What is a Tongue Tie Release and where can I book one in Toronto? : top important facts about tongue tie releases

If your baby has been diagnosed with a tongue tie, you will likely have a lot of questions. You’ll also likely have come across the range of media attention on tongue ties, that has been cropping up lately (like this New York Times piece, this one from later in the year and this one from a Toronto news media outlet).

The baby days are foggy and the media is overwhelming enough, which is probably making this decision feel immense.

We’re going to clear up some of the fog for you here.

Should I pursue a tongue tie (a.k.a frenotomy, frenectomy, revision) release?

The ultimate answer to this question is that it is your decision.

You never want to feel pressured into a procedure. You always want to be well informed.

When exploring the option of a tongue tie release, you may want to consider the following, alongside professionals who specialize in tongue ties (like our team in Toronto at Kindercare Pediatrics):

Firstly, what do the frenulum and tongue look like?

Is the frenulum thick or thin?

Where does it attach to the tongue and to the floor of the mouth?

You can explore this article here, for more information on physical assessment tools. We go into detail about symptoms and the various tools that are used to screen for tongue ties.

Secondly, how does the tongue function?

Can it move up and down, side to side and out of the mouth?

Does it look like a bowl when your baby cries?

Lastly, and most importantly, how is feeding going?

Do you have nipple pain and damage that won’t go away?

Is your baby consistently sleepy, when breastfeeding and/or bottle feeding?

Are they unable to get full, with breastfeeding?

Is your baby increasing fussy, when breastfeeding and/or bottle feeding?

Are they making clicking noises, when breastfeeding and/or bottle feeding?

Are they regularly coughing or gagging, when breastfeeding and/or bottle feeding?

Do you see lots of milk leaking from the side of your baby’s mouth, while they are feeding?

Are they taking in air, while feeding?

Have you worked with a lactation consultant in aims of helping?

A great equation to diagnose a tongue tie is:

Tight tissue + restricted tongue mobility + feeding issues (that cannot be resolved with skilled lactation support) = tongue tie

If your baby’s frenulum is only moderately restricted and feeding is going well and/or you’re seeing improvement in any symptoms, then you may not want to pursue a tongue tie release.

This could be an improvement in nipple pain or damage, baby’s gagging, coughing, leaking or clicking, is decreasing while feeding, or your baby is able to become more satiated with breastfeeding.

Breastfeeding and bottle feeding is so multi faceted. There can be a plethora of interventions to work with, which is why seeking skilled support from a feeding specialist, like a lactation consultant, is so important.

If you’ve worked with a skilled lactation consultant and your pain level remains quite high, your baby is consistently sleepy or fussy at the breast, and they are coughing, gagging, clicking or leaking milk regularly, with the breast and/or bottle, or they’re distressed and not gaining weight well, it’s reasonable to pursue a tongue tie release.

Should I pursue a scissor release or a laser release? Should I see a pediatric dentist or doctor?

The current evidence shows that there is no benefit, across the board, to choosing either laser or scissor tongue tie releases. There are, however, situations where a release via laser or via scissor makes more sense.

A Tongue Tie Release via Scissors

Trained pediatricians perform tongue tie releases using sterile scissors, often with the assistance of a nurse or a lactation consultant. You many choose to pursue a tongue tie release with scissors because:

• Your baby is under 4 months old.

• The frenulum and surrounding anatomy has been assessed to be appropriate for release via scissors.

• The procedure is quick.

• Babies are often offered oral sucrose, which helps manage pain.

• Parents stay in the room.

• Dental fees are prohibitive for your family.

The Process of a Scissor Frenotomy

Your baby will be swaddled, so that they’re comfortable and so that their arms are out of the away.

In our clinic, the pediatrician wears a bright light, so we apply a covering to babies’ eyes, to protect them.

They will then be offered oral sucrose. Approximately 1 minute later, the lactation consultant will use two fingers to lift the tongue and the pediatrician will use the sterile scissors to cut the frenulum.

At our clinic, in most cases, we do not leave any tissue remaining. The wound looks like a diamond shape when the full frenulum is released.

Immediately after the release, the baby is brought back to their parents. Often they need some rocking and soothing to calm them before feeding. When they are calm, they can latch on a breast or bottle, to help comfort them further.

I work at a Toronto based clinic, called Kindercare Pediatrics, as a lactation consultant. We regularly assess for and provide families with releases, via scissors, should they choose to pursue one. Get in touch to book or learn more.

A Tongue Tie Release Via Laser

Trained and equipped pediatric dentists perform tongue tie release using lasers (types include Diode, CO2 and Ebrium), with the support of dental assistants and lactation consultants. You many choose to pursue a tongue tie release with a laser because:

• Your baby is older than 4 months old.

• The frenulum and surrounding anatomy has been assessed to NOT be appropriate for release via scissors. This might be due to the fact that it is particularly tight, thick or the salivary glands are prominent.

• The laser cauterizes, so there is minimal bleeding.

• There are no pediatricians near you who perform releases via scissors.

The Process of a Laser Frenectomy

Your baby will be taken to a procedure room and you will wait in a separate, consultation, room.

Once in the room, your baby will swaddled, so that they’re comfortable and so that their arms are out of the away.

Because a laser and bright lights will be used, babies’ eyes are covered with goggles, to protect them.

Many dental clinics will take a before picture of the frenulum.

The dental assistants will support the baby further, to make sure they do not move when the laser procedure starts. Another assistant, will lift the tongue with a tool that targets the frenulum.

The dentist will then slowly use the laser to release the frenulum.

Once the tissue is released, an after picture is often taken.

The baby is then brought back to their parents. The baby can then be further calmed and can breastfeed or bottle feed.

Many laser clinics require that parents view a demonstration, performed the dentist or lactation consultant, of post release exercises. They may also want to see parents trialling them, before the end of the visit.

Where can I access a tongue tie release via laser release in Toronto?

Options for laser releases in Toronto include Smile Squad - dental, Laser (Gep) Tots, and Dentists on Bloor.

What is the best age to have a tongue tie release performed?

Generally, a tongue tie release procedure is easier (for babies, their parents and practitioners), the younger the age. Younger babies tolerate and recover from the procedure extremely quickly. Older babies, children and adults, particularly, generally take a bit longer to recover.

If your baby is diagnosed with a very tight and restricted tongue tie, early on in their life, but there are no current feeding concerns, you may still want to pursue a release. However, it’s important to know that a tongue tie release can be performed at any age.

FACT - Parents, understandably, worry about speech and solid food issues, when their baby is diagnosed with a tongue tie. There is no way to predict if a baby will have troubles with solid foods or speech, in the future!

What are the benefits versus the downsides of a tongue tie release?

Unfortunately, there are not a lot of studies out there, on tongue tie releases.

However, the limited evidence, that we do have, shows that tongue tie releases can help:

• Reduce maternal nipple pain and damage. Multiple studies show that parents report a decrease in nipple pain with breastfeeding, after tongue tie releases.

• Babies access milk easier, with breast and bottles. They may also be less sleepy or fussy at the breast or with bottles.

• Maintain and improve milk supply. In many cases, when babies are able to fully use their tongue, they can access the milk more efficiently and fully, which positively impacts milk supply.

• Babies are able to form a better seal on the bottle or breast and symptoms decrease. Post release many people report a positive change in coughing, gagging, clicking and leaking.

Downsides of a tongue tie release include:

• Bleeding. With scissor releases, there is always some bleeding, at the incision site. For most babies, this completely resolves in 2-5 minutes (most often on the shorter end of the time frame). Feeding (by breast or bottle) helps slow the bleeding down.

  Rarely, we have to apply pressure with gauze at the incision site, if the bleeding is heavier.

  Babies swallow the blood and it is common to see black flecks (this is the digested blood), in babies’ diapers on the day of the release. This is not risky to the baby!

• Length of the procedure (with laser). Frenotomy procedures, performed with scissors, are extremely quick. The longest part is the 5 minute set up, while the actual procedure takes around 30 seconds.

  With laser, the procedure is lengthier - from 5-10 minutes. Added to this, parents are not in the room with their baby, so the time frame can feel immense.

• Crying and discomfort. While oral sucrose can be offered and it does seem to help, there is always some element of pain for babies. Generally, babies will be calm and have stopped crying within 2-5 minutes post procedure.

  There can also be (very understandably!) a lot of emotions felt by parents. It’s important to find practitioners you trust and feel comfortable with, so you feel informed and supported the whole way through.

• Cost. Scissor releases are covered, in Toronto and Ontario, by OHIP. There may be a small cost associated, if a lactation consultant is offering their expertise and supporting with the tongue tie release. This portion may be covered by private health insurance. Ask your IBCLC for their IBLCE certification number, to submit to your insurance company.

  The cost of laser releases run much higher - in the $500-$900 range. If you have dental insurance, it may be covered.

Very rare downsides of a tongue tie release include:

• Babies might develop feeding aversions. This tends to be rare. Babies with a history of oral aversion will be more predisposed to a feeding aversion post release.

• The bleeding does not stop. With scissor releases, there is a very rare chance that the bleeding does not stop. In this case, babies would be sent to a hospital, where the incision site would be cauterized.

• Infection at the incision site. This is extremely rare and most evidence points to it not being an issue. The incision site always looks yellowy, whiteish post release. This is normal colouring for healing tissue. An infection would look red, with oozing and would be accompanied by a fever.

• The frenulum grows back to the same spot. The mouth heals quickly. In some cases, the frenulum reattaches to the same spot and symptoms reappear, when the regrowth is complete.

Lastly, one of the most important risks to understand about tongue tie releases, is that sometimes it just doesn’t help! The truth is, we can never predict if a tongue tie release will help resolve symptoms or not. We will only know if it’s going to help, after trying one.

Should I be looking into post-tongue tie release exercises or not? Is there anything else I should do after the release?

There is currently no consensus on whether post tongue tie release exercises, are effective at preventing significant reattachment of the frenulum.

Unfortunately, the opinions and the current evidence in the tongue tie world are polarized.

Some evidence shows that parents that performed the exercises and parents that did not, achieved similar results.

Dr Ghaheri, a well known dentist in the tethered oral tissue world, adamantly stands behind post release exercises. You can find his aftercare approach here.

The American Academy of Pediatrics does NOT recommend post frenotomy exercises. See their evidence here.

If you’re considering post release exercises, but touching or moving your fingers near the wound and causing your baby discomfort, feels like too much, I’d suggest looking at LA Lactation’s videos here, here and here, for some more gentle options. You can also consider using these exercises prior to a tongue tie release.

Some babies are fussy in the 24-48 hrs after a tongue tie release. In those cases, you’ll draw on all your normal calming and soothing techniques first. If those are not helping, you can offer your baby infant Tylenol. You’ll want to base the amount given on your baby’s weight. The doctor or dentist should advise you of this amount, before you leave the appointment.

You do not need to clean the area or do anything different than usual, after a tongue tie release - just feed, care for and snuggle with your baby!

Please reach out to me directly, if you’re looking for lactation and infant feeding support or if you have questions about your baby’s suspected tongue tightness and/or a tongue tie release, in Toronto (or elsewhere!).

I’d love to chat.