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Why Do Specialists Disagree on Tongue Tie Revisions?

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Your baby has a tongue tie.  Should you have it revised?  The answer to your question may depend on who you ask.  Pediatricians, Dentists, and Speech and Language Pathologists all have different perspectives on how tongue tie affects a child’s growth and development, and when it becomes a problem.

Pediatricians and Baby’s First Year

Pediatricians are often skeptical of the value of tongue-tie revision. In the past, many ties were revised in the hospital. For a newborn, the procedure often involves a quick snip without anesthesia and only a drop or two of blood. However, for pediatricians, the evidence for tongue-tie revision is mixed. During baby’s first year, much of a pediatrician’s focus is on nursing and weight gain. At birth, it’s impossible to tell which tongue ties will interfere with weight gain, and which will loosen naturally as the baby learns to nurse. Therefore, many pediatricians have moved away from revising the tongue ties during the postpartum hospital stay.However, there is a problem with the ‘wait and see’ approach. For babies who fail to gain weight and may need the tie revised later, delayed surgery often involves anesthesia and can be risky for the child.

Dentists and the Effects on the Mouth

Dentists often take a longer view of tongue-tie and its effects.  Even in children who learn to nurse efficiently, tongue-tie can affect the shape of the mouth for years to come.  In normally developing children, the tongue rests in the palate and acts as a natural palate expander.  When the tongue is tied, the palate may not expand as expected. The teeth may become crowded. In time, the child may need orthodontics, or may even have to have teeth pulled.   Because tongue tie revision can allow for normal development, it prevents certain dental issues and can save families money down the line.

Dentists are also increasingly aware of the link between tongue-tie and sleep issues.  Normally, the tongue rests in the roof of the mouth during sleep. When it's tied, it can obstruct the airway and lead to obstructive sleep apnea (OSA).  Children with OSA may exhibit academic and behavioral issues.  Over time, interrupted sleep can cause obesity, type 2 diabetes, and cardiovascular issues. 

For dentists, it makes sense to err on the side of revising ties as soon as possible. We see so many problems in our patients that could have been prevented if the tie had been revised immediately after birth.

Speech and Language Pathologists

Speech and Language Pathologists (SLPs) have long observed a connection between tongue-tie, articulation issues, and feeding issues. Children with tongue-tie may have a hard time learning to make the 'l' and 'th’ sounds.  Their speech is even worse when a tongue tie is combined with motor planning or motor control issues.  Tongue-tie can also affect a child's ability to move food around the mouth when chewing. This can lead to problems with choking, or to food becoming caught in the palate or teeth.  By the time a child sees an SLP, they've often reached the point where tongue-tie has become a major issue and is causing problems that could have been prevented if had been released earlier.

Should I Push to Have My Newborn’s Tie Released?

As you can see, there are experts on both sides of the issue.  However, a release for a newborn is usually a quick release with a laser with no bleeding and minimal discomfort along  with quick healing.  Meanwhile, waiting results in anesthesia and a more complicated and expensive surgery.  It's a big decision to make in the days or hours after birth, but it's important to remember that tongue-tie is about more than feeding and weight gain.

If you'd like a second opinion on your child's tongue and palate, make an appointment with your pediatric dentist!   If you're a provider or dental team member interested in learning more about the links between tongue-tie and sleep apnea, consider taking one of Dr. Dassani's courses on obstructive sleep apnea to learn more about the physical conditions that can cause OSA.