
In general, a laser frenectomy will heal completely in ten days or less. The danger here is that the incredible healing powers of an infant’s body heals the wound too quickly, attaching back to the same place.
Aftercare for laser frenectomy should include gentle stretches to the tongue in all directions. There are three steps to stretching the tongue after a frenectomy.
- Wash your hands thoroughly before inserting one index finger on either side of your baby’s tongue, towards the back of their mouth.
- Place one finger near the area where the frenum attaches to the floor of the mouth and use the other to move from that area to the tip of the tongue.
- Finish with a massage to both sides of the floor of the mouth, away from the frenectomy site. You can be firmer in this motion because you are not near the laser incision.
The goal of these stretches is to keep the frenum from reattaching improperly. Your baby will not enjoy them, so keep sessions short and offer plenty of cuddles and comfort before, during, and after. Doing these stretches before or after diaper changes is a great way to be consistent with them.
AZ Dentist is a Phoenix area infant dentist that performs laser frenectomy to treat a tight frenum. If you are struggling with nursing and think your baby may have a tight lingual frenum, give us a call to schedule an exam today. We can help.
