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5 Ways to Prepare Your Child for the First Dental Visit

It is an honor to see a child for their very first dental appointment.  Having seen countless numbers of children for their first dental visit, I have come to recognize ways parents can help the appointment to be more successful. 

A child’s first dental visit can set the tone for future dental appointments.  My goal, as a pediatric dentist, is to create a positive experience by keeping the mood light, taking extra time to introduce our dental instruments, and using verbiage that will allow the child to feel comfortable in this new environment.  The first dental visit is as much for the parents as it is the child.  It is the parent’s responsibility to discuss issues with cleaning at home or any dental concerns.  It is the dentist’s responsibility to instruct the parent on the most recent dental recommendations as well as to address the parents’ concerns to set the child up for healthy dental habits at home.  It is extremely important for the parents and dentist to be on the same page and, as a team, work together to give the child the best possible dental health.

1. Stay Positive

Many people experience anxiety when it comes to visiting the dentist. The anxiety typically stems from a negative experience that occurred in the past. It is important to shield your child from these feelings. Children are sensitive to their parent’s emotions and can become anxious if they know their parent is afraid of the dentist. Dentistry has changed drastically over the past 20 years and continues to change daily to allow for a better dental experience.

2. Brush Your Child’s Teeth at Home

Setting your child up for a positive dental experience starts at home.  If a child sees a toothbrush and a toothbrush being regularly used at home, then when they come to the dentist, although the environment is new, they will see familiar items and understand what they are used for.  People are comfortable with the familiar, and oftentimes anxiety stems from the fear of the unknown.

3. Use the Right Words

In becoming a pediatric dentist, I developed a language all my own.  It is important to translate what is being done or what a child will feel into words they can relate to and be okay with.  Avoid the S-H-O-T word at all costs, especially prior to the first visit.  Unless it is an emergency visit, there is no need for an injection at the first visit.  This goes along with cleaning at home.  I cringe every time I hear a parent say, “If you don’t let me (or the dentist) brush your teeth, you are going to get cavities, and the dentist is going to give you a shot.”  Threats like this are scary, unnecessary, and make the child afraid of going to the dentist. 

Instead tell your child, “The dentist is going to brush your teeth and may take some pictures of your teeth.”  In my office, the dental explorer is called a “tooth counter.”  The suction becomes “Mr. Thirsty.”  The air is “wind.”  The water is my “squirt gun.”  The mirror is called my “Barbie mirror.”  And so, it goes.  Perhaps one day I will be asked to write the Milling Pediatric Dental Dictionary, but until that day arrives, I will continue developing its vocabulary.   

4. Read a Book

Numerous books and characters go to the dentist.  If your child likes Peppa, there is a book for that.  If your kid likes Daniel Tiger, there is a book for that.  The Berenstain Bears?  You got it.  There is a book for that.  No book will ever be able to explain the exact dentist and dental office because all offices are different, but the general idea and themes will be there.  Often children want to experience what their favorite characters experience.  Now, if only I could get Spiderman to go to the dentist. 

5. Do Not Make It a Big Deal

Going to the dentist for the first time is a big deal, and I would never want to cheapen it.  It is a milestone in our little children’s lives, and as mothers, we want every milestone to be picturesque.  What if they misbehave?  What if they cry?  What if they spit in the dentist’s face?  What if they bite the hygienist?  How will this reflect on my child or my parenting?  Do not go down the rabbit holes of “what ifs.”   

If your child is young, it is perfectly normal for a few tears to be shed.  Does your child cry or fight you at home when brushing?  Then why would it be any different at the dentist.  If I may be so bold as to give another piece of advice, do not hover.  Give your child and the dentist space so a trusting relationship can be built.  Parents are the ultimate authority in a child’s life.  Even though a parent’s intentions are often to be helpful, when a parent interjects reprimands or encouragement, it detracts from what the dentist is saying and doing.  It can be confusing to a child to hear multiple people telling them what to do.  A child always hears a parent over any other authority figure.  Although they do not always do what we say, as parents, they are always listening for that familiar voice they know and love.

If you keep in mind these five things, you will set your child up for a great first visit.  And if the appointment goes south, do not be too hard on yourself or your child.  Go into the appointment with an open mind, and give your child the opportunity to flourish in this new environment.

What Is a Pediatric Dentist?

Pediatric dentistry is a growing subset of dentistry.  Children are not little adults and require different tactics than adults when it comes to dentistry.  What works for one child may not work for another.  It is my job to be reading the mood of the child and create a comfortable environment where the child can have a positive dental experience.  Before becoming a pediatric dentist, many of my adult patients were holding onto bad dental experiences they had as a child.  It is my goal to prevent negative dental experiences, so every child will continue to seek preventative care for the rest of his or her life.

A pediatric dentist completes four years of dental school and progress to two (sometimes three) years of specialty training to receive our degree.  Every pediatric dental residency is required to train its students in eight areas: prevention, trauma, sedation/general anesthesia, growth/development and orthodontics, treating patients with special needs, oral pathology, and behavior management.

Prevention: Dentistry is one of the few professions that is constantly trying to put themselves out of business.  Preventing disease is a better form of treatment than fixing the disease once the process has started.  That begins with starting good oral hygiene at an early age.  At my patients’ first visit, I have a discussion with the parents about their child’s dental home care and give my recommendations on how to prevent their child from getting cavities.  This is the first step in setting a child up for a positive dental experience.

Trauma: Accidents happen.  Teeth get bumped, bruised, broken, knocked out, knocked in, you name it!  I am well-versed in what to do and how to give the tooth the best chance to survive after having an injury.  Some teeth respond well and unfortunately some do not, depending on the injury, but all I can do is follow the recommendations for each injury based on the best scientific research we have at our disposal.

Sedation/General anesthesia: Dental sedation is when a patient is prescribed a medication to relieve anxiety or prevent memory so dental treatment that is medically necessary can be completed.  General anesthesia is used when the patient’s dental needs are too great to be completed with sedation.  These tactics are used with adults as well as children.  Sedation of children became more popular when certain behavior management techniques fell out of favor (i.e. physical restraints and voice control).  Sedation and general anesthesia are always something to be taken seriously by making sure your provider has the proper training to administer the medication as well as the skills required to rescue a child if they become too sedated.    

Growth/Development and Orthodontics: Unless a pediatric dentist is dually trained, he or she is not an orthodontist.  With that said, every pediatric dental residency is required to train in orthodontics.  Some pediatric dentists feel more comfortable in this realm than others, but all pediatric dentists are specialists in growth and development.  At each dental appointment, it is important to monitor for potential issues associated with the growth of the patient and whether there is a potential problem with crowding, spacing, discrepancy in number of teeth, size of teeth, malocclusion (problems with the way the child is biting), etc.

Patients with Special Needs: A pediatric dentist can treat patients of all ages who have special needs.  Special needs include physical disabilities such as rheumatoid arthritis, cleft lip and/or palate, or spina bifida.  Patients can also have mental disabilities such as Asperger’s, autism, or Down syndrome.   Every person with special needs is unique, and it takes a bit of creativity to find a dental health regimen or treatment strategy that is successful for each patient.

Oral Pathology: Because the oral cavity is the gateway to the body, many pathologies have oral presentations.  Sometimes the first signs of certain diseases present orally.  For example, patients with Crohns disease and other autoimmune diseases can present in the mouth prior to any other presentations.  Tobacco use presents in several ways in the mouth and conversations can be had on stopping tobacco use.  Bulimia also has oral indications and can be discussed so the patient can receive the help that they need.

Behavior Management: Behavior management is what sets a pediatric dentist apart from a family or general dentist.  There are many general dentists who are fantastic when it comes to treating children, but when all you do is see children, managing their behavior is a well-honed skill that only comes with practice.  All the aforementioned areas are pillars of what a pediatric dentist knows, but behavior management cannot be taught by books.  It is learned through treating countless children, knowing when to use TLC, when to take extra time, when to encourage, when to sing a song, when to distract, or when to recommend dental sedation. 

The Scary (Or Not So Scary) Truths about Halloween Candy and Your Child’s Teeth

Beside Christmas, Halloween is my children’s favorite holiday.  They love Halloween books, and we read them all year round.  They adore playing dress up which we also do all year round.  And they, like most children, enjoy candy which we do our best not to eat all year round.

I have a problem.  Dentists have always been painted out to be anti-candy, anti-sugar, and anti-fun.  I happen to love candy, sugar, and fun, so what is a poor dentist to do?  I will never be the dentist who hands out toothbrushes instead of candy for Halloween.  I do, however, know some facts about candy and can help your child (or you) enjoy their haul without putting their teeth at risk.

Caution!  I am about to get “science-y.”  Anytime we eat or drink anything other than water, our mouth becomes acidic.  Our saliva attempts to bring our mouth back to a neutral pH, but if beverages or snacking are frequent, the mouth will stay at an acidic pH for an extended period.  An acidic environment allows the bacteria that create cavities to thrive and thereby allows cavities to form.  The bacteria that encourage cavity formation love to eat sugar.  It is what they digest the best and the by-product is even more acid.  Can you see the slippery slope?

Not all candies are created equal.  Chocolate candy, although sugary, is easier for the saliva to rinse away than sticky candies like skittles, sour patch kids, taffy, etc.  Suckers and hard candies do not tend to stick to teeth as long as sticky candies, though they do stay in the mouth for an extended period of time.  Basically, the chocolate candies tend to not cause as many problems. (And they happen to be my favorite too!)

Here are a few strategies you can try:

  1. Have your child pour out all of their candy on Halloween night and tell him or her he or she can eat as much as he or she wants, but whatever is leftover is getting thrown away or, even better, donated to a candy give-back program for the troops.
  2. Let your child eat the candy he or she wants on Halloween night, take up the rest, and put it away for after dinner snacks.  Brush and floss teeth before bed. 
  3. Keep the candy stash and give as treats every now and then but do it at times when the candy will not sit on the teeth for an extended period.  Follow the candy with a cup of water to help neutralize the mouth.

Do not give candy as incentives throughout the day.

Do not put the candy in a place that is easily accessible to your child.

Do not give candy before bed without brushing afterward.

If you follow these recommendations, your child should have no problem with his or her teeth.  I hope you find this helpful and HAPPY HALLOWEEN!!!

Help! My Child Broke His Front Tooth

Certain physical characteristics predispose children to dental trauma.  Typically, the top front teeth protrude and do not have support from the bottom teeth.  If any blow to the face occurs, such as a fall, the front teeth take the brunt of the force and can break. 

When a child breaks his or her (but lets be realistic…most of the time it’s boys) front tooth, he typically falls into one of two categories: he is either a toddler or an adolescent.  Toddlers tend to fall more frequently because they are still obtaining the motor skills to walk, whereas, adolescents have more sports or roughhousing related injuries.

Dental fractures fall into categories as well: they can be complicated or uncomplicated.  Uncomplicated fractures involve the enamel and/or dentin layers of the tooth, while the complicated fractures expose the nerve tissue of the tooth.  The uncomplicated fractures can typically be restored with dental composite (filling material) or a crown.  If it is a minor fracture, some times no treatment or smoothing the roughened enamel is all that is requried.  When the nerve is involved, root canal therapy may be necessary or if it is a baby tooth, removal of the tooth may be the best option. 

This picture is of an eight year old boy with a history of being a thumb sucker.  When a child is a thumb sucker for an extended period of time, the front teeth can flare forward and increase the child’s risk of traumatizing the front teeth.  This child had fallen and broken his front tooth on the concrete a week or so prior to the appointment.  The tooth started to turn dark a few days after the injury.  At this point, it was uncertain if the nerve of the tooth was damaged.  It was not exposed but was sensitive, so some composite restorative material was placed over the nerve to prevent it from being sensitive while we awaited the nerve’s healing.  Sometimes when a tooth turns dark right after an accident, it is because of ruptured blood vessels, and it presents the same way a bruise would on the skin.  If a tooth has experienced trauma but turns dark several months down the road, it is because the nerve and blood supply have been damaged beyond repair and the nerve has died.  When a tooth becomes necrotic, there are two options: either root canal therapy can be completed or the tooth can be removed.   

In a follow up picture taken three months following the injury, the dark coloration had almost completely disappeared and the tooth goes on to live another day!

Help! My Child Bumped Their Tooth

The blissful days of summer: mornings spent sleeping in, playing in the summer heat, and splashing into an ice-cold pool. Each day is much the same. It is the time of year where bedtimes are relaxed and catching fireflies is part of the nighttime routine. In my office, it is the season for teeth to get bumped, break, or fall out. Usually these incidents start with the phrase, “Hey, Mom!  Watch this!” 

These are the questions you need to ask yourself when this happens:

  1. Is my child okay?
  2. What is involved? Is it the tooth, gums, lip, or a combination?
  3. Does the tooth look different? Is it shorter? Is it longer? Is it broken? Is it pushed forward? Or backwards?
  4. Is the tooth loose? Is there bleeding around the tooth?

In any of these cases, it is a good idea to have your child seen by their dentist to have an exam and  dental radiographs (X-ray) to make sure everything is okay and to get a baseline report to monitor the tooth in the future.

I am starting a trauma series due to the influx of cases I see in my office during the summer months. In this segment, I will discuss a tooth that has been bumped but still looks the same as it did before the incident and is not loose.

This is diagnosed as a concussion, and the American Academy of Pediatric Dentistry (AAPD) defines it as an “injury to the tooth-supporting structures without abnormal loosening or displacement of the tooth.” Following a concussion dental injury, the tooth may be tender for a few days. On a radiograph, the tooth will look the same as it normally does. The goal following this type of injury is to allow the tooth to heal and return to its normal state. Whether it be a baby or adult tooth, no treatment is necessary aside from monitoring for signs of pulpal necrosis, aka the tooth dies, may he rest in peace.

“Heavens to Betsy! What would a tooth look like if it does succumb to this injury?” you may ask. Pulpal necrosis may present as pain, crown discoloration, abscess, and tooth mobility. The same symptoms can present for baby and adult teeth. The likelihood of a tooth developing pulpal necrosis increases the more the tooth has been displaced from its socket, so in the case of a concussion injury, pulpal necrosis is unlikely

“Whew! That is a relief, but my child’s tooth is still tender.” To help with any discomfort your child may be feeling, acetaminophen and/or ibuprofen can be beneficial as well as maintaining a soft diet for a few days until the tenderness subsides.

References:

Dental Trauma Guide:

AAPD Trauma Guidelines:

https://www.aapd.org/media/Policies_Guidelines/E_Fractures.pdf

https://www.aapd.org/assets/1/7/G_Trauma.pdf

COVID-19 and Your Teeth

When I first discussed doing a blog post with my advertising guy during the COVID-19 crisis, I pretty much shut down.  Aside from feeling extremely overwhelmed with having to close my business, figure out what governmental loans to apply for and at what specific time to apply for them, I was navigating being a stay at home mom for the first time since my oldest child was five months old.  I was thinking, “You’ve got to be kidding me.  Social media is not a priority that is even close to being on my radar right now.”  Thankfully, my advertising guy is my husband’s best friend, and allows me space when I need it but gives me honest feedback.  He encouraged me to continue with my social media and blogging.  Insert eye roll here.

He was right.  As I have accepted this situation I find myself in, I have been able to see how drastically our day-to-day lives have changed.  When yesterday, I was getting up, exercising, eating breakfast, out the door, dropping the kids off to school, arriving at work, answering emails, etc, and today, I am getting up and trying to imagine how this pandemic will unfold, filling my days with anxiety-laden thoughts.  Heaven forbid I watch the news!

I have never been in a situation where I could not leave my house and have no interaction with people besides my immediate family.  When the mandate was placed that I was not able to work anymore aside from urgent dental needs, I decided to go home, take my kids out of daycare to save money, and make the best of my new situation.  It was up to me to create a new routine, and I have learned that a loose schedule is key. 

So, how does COVID-19 affect your teeth?  To my knowledge, COVID-19 has no effect whatsoever on your teeth.  But wait for it!  During this quarantine, I have found that in my own house, when we are off our routine, self-care is often the first thing to go.  The nighttime brushing typically gets completed, but in the morning it’s off to the races.  I get up early and get my husband off to work.  Then my kids are up begging for their breakfast, and soon it’s nap time and I realize I never brushed my teeth let alone my children’s teeth.  Making a conscious effort to remember to take care of ourselves during this time is important. 

One of the other things I have realized that can increase the risk of getting cavities is, I snack more when I am at home than when I am on the go.  The more frequently snacking occurs, the more often the mouth is under acidic attack and has less time to recover.  It is not always the food that is the problem, but how often snacking occurs.  A big problem that can lead to cavities is sipping on beverages that are not water throughout the day.  Oh, it’s no big deal.  It’s a diet coke.  Yes, there is less sugar in diet coke than regular coke.  Both are acidic and can cause your enamel to decay.  The person who drinks a cup of coffee with breakfast is a lot less likely to get a cavity than the person who sips on coffee throughout the day.

The last thought I will leave you with is this: kids are vaping.  Kids can sense the tension that is going on in this world and are more likely to be vaping on a regular basis because they are bored, have more time on their hands, miss their friends, and are anxious.  I have not found many studies on what vaping does to oral tissues.  It is still too early to say anything definitively, but from my own personal practice, I see more issues with dry mouth in kids that vape.  Saliva is important in maintaining a healthy oral flora and counteracting an acidic environment to prevent cavities.

I hope you find this information helpful and informative.  Please stay safe and stay home to prevent further spread of this disease!

P.S.  Are your kids as uncooperative with taking pictures as mine?  Oh well, this is the best I got!  Happy Quarantining!

What is a Dental Cavity

A cavity or dental caries is nothing more than a hole that has formed in the tooth by dissolving an area of the outer layer: enamel.  Enamel is the second hardest compound on earth, second only to diamonds.  A cavity can form when three things are present: a tooth, food and bacteria.

Firstly, a tooth must be present for a cavity to form.  I promise I am not trying to sound silly, but babies could have the bacteria and eat food, and not get cavities because there is not a tooth for the bacteria to attach.

Secondly, food must be present for cavities to form.  Certain foods can lead to cavities more frequently than others.  Foods that are high in processed sugars, such as candies, starches, and fruit juices, are more easily processed by the bacteria that live in our mouths.  Foods that are less likely to create cavities are things such as cheese, nuts, and apples. 

Thirdly, bacteria or “sugar bugs” as I call them, must be present for a cavity to form.  The mean sugar bug’s name is Streptococcus mutansS. mutans can adhere to teeth and if left to his own devices, can produce an acidic byproduct that can breakdown the protective enamel exposing the softer dentin below.  S. mutans loves starchy foods because it is easier for them to breakdown.  And guess what its byproduct is.  That’s right!  Acid.  S. mutans has an interesting quality in that it thrives in an acidic environment and every time we eat or take a sip of a beverage other than water; the oral cavity becomes acidic.  Now, it’s okay!  Our saliva attempts to counterbalance the acidic environment and bring the mouth back to neutral.

But, when food and plaque sit on teeth, the environment underneath the plaque is acidic, it can stay stuck to the enamel until we remove it from the teeth with a toothbrush or floss.  In the acidic environment, the minerals that make enamel so strong, can get broken down and is unable to recover.  At that time, a cavity will form. 

The last thing needed to form a cavity is time.  It takes time for the acid to break through the enamel and reach the underlying layer of dentin.  Can I give you some bonus information?  Did I hear you yell an emphatic “YES”?  I’m so glad you did.  Research studies show that it takes approximately six months for a cavity to break through the enamel layer.  It is for this reason that insurance companies cover a cleaning every six months and one day.  And not a moment sooner!

What Does a Tooth, Cake, and an Ogre Have in Common?

I know you remember the scene where Shrek is explaining to Donkey that ogres are more than the frightening fairy tale lore they are known for.  “They have layers.  Onions have layers” explains Shrek huffily.  Donkey thinks for a minute and replies, “Not everybody likes onions.  CAKE!  Cake’s got layers.  Everybody likes cake.” Teeth, like cake, have layers. 

The white outer layer is called enamel.  Enamel is the second hardest compound in the world, preceded only by one of my other favorite things, diamonds!  Enamel protects the inner tooth layers from extreme temperature changes and normal wear and tear from chewing food.  Enamel is densely mineralized and is constantly responding to changes in its environment.

The middle layer is called dentin.  It is less mineralized than enamel and has a yellow hue.  Dentin is amazing because it can sense if a cavity is forming, and it will lay down more dentin to wall off the cavity and protect the nerve and blood supply inside the tooth.

The innermost layer is called the dental pulp which contains the nerve and blood supply to the tooth.  This is why a tooth can feel cold, heat, and pain.  If a cavity comes close to or reaches the pulp, it can allow a pathway for bacteria to proliferate and cause an infection.   

Each layer has its unique purpose.  It is amazing how a tooth can fight a cavity without a single action from us.  Whether it be a cake, an ogre, or a tooth, I am a fan of layers, and you should be too.  Now, please pass the cake!

What is Conscious Sedation?

To sedate or not to sedate, that is the question.  Dental sedation has been brought to light by the media in the past few years and the light has not been very complementary.  Sedation is when medications are administered to create a relaxed or peaceful state.  It is a spectrum, and depending on the patient’s needs, the provider will decide what level of sedation is necessary to accomplish the desired goal.

Dental sedation can be used for adults, but I will be focusing on sedation for children since that is my area of expertise.  When I was in residency, in our first sedation class my professor said, “Children are not little adults!  Do not sedate them like they are an adult.”  At the time, I did not know what he meant.  When working with adults, there is more standardization as far as prescribing medications.  With a child, typically, prescribing should be based off his weight and not his age or maximum dosage.  Young children do not have mature respiratory systems, do not have a large oxygen reserve, and can become overly sedated quickly.

There are hundreds of medications that can be used to sedate children and as some would say, “many ways to skin a cat.”  I will not discuss specific medications, but each provider has their “go to” medications that they use depending on the situation and the desired goal.  When the term “conscious sedation” is used, I am referring to minimal sedation.  My goal for a child is that he be awake but relaxed for the procedure.  The child should be able to follow my instructions and have all his normal reflexes intact.

Conscious sedation is safe when practicing within the guidelines set forth by the American Academy of Pediatric Dentistry.  This is not to say that there should not be some level of healthy fear anytime medications are introduced.  As I stated before, sedation is a spectrum and a child can easily slip further down the sedation spectrum than may be intended.  Whenever a child is sedated, it is important to keep in mind where the child is on the spectrum, and as a provider, “Am I comfortable with how this child is responding?”  If not, what is the causing the problem and how do I fix it quickly. 

When I was in dental school, I had several patients that were terrified of the dentist.  Many of these patients had a bad experience as a child and have carried these fears into adulthood.  Sedation was not a common practice even twenty years ago.  At that time, it was not uncommon to use restraints or behavioral techniques that are not as acceptable at this day in time.  Children are impressionable creatures and do remember bad experiences that may affect them for the rest of their life.  This is one of the reasons why I decided to go into pediatric dentistry.  If I can give a child a good dental experience, then that child will carry this mindset to adulthood and is more likely to seek dental care on a routine basis instead of waiting for an emergency to arise. 

I am not going to lie, sedation appointments are not my favorite, but if it will give a child a good experience, I will do it.  During residency, I completed over double the amount of sedation cases required and feel comfortable with the medications I prescribe.  I maintain my Pediatric Advanced Life Support certificate.  All my staff is certified in Basic Life Support.  I complete an inventory of our crash cart monthly to make sure I have everything I need on the off chance I run into a situation where I may need to rescue a child.  We have staff meetings weekly where we discuss various office emergencies, and how we will handle them.  I hope to always maintain a healthy fear that I may need to use my advanced training.  Sedating a child is never something to be taken lightly, but it can be a useful tool in creating an enjoyable dental experience for some children.

What is Infant Tongue Tie?

Infant tongue tie is something that has come to light in the past few years as more and more of us mommies are breastfeeding our babies. I have been getting questions at an increasing rate on this topic. Does my baby have tongue tie? Is it a problem? Do I need to do something about it?


What is tongue tie?
Tongue tie is when the tip of the tongue is attached to the floor of the mouth. There are varying degrees of tongue tie from minimal attachment to the full length of the tongue being attached to the floor of the mouth.

What problems can it cause?
In infants, it can cause difficulty feeding/latching and for momma, it can cause nipple pain upon feeding.

Do I need to do something about my infant’s tongue tie?
This is the process I use to decide if my patients are candidates for the surgical procedure to relieve the tongue: I ask parents if it is causing a problem?” If the parents say no, it is usually something they have noticed visually and not noticed problems. These children are not a candidate. If the parents say “yes,” then I ask what problems they are experiencing. If the parents say the child has colic or gastric reflux and is fussy, they are not typically a candidate. These issues are best brought up to the child’s pediatrician and once GI issues have been ruled out, they may be a candidate. If the parents say the child is having difficulty eating, is in a low weight class, or the mom is having pain on feeding, then the surgery may be helpful. Notice, I said MAY be helpful. This is the controversial part! Scientific research has found a correlation between the surgical removal of the attachment and better feeding/less nipple pain. Is it a relatively harmless procedure? Yes. Is the recovery difficult? Not typically. Is it helpful in some cases? Yes. Is it 100% effective? No. Am I going to recommend it to all of my patients with tongue tie? No. A serious discussion needs to occur between the provider and the parents where the pros and cons of the procedure are weighed to determine if it is the right course of action. A good clinical evaluation is important. Sometimes the tongue is not the main source of the problem. Occasionally, the top lip can be attached firmly and is not allowing the baby to latch effectively.

Who performs this type of procedure?
Due to its controversial nature, only a select few doctors perform it. The best place to start in most cases is a lactation specialist. Although they do not perform the procedure, usually they know who in your area does. Among the list may be Ear, Nose and Throat physicians, Neonatologists, Periodontists (dentists who specialize in gums), Pedodontists (children’s dentist), and Oral Surgeons.

What does the surgery entail?
There is a section of gum tissue under the tongue that attaches to the floor of the mouth. This tissue is called a “frenum” or “frenulum.” The frenum is cut with either scissors, a scalpel, or a soft tissue laser to allow the tongue to move freely. Sometimes it is necessary to place stitches to allow the tissue to heal, but it is not always required.

Will my baby have to be put to sleep?
This depends on the surgeon you are using. Typically these babies are less than 6 months of age and general anesthesia is not required. Some ENT physicians may combine this procedure in with another surgery, for example, if your child also needs ear tubes. Most of the time, these procedures can be completed with your baby awake.

Will my child feel pain?
Babies are like adults. They do feel pain just like anyone else. But, there are risks to giving infants numbing medication because they are so small, and it is easy to give them too much. Some practitioners are of the school of thought that the child will not remember the procedure, so they do not give the baby numbing medicine. This is a topic to discuss with your surgeon and decide how you would like to proceed.

What is the recovery like?
Typically, following the procedure, the provider will give the baby to the mom to begin breastfeeding and help soothe the child. Yes, unless your child was put to sleep, your baby will scream throughout the procedure. This is normal and is not necessarily indicative of pain. Most babies do not like to have their mouth messed with, and their only known way of responding is to cry. Before you leave with your baby, you may be given instructions to do tongue and lip exercises at home. Typically the surgeon will schedule a follow up exam a week to a month following the surgery. This will allow them to monitor the healing and make sure the procedure was successful. In the meantime, Tylenol/Motrin can be used for any post-operative pain unless the pediatrician recommends otherwise.

I hope this is helpful and not overwhelming. I am attaching links to this post with more information on the topic.

http://www.aapd.org/assets/1/25/kupietzky-27-1.pdf

https://www.ncbi.nlm.nih.gov/books/NBK299106/