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 will 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

During your consultation, Dr. Sacker will discuss your intake history and any media files provided. She will also talk about any areas of concern with your family and then examine your child's mouth and tongue function. 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. If your child is old enough to sit with topical anesthetic gel then this will be placed on the sites for 10 minutes and your child can watch Netflix or Disney Plus.  Dr. Sacker will carry or walk your child into the procedure room. Typically, you will only be away from your child for about 10 minutes. Due to laser safety certification rules, parents are not allowed in the procedure room. We also want you to be the ‘positive rescue person’ and not be associated with the procedure. We encourage you to take a short walk outside around the building balcony which overlooks a beautiful, tropical courtyard.

 

Procedure

In the procedure room, Dr. Sacker will talk through each step of the procedure so your child feels calm and reassured while they continue watching their media show.  We will take pre-procedure pictures for our medical records and use our Cold (Low level infrared light therapy) laser for anesthesia along with a topical application of a numbing gel (lidocaine 10% and Tetracaine 4%) if not already applied. 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 under the 'Shared Files' folder 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.)  Your child will be brought back to you immediately after the procedure and offered a popsicle while continuing to watch their favorite show.  While your child is still numb, Dr. Sacker will show the aftercare exercises on your child and you will practice until you feel comfortable and confident that you can do them at home.   

 

Aftercare and Initial recheck

It is very important to stretch and massage the sites at least every 2-4 hours for 2 weeks. Use your index finger to push the lower diamond down into the floor of the mouth with firm pressure like pushing your finger into cold peanut butter then turn towards the throat and pull the tongue muscle up to the palate to stretch the center area of the diamond.  Push into all 4 corners of the diamond to keep them as open as possible.  You cannot push too hard.  Smooth out the healing tissue and break any vertical strings or fibers that form as that is the tongue trying to reattach.  The lip and cheek sites should just be pushed with the pad of your finger to keep those sites as open and flat as possible.  Use the childrens benadryl on the sites to help with discomfort.  The coconut oil can be used on the gums and also on the tongue site after you stretch first.   You will be scheduled to be seen again in 2 to 4 days for an initial recheck visit to stretch and check the sites.  The goal is that your stretches feel like our stretches.  We do not intend to cause pain or bleeding with our stretches but this may happen during the visit if the stretches were not done firmly or frequently enough.  All follow-up site check visits are included.   We will help you with stretches in the office as often as needed.​

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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, stretch and check the sites to assess if your child is healing properly, and decide if your child is ready to transition from stretches to firm massage of the sites 3 times per day for the next 3 months. This is important to prevent scarring and recurrence of attachment 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 child is unique and each child has a different pain threshold, muscle sensitivity and tightness, and rate of healing. Many children will need Speech/Myofunctional therapy to help strengthen the tongue muscle or bodywork to help relax tense muscles that have been compensating for years.  We are here for you and will help you through the healing process.