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Arrival

Upon arrival at the office, you will be greeted by our Team. We will have verified that the patient portal intake forms were completed and have reviewed any uploaded media files. Dr. Sacker will then take you to our consultation room. We will take payment before you leave the office.

 

Consult

Dr. Sacker's focus is to help your baby's mouth be more functional.  Our office is focused on patient education and aftercare.  Releasing restricted oral tissues improves mouth function which improves quality of life and guides proper development of your baby's anatomy to prevents future feeding, speech and dental issues.  Because our Team is all lactation trained, breast feeding (and bottle feeding) videos are very important for us to assess tongue and lip function.  Dr. Sacker and her team of IBCLCs all review these prior to your visit so time is not taken away from the consultation and aftercare. Dr. Sacker wants babies to be hungry during the consult so they can feed after the procedure.  We use this aftercare time to help you and your baby feed better with new anatomy.  This is what sets us apart from other offices.  During the consultation, Dr. Sacker will discuss your intake history and all media files provided. She will also talk about any areas of concern with your family and then examine your child’s mouth. If a diagnosis of one or multiple ties is confirmed, she will then go over the significance of the ties; the laser procedure for treatment and review the aftercare exercises and instructions. Dr. Sacker will carry your baby into the procedure room. Typically, you will only be away from your baby for about 10 minutes. Due to laser safety certification rules, parents are not allowed in the procedure room. It is important that you be the positive rescue person and not be associated with the procedure. We encourage you to take a short walk outside to view our beautiful tropical courtyard.

 

Procedure

In the procedure room, we will take pre-procedure pictures for our medical records and use our Cold Laser (Low level infrared light therapy) for anesthesia along with a topical application of a numbing gel (lidocaine 10% and Tetracaine 4%). Our Light Scalpel CO2 laser will then be used to treat any tongue, lip, and buccal ties. A repeat of the Cold laser treatment will then be used to stimulate healing and help with pain control. Finally, post-procedure pictures will be taken for charting. These photos are also available on our secure patient portal by logging in and clicking on the patient’s icon and then clicking the ‘Shared Files’ tab. You can use these photos to make sure healing is going slowly and that you are keeping the diamond healing vertically and not horizontally.  (Printing the before and after pictures for your Pediatrician and also submitting them to your dental and medical insurance is very helpful and educational.)

 

Post Procedure

Your baby will be brought back to you immediately after the procedure and you will be seen by our IBCLC to help with latching your baby and reviewing aftercare instructions once again. Our IBCLC will demonstrate the exercises on your baby and you will be “hands on” and practice so we can make sure you understand what to do and are confident that you can perform them correctly. We will also do a weighted feed to assess milk transfer.  We will send you home with an aftercare packet with some diluted clove oil, Tylenol/Ibuprofen dosing sheet and aftercare instructions, and information about how to reach us.

 

Aftercare 

It is very important to stretch and firmly massage the sites at least every 2-4 hours for 2 weeks. The more frequently and the more firmly the sites are stretched the better they feel.

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Use your clean fingers or finger cots to massage and stretch the site. You may first rub the gums, inner cheeks and palate in a playing motion to encourage the tongue to move and relax the baby.  Try to make a game of it to discourage oral aversion. After the massage, place your finger horizontally under the tongue touching the inside lower jaw.  Roll down the inside gumline and push firmly on the floor of the mouth like you are digging your finger into cold peanut butter; roll over, lift and stretch the entire diamond shaped opening lifting the tongue towards the palate/roof of mouth.  Make sure you see the opening and that it stays as large as when it was created. You can login to your Patient Portal to view the after pictures to look at the diamond. Your finger will rub over and pull the diamond up to the palate.  Lift the tongue up to the roof of the mouth holding and stretching with your finger for 1-2 seconds. Then take the pad of your index finger and march the floor of the mouth from left to right and back just between the lower diamond and the salivary glands.  Go from left to right then right to left. This will stretch out the lower diamond better and keep the floor of the mouth pushed down towards the belly button or if upright towards the ground. Stretch before or after feeding; at least every 4 hours for at least 2 weeks. Stretching the upper lip involves using your finger to lift the upper lip so that the area above the teeth is visible and you see the opening.  Push the lip up in the center and rub the upper gumline horizontally to prevent sticking. You may use coconut oil for this also. For buccal ties, just continue rubbing over the upper gumline to push the cheek muscle up and prevent it from sticking down to the gumline. When your baby is feeding, make sure the lip is flipped and stretched up and is relaxed.

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If your child or infant sleeps through the night, please wake to stretch for until we see you for the first recheck.  If you did a good job and there is no reattachment,  then you may skip one stretch at night to allow sleeping 8 hours at night and just stretch during daytime hours. Make sure to do a good, firm stretch in the morning.  This may be a bit uncomfortable so using some diluted clove oil (7 drops of clove oil in 2ml of liquid coconut oil) or Benadryl liquid topically before may help. Push at diamond points and crease to keep the area stretched wide and prevent it from contracting down. Rubbing the sites will prevent scarring and prevent the need for a revision. After the 2 week medical clearance, you should continue firm massaging of the frenectomy sites and the floor of the mouth at least 3 times a day for 3 months.

 

You can use some coconut oil on your finger to massage the gums and rub the sites to prevent the tissue from sticking together. You can also dip your finger in some diluted clove oil (7 drops of clove oil in 2ml of liquid coconut oil) or Children's benadryl oral liquid to apply to the areas prior to stretching.  This will slightly numb the area.  It is not unusual to see some oozing of blood for the first few days so do not be alarmed. This can be a positive warning to encourage you to keep stretching to prevent the diamond from sealing together; not doing so will prevent elevation of the tongue. Bleeding can also be caused when there is tension on the muscle or the floor of the mouth. This is an example of when massage and bodywork can be helpful. The bleeding will stop with sucking or feeding, or with holding a cold, wet piece of gauze on the area.

 

For the day, you can expect the tongue tie opening to look like a beefy, red diamond-shaped opening. But it will quickly start to fill in with healing grayish/whitish/yellowish tissue. We want the opening as large as possible, so keep stretching. Tylenol is fine to use every 4 hours if needed for discomfort. When we see you for the initial 2 to 4 day follow up and if your baby is still uncomfortable, then we can repeat a cold laser treatment to help with healing.  Cold laser treatments can be repeated daily if needed. We also offer CST treatments for comfort for an additional charge.  If your baby continues to have feeding problems after healing, we have an Occupational Therapist we can bring in our office to provide feeding therapy for additional charge. We also have referrals for Chiropractics, Craniosacral Therapy, Speech Therapy, and Myofunctional Therapy.

 

Remember it is important to continue to breastfeed as much as possible to help your baby learn how to use their tongue’s new abilities. It may take several days or up to 2 – 6 weeks for you to see and feel a difference. New muscles are being used and they need to develop some strength. As the area is healing, continue the mouth massage to keep the tissue soft and prevent the need for a revision. It is normal to feel some tension in the sites around week 4.  Keep massaging firmly and check in with us.  Remember, we do not charge our patients for procedure site rechecks.

 

Continue to use topical ointments and hydrogels for your nipples if they are sore, cracked or bleeding and follow up with your lactation consultant. You may have to continue to use your comfort measures for a while longer as your baby continues to learn to and use the tongue correctly. Wean off using a nipple shield as your baby's mouth gets stronger.  Skin to skin and co-bathing is very soothing for mom and baby.​

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Feel free to text Dr. Sacker directly and include pictures. You may also email videos and links.

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Some patients can get frustrated after the procedure. Remember that you are learning to use their tongue in a new way. This can get overwhelming and just takes time and patience. You and your baby/child may be using muscles that were restricted or not even developed and definitely not used before. It is just like any other muscle. When you finally start to use them, they are weak before they become strong. So the first week your child may become frustrated with this process until their muscles become strong and they figure out how to use them. The most important thing is keeping calm and continuing to be encouraging to keep working at it. 

 

Time for success varies although we do see some immediate success after the procedure, most patients take 2-3 weeks before seeing more significant results. We have also found some patients can take up to 6-8 weeks to show improvement. This is very typical for symptoms such as sleeping with their mouth closed and tongue up (make sure to continue using the Mam pacifier for tug of war exercises and practice the sleep posture hold exercise on our video page. Continuing with therapy (lactation and/or bodywork) may speed up this process. Please keep in mind that some patients require multiple sessions after the release of tethered oral tissues.  Remember, if there is also muscular tension in the floor of the mouth, jaw, neck, shoulders or back then it is important to seek out an experienced Bodyworker to help with relaxation and avoid reattachment. If your baby or child continues to have weak muscular issues then we would recommend an in-office evaluation by our Occupational Therapist, Ora Duben. Please let us know if you feel this would be helpful.  We will also assess the need for this service at the 2 week follow-up visit.

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Initial Recheck

You will be scheduled to be seen again in 2 to 4 days for an initial recheck visit and weighted feeding.  At this visit, we will stretch your babies sites.  The goal is that our stretch feels like yours.  If you have not been stretching firmly enough or properly then we may make the sites bleed with our stretch. This is never the goal or intention.  Gauze and feeding will stop the bleeding.  We will review stretching again and show you where they reattachment occurred and how to prevent this from happening again.  We want the sites to heal correctly and we know you do too.  All follow-up procedure site check visits are included regardless of how many you need.  We encourage you to also follow up with your personal IBCLC for lactation support in between our recheck visits.

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Post-Procedure 2 Week Re-Check

We will also want to see you back in the office 2 weeks after the procedure.  We will take photos, check the sites visually, perform a stretch all to assess if your baby is healing properly, and decide if your baby is ready to transition from stretches to firm massage of the sites 3 times per day for the next 3 months. If the area is still healing or like above, we cause bleeding from opening a reattachment then we may continue stretching for 1-2 more weeks before going to massage.  This is important to prevent scarring and recurrence and will increase your chances of long-term success.

 

We will be available directly by text.  You can also email or phone for questions or concerns. Every baby is unique and each child has a different pain threshold, muscle sensitivity and tightness, and rate of healing. We are here for you and will help you through the healing process.