Buccal (Cheek) Tie Information

What is a buccal tie?   

Unlike lip and tongue ties, a buccal tie is NOT normal.  The tie itself is a small band of tissue (a frenulum) that connects the cheek to the upper or lower gum line. It is made of collagenous fiber that does NOT stretch.  The tissues and muscles around the tie may stretch to accommodate the ties, but the actual tie does NOT stretch.  These ties can form at any time, but they often form in utero to make up for lack of tongue function.  If the cheeks are being used to suck in the amniotic fluid then a tie will form.  The more the cheek muscle is used, the stronger and bigger the tie gets.  The cheek muscles on either side of the nose itself will get stronger and larger as well which puts pressure up against the eyes and makes it more challenging to smile.  It also does not feel good when your face is tight and muscular.  We want soft and squishy kissable cheeks.  It should not hurt to pull your cheek out and you should not feel anything along your gum line when you rub the upper and lower gums.  Many providers have not been educated about cheek ties, do not know how to assess for a buccal tie, or make this diagnosis.  This is why it is important to see a provider trained to diagnosis and release these ties.


What are problems or symptoms that a buccal tie can cause?

In breastfeeding or bottle feeding, cheeks are just meant to rest and guide milk back to the posterior tongue which lowers during a swallow.  When cheeks are used to suck, instead of the tongue, more air is brought in and swallowed which leads to gas, reflux symptoms, and colic issues.  The suck of the cheeks can often be seen while nursing as a depression or dimpling from where the tie is attached.  It can often be painful for Mom and baby as well.  Some babies suck so hard with the cheeks that they collapse the nipple of the breast or bottle like a straw and cannot get milk which is frustrating.  Different problems may also occur later in life.  Children will often use the side of their tongue with the cheek tie to pocket food, then chew and swallow the food.  This is a very inefficient way to eat as it takes a long time to break down food this way in the mouth or in the stomach itself.  This leads to digestive issues and constipation.  It can also be painful to smile and laugh because of the tension in the tie.  It becomes difficult and painful to brush and floss with the ties in the way.  Children are at increased risk of cavities between these teeth because the tie will hold milk or small pieces of food in the area.  The buccal ties will also push the teeth out of alignment or prevent the adult teeth from coming in properly.  Later in life, we will also see gum recession from the tie pulling the gum line away from the tooth.  Once the gum has receded then the options for treatment are gum grafting with is costly and painful. 


How are buccal ties treated?

Buccal ties cannot be safely released with a scissors or scalpel.  I have tried many times with a diode laser but it is too hot, painful, and caused scarring in the area.  A CO2 laser is a must for this procedure which is what we use in our office.  The CO2 laser frenectomy is done in our laser safe procedure room. We treat the area with the painless cold laser to relax the muscle, control pain, and aid in healing. The procedure itself is takes a 1-2 seconds and your baby can go straight to the breast afterwards.  Many mothers feel less nipple pain with softer latch and suck almost immediately.