Question 1

I'm scared to put my baby in pain. Is it worth doing a procedure so young?

Accepted Answer

When we fix the ties early, then we get the most movement in the mid-face including the jaw and sinuses.  Babies do their most growth in the first 6 months of life.  When a baby is sucking and is using the jaw to move up and down instead of gliding forward, then the jaw joint is not growing properly.  When we change this motion by releasing the a restricted tongue, then the baby can make the wave-like motion and the jaw can glide forward.  When more time is spent gliding, then the baby will stretch out the joint and allow the jaw to move forward with facial growth.  If there is a tongue tie connected to the jaw, then it is holding the jaw back and this prevents normal growth of the jaw.  Babies start solids after 6 months and the jaw naturally changes at this age to an up and down motion.  Also, the older the baby, the less likely they will change their feeding and nursing behaviors. Young babies live in the moment and their brains do not have object permanence yet, so they forget and are easily distractible.  The older the baby gets, the more they are aware of the situation and remember when they see your finger approach their mouth.  We still try to keep it fun and don't worry, babies are very forgiving. The areas are well healed within two weeks, which is a very short time compared to the need for years of Orthodontics.  If the tongue is not resting up on the palate or roof of the mouth then the palate is not getting expanded naturally and the jaw and teeth will have to be moved later. This is where painful Orthodontics, including palatal expanders and orthodontic appliances, are in the mouth for months to years.  Jaw surgery for late teens needs to be done after puberty. The oral surgeon breaks the jaw and resets it forward to allow new bone to form.  Yes, it is as awful as it sounds.  Remember, when we get the sinus area to develop properly, then there will be fewer ear and sinus infections which means less pain and fewer antibiotics. The list goes on and on...

Question 2

My baby is gaining weight, so why should I fix the ties now?"

Accepted Answer

We need your baby to be feeding themselves and not you feeding your babies.  Moms will have a hormonal response to the baby that usually lasts 3-5 months.  The baby will stimulate the breast and cause a letdown of milk.  Some babies are just sitting there at the breast and swallowing the milk.  We call this "riding the letdown.” We need the baby to trigger the supply and demand cycle so the breast empties and fills back up.  If this does not happen, then the supply will slowly decrease over time and it can be difficult to build back up.  We want to fix the ties before this happens.  If your baby is not actively using the tongue, then the muscle does not strengthen.  This causes weight issues later on because the baby needs to take more volume to gain weight.  This is sometimes when we see Moms constantly moving the baby from one breast to the other to continue to trigger letdowns.  If the baby is not nursing past the initial letdown and moves to the other side, then there is very little hindmilk extracted. This compares to when we eat simple carbs all day and no protein or fat. It is very unsatisfying and not conducive to healthy brain and muscle growth.

Question 3

Why choose a CO2 laser to repair the ties instead of just a pair of scissors or a simple diode laser?

Accepted Answer

​Dr. Sacker has used all 3 so she knows first-hand! Scissors are sharp and make an even cut that can more likely reattach.  It is also very common to not cut enough or not be able to cut enough because of the tie depth, location, or extent of restriction.  The doctor can only cut what he or she can see and what is safe to cut.  Since the doctor cannot see what is under the area being clipped, he or she would have to stop short.  It is very common for providers to cut the anterior, or front portion, of the tongue tie in front of the salivary glands and leave the posterior portion intact.  The problem with this is that the posterior portion is what controls the middle and back portion of the tongue- the area that is needed for breastfeeding and swallowing. It is also very difficult to cut into a submucosal tie that is more of a sheath attached to the surface of the tongue. It will bleed and the doctor cannot open it fully as a result of the bleeding and safety issues. Buccal ties also cannot be cut with scissors because of their location and size. Upper lip ties can be partially cut by skimming the gumline with a sharp instrument. The upper lip tie is covered by a sheath of sensitive tissue so it always hurts and bleeds with scissors. The doctor would be unable to cut it completely into the groove between where the teeth form, leaving the remainder of the cord attached to the bony area and upper gumline.  The clip with scissors does help elevate the lip for breastfeeding, but it often regrows and will affect teeth location and make teeth brushing difficult or painful.  Lasers can repair an incompletely released lip tie at a later date, but the area is more sensitive and has scarring from the previous clip so more laser energy is required, making the procedure itself and the healing more challenging.  
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The CO2 laser is the most gentle soft tissue laser on the market right now. Most of the time, there is no bleeding. Using this laser can also be faster than using scissors. It is safer than scissors because it works above the tissue, cauterizing while vaporizing the tissue in a bloodless field. This allows for a clear view of vessels and nerves. The diode laser works with heat and requires more energy to release the tissue, causing more scarring, especially with submucosal ties. The diode laser is also very hot and unsafe to use on buccal ties, unlike the CO2 laser. Just like our iPhones and other similar technology, we have better ways to do things now; we just need the medical community and insurance companies to catch up so our families can get the best care possible!

Frequently Asked Baby Questions

I'm scared to put my baby in pain. Is it worth doing a procedure so young?

My baby is gaining weight, so why should I fix the ties now?"

Why choose a CO2 laser to repair the ties instead of just a pair of scissors or a simple diode laser?