By Eva Briggs, MD
Ankyloglossia is the medical term for tongue tie. In recent decades procedures to treat tongue tie have exploded. The number of procedures for tongue tie increased 800% between 1997 and 2012. This rise is alarming to pediatricians, suggesting over diagnosis and over treatment.
The increase coincides with the increase in breastfeeding, which has been promoted due to many health benefits of breast feeding.
Most of these tongue tie problems resolve without resorting to surgery on an infant’s mouth.
Tissue that connects the bottom of the tongue to the floor of the mouth is called a frenulum. It’s a normal feature of human anatomy. Only severe cases of tongue tie actually cause breastfeeding problems. Tongue tie is severe when the frenulum connects to the front of the tongue and prevents it from protruding beyond the lower gums.
Part of the rising rates of tongue tie release (frenulectomy) stems from the increased availability of lasers, marketed aggressively to dentists and others. For years tongue tie was treated by pediatricians snipping tissue with scissors. In most cases this is quick with minimal pain and bleeding.
Someone with a laser can charge hundreds of dollars for the procedure. Social media influencers and Facebook groups have created a demand for the procedure. They promote it, without evidence, to help not just with nursing problems but as way to prevent speech delay and sleep apnea.
Although laser frenulectomy is usually without problem, a small number of infants have severe complications. Pain from the procedure can cause the child to stop nursing. In severe cases the infant can become dehydrated and malnourished. They may even need hospitalization.
Some proponents of tongue tie release push for other dubious procedures. One is mouth stretching after the procedure, allegedly to prevent the cut tissues from reattaching. There is no evidence for this painful procedure.
Cheek tie release — cutting tissue that attaches the cheeks to other mouth structures — is another surgery without proven benefit. Similarly, there is no benefit to cutting lip ties, tissue that attaches the lip to the gum. This tissue is also normal, and no evidence connects it to a future gap between the front teeth.
As early as 1791, a German obstetrician expressed the following concern about tongue tie release: “Frequently parents are deceived for profit, greed, and ignorance.”
The American Academy of Pediatrics recommends lactation support before considering surgical treatment of ankyloglossia.
Surgery is indicated only for cases of ankyloglossia where the frenulum attaches to the front of tongue and prevents latching and does not respond to lactation therapy.
Simple snipping with scissors is preferred to laser therapy. Frenulectomy is not needed if the infant is not breast feeding and is not indicated for prevention of speech problems or sleep apnea. The AAP also cautions against cutting cheek ties or lip ties.
Eva Briggs is a retired medical doctor who practiced in Central New York for several decades. She lives in Marcellus.