Tongue, Lip, and Buccal Ties
Breastfeeding is hard, and it can be harder due to factors such as oral ties. Oral ties seem to be quite controversial in today’s society among providers. But when our daughter was born and we experienced oral ties it truly opened our eyes up and since then we have been on the lifelong journey of learning from other providers in the field and educating our patients.
What are they?
Oral Restrictions are defined as unusually shortened, thickened, or tightened lingual frenulums. Frenulums are normal anatomical structures of the mouth but it is important to note that when shortened, tight, or thickened they can cause restrictions in the mobility and function of the mouth.It is so important that a proper evaluation of FUNCTION be assessed versus simply a visual examinations when getting assessed for oral ties. There are a few different locations this can occur at including the tongue, lip and cheeks. This anomaly restricts normal oral movements and can interfere not only with breastfeeding but many other functions.
Location of Oral Restrictions
A tongue tie is characterized by an unusually shortened, thickened, or tightened frenulum under the tongue that tethers the tongue to the floor of the mouth. This causes the tongue to have a lack of full range of motion. Babies will often have a low tongue posture, which means that the tongue rests on the floor of the mouth as opposed to the roof of the mouth. When this is the case, babies have an inability or diminished capacity to raise their tongues up to contact the nipple during breastfeeding or bottle nipple during bottle feeding, resulting in weak intra-oral pressure which may interfere with breastfeeding. This can also cause a high palate with limited space and a hypersensitive gag in the child. A baby with a tongue tie may have trouble lateralizing their tongue as well which is necessary for optimal hard palate and cranial development.
A lip tie is a condition characterized by unusually shortened, thickened, or tightened frenulum located in the middle of the top lip that causes the skin of the upper lip to attach to the gums. When pulling the top lip up to the baby's nose you may notice the gums blanching white or inability to reach the nose. This restriction makes it hard for an infant to move their lips freely and latch deep enough for an effective feed. You may notice that your baby's upper lips are not flipping out or you constantly have to “flip the lip” when nursing or bottle feeding.
A buccal tie is an abnormally tight frenum in the upper lip/ side of the cheek area in the mouth. When pulling the cheeks back, you will notice the frenum blanching the gums white. It might elicit pain from the patient, and it will look like the sail of a sailboat. This tie can cause receding gums as the infant ages. Buccal ties also cause a lot of mouth tension which makes it hard to move the lips. These can be the cause for dimples because the frenum is so tight that it pulls the cheek in.