Frenulum Surgery? sorry, long.

[Dobela]

My dd3 had a dentist appt today. He noticed that her frenulum is still attached to her tongue and said she is "slightly tongue tied". ( Does this even make sense yet? I'm not sure how to describe this) His concern is that without greater tongue movement she will not be able to eat and clean her teeth properly as her tongue is obviously part of that. She has some tongue movement but not what he thinks it should be for her age. He suggested that we start considering having surgery to have it clipped. No rush in the surgery, but he did recommend it before she started getting permanent teeth in. To have it clipped she would have to get a referral from our pediatrician (who would do it if I asked, she is good for referrals), then go to an oral surgeon who would have to use anestheitcs for the surgery. Just saying that I would need to put my dd under anesthesia makes it hard for me to breathe.

 

That all being said, dd3 has had eating and swallowing issues since her very premature birth (born at 26 weeks weighing 1lb 14 oz). We have to have swallow studies every 8-12 months to see if she still aspirates with thin liquids. She had therapy with an SLP from age 1.5 to 2.5 due to eating issues. At that time she didn't have lateral tongue movement or appropriate chewing. In early August she again qualifed for speech language therapy, but just barely and only for receptive language. However, while doing the eval the SLP noticed low muscle tone in the face and poor tongue control and expressed serious concerns about this. During their sessions she is spending much of her time working on the eating issues because she doesn't need much language help. Each week she has me report about any eating problems and gives us special oral motor 'homework' involving her tongue and cheeks.

 

For the record, dd's articulation and expressive language is considered to be just fine and developmentally appropriate-which is why she barely qualified for therapy in receptive language, and tested out during the year she idn't have therapy. She is easily understood by everyone.

 

Now, this is the second SLP that we have seen for therapy and neither has ever suggested dd3 might be tongue tied. DD has also been to special clinics for feeding issues and they have never mentioned it. However, once we discovered the aspiration issues when she was 13mo that really became the focus.

 

I guess I have the following questions:

1. If your child had this surgery, what was it like? Recovery? What do I need to know and expect?

2. Could the SLPs missed the frenulum attachment since the dentist calls it 'slight'?

3. Or, could the apparent 'tongue tied' be caused by her low muscle tone and be possibly corrected with more therapy? Part of the diagnosis was because she couldn't immitate simple tongue movements like licking across her lips (which I knew she couldn't do).

4. What do I do or ask or look for now?

 

Thanks!

[CalicoKat]

My dd3 had a dentist appt today. He noticed that her frenulum is still attached to her tongue and said she is "slightly tongue tied". ( Does this even make sense yet? I'm not sure how to describe this) His concern is that without greater tongue movement she will not be able to eat and clean her teeth properly as her tongue is obviously part of that. She has some tongue movement but not what he thinks it should be for her age. He suggested that we start considering having surgery to have it clipped. No rush in the surgery, but he did recommend it before she started getting permanent teeth in. To have it clipped she would have to get a referral from our pediatrician (who would do it if I asked, she is good for referrals), then go to an oral surgeon who would have to use anestheitcs for the surgery. Just saying that I would need to put my dd under anesthesia makes it hard for me to breathe.

 

That all being said, dd3 has had eating and swallowing issues since her very premature birth (born at 26 weeks weighing 1lb 14 oz). We have to have swallow studies every 8-12 months to see if she still aspirates with thin liquids. She had therapy with an SLP from age 1.5 to 2.5 due to eating issues. At that time she didn't have lateral tongue movement or appropriate chewing. In early August she again qualifed for speech language therapy, but just barely and only for receptive language. However, while doing the eval the SLP noticed low muscle tone in the face and poor tongue control and expressed serious concerns about this. During their sessions she is spending much of her time working on the eating issues because she doesn't need much language help. Each week she has me report about any eating problems and gives us special oral motor 'homework' involving her tongue and cheeks.

 

For the record, dd's articulation and expressive language is considered to be just fine and developmentally appropriate-which is why she barely qualified for therapy in receptive language, and tested out during the year she idn't have therapy. She is easily understood by everyone.

 

Now, this is the second SLP that we have seen for therapy and neither has ever suggested dd3 might be tongue tied. DD has also been to special clinics for feeding issues and they have never mentioned it. However, once we discovered the aspiration issues when she was 13mo that really became the focus.

 

I guess I have the following questions:

1. If your child had this surgery, what was it like? Recovery? What do I need to know and expect?

2. Could the SLPs missed the frenulum attachment since the dentist calls it 'slight'?

3. Or, could the apparent 'tongue tied' be caused by her low muscle tone and be possibly corrected with more therapy? Part of the diagnosis was because she couldn't immitate simple tongue movements like licking across her lips (which I knew she couldn't do).

4. What do I do or ask or look for now?

 

Thanks!

I've got a coupke kids with this and I've been told they don't do that surgery any more because it can lead to bigger problems later with their speech. My kids have been fine in the verbal department too.

[Carrie12345]

Can you call up her therapists and get their thoughts on the dentist's suggestion? And, even after that, I'd get a second opinion from another dentist.

 

I personally haven't heard of any child having a frenulum snipped past infancy, when it's interfering with feeding. Not to say it isn't a valid procedure, but I'd be suspicious, given her history of monitoring.

[gingersmom]

I would never do it.

 

There is a little boy on my street who had it done because they were told it would help with his speech. It did not.

 

You need to see an OT who specializes in feeding issues. I highly doubt they would recommend it.

[Miss Sherry]

When I was in my early 30's a dentist told me I needed that surgery. :001_huh: His assistant told me not to worry because they did that surgery a lot.That comment was a red flag to me. :glare: It sounded to me like an unnecessary surgery that the dentist wanted to make money on, so I passed on it. No other dentist has ever mentioned it to me.

[Dobela]

I would never do it.

 

There is a little boy on my street who had it done because they were told it would help with his speech. It did not.

 

You need to see an OT who specializes in feeding issues. I highly doubt they would recommend it.

She is seeing an OT as well, and she does work on feeding issues too. Her OT seems to think that part of the eating issues are from lack of body awareness and sensitivity issues. I tried to contact her SLPs but both were unavailable today. I will speak to them after the holiday.

 

I just keep wondering - if this would help with the eating issues she has it could be worth it, but I have no doubt she doesn't need it for speech. Sigh. I really trust her dentist as well and I guess that is why I think maybe is *might* be that missing link to fix the puzzle KWIM??

[Dobela]

When I was in my early 30's a dentist told me I needed that surgery. :001_huh: His assistant told me not to worry because they did that surgery a lot.That comment was a red flag to me. :glare: It sounded to me like an unnecessary surgery that the dentist wanted to make money on, so I passed on it. No other dentist has ever mentioned it to me.

Her dentist wouldn't do the actual surgery, we would have to be referred out.

[Miss Sherry]

Her dentist wouldn't do the actual surgery, we would have to be referred out.

As has already been mentioned, I also think you should get other professional opinions. I would ask her OT and get another opinion from a dentist that your dentist does not have any connection with. Keep in mind that your dentist is not just a humane person volunteering his time, he has a business and some doctors and dentists are known for doing unnecessary procedures to bring in money. Since working as a medical assistant I am much more a skeptic than I would be if I hadn't seen for myself how some doctors find ways to make money by doing unnecessary procedures. I believe it is all condoned in their own minds and they would never admit even to themselves how much they do that is not helpful or necessary. It's so ironic how much becomes unnecessary when a patient doesn't have insurance that covers certain procedures.

[Crimson Wife]

All three of my children have had the procedure done and calling it a "surgery" is a HUGE stretch. It takes literally 30 seconds to do and there's hardly any blood. My oldest and youngest had it done early enough (6 mos and 4 mos) that they didn't even need anything more than a local anesthetic. The ENT doctor just took a teeny pair of scissors and snipped. Recovery was virtually immediate as I popped in a bottle with sugar water per the doctor's orders.

 

My DS was misdiagnosed at birth by an idiot nurse who claimed that he wasn't tongue-tied when I noticed he was. He latched on okay so I stupidly canceled the appointment I had pre-arranged with the ENT. When he had trouble transitioning to a sippy cup and table foods, I finally got the correct diagnosis. But by the time I could get the procedure scheduled, he was 15 months and needed to have it done under general anesthetic. And he wound up having articulation problems that his SLP believes is probably the result of being tongue-tied into toddlerhood. He has finally overcome the speech issue, but I really wish I'd had the procedure done in infancy like his sisters had.

 

Pediatricians and family practitioners used to do the procedure routinely in their office. DH's grandfather, who was a retired family physician, actually offered to do it himself for our older two (we politely declined because he was in his late 80's with failing eyesight ;)). I don't know why it has fallen out of favor in the medical community, because it's really the most minor thing. Don't be afraid to have it done if the ENT recommends it.

[Crimson Wife]

As has already been mentioned, I also think you should get other professional opinions. I would ask her OT and get another opinion from a dentist that your dentist does not have any connection with. Keep in mind that your dentist is not just a humane person volunteering his time, he has a business and some doctors and dentists are known for doing unnecessary procedures to bring in money. Since working as a medical assistant I am much more a skeptic than I would be if I hadn't seen for myself how some doctors find ways to make money by doing unnecessary procedures.

 

This was not my experience at all. When I had my 3rd child evaluated, the ENT actually declined to do the procedure at first even though he agreed she was tongue-tied. It wasn't until she failed to gain the proper amount of weight between her 2 mos. and 3 mos. appointment that he agreed to do it.

 

The ENT actually doesn't make that much off the procedure from the Explanation of Benefits documents I've seen for my 2 younger kids (with my oldest we had military insurance rather than private).

[Snickerdoodle]

This was not my experience at all.

 

Nor mine. I had to push to get it done and I'm glad we did.

[Tiramisu]

When my 4th dd was born, she had an attached frenulum. I spoke to pediatricans, a pediatric dentist, and an SLP. No one would consider cutting it unless there were issues with nursing or feeding, and we never had any. I was rather freaked out and talked to everyone I could about it. (I didn't know about the Hive then.) I did quite a bit of research which seemed to indicate that there actually isn't much of connection with a tongue tie and speech difficulties later. But, I can imagine it would really depend on the degree. I've also heard of at least one case when a family decided to get the frenulum cut because of speech issues and it didn't help, but another case where it helped almost immediately with the benefit of speech therapy.

 

Why this can be an easy procedure or not has to do with whether or not there are blood vessels in the part that they would have to cut. I've heard that midwives used to check and clip right after birth, but I've also heard of cases requiring general anesthesia.

 

Since my 4th dd was born, I've met plenty of adults with this and families with multiple members with tongue ties, but, actually none of them have had any noticeable speech differences. Ironically, my 2nd dd also a tongue tie and I never knew it until one day when we were all sticking out our tongues and I realized she couldn't stick hers out that far. She was probably about 6 or 7. Of all my children, she always had the most perfect articulation since the time she began to talk. People always commented on how clearly she spoke as a toddler. At the same time, looking back, she had a funny latch while nursing and it turns out that her top lip is also tightly connected. None of this ever interfered how well she ate, she was the plumpest of all my children, too.

 

A friend's 14 yo dd just had her surgery on her frenulum. They decided to do it because she was getting her tonsils out and decided to take advantage of the fact that she was going under general anesthesia. In her case, the decision was for cosmetic reasons. She was being taunted by her classmates because of the look of her tongue. She had a lot of pain after the surgery, but not from the frenulum but from the tonsils.

 

It seems like there are a lot of things to consider in your case. I would really try to get as many opinions as you can from as many different kinds of professionals, dentists, SLPs, OTs, ENTs, as you can manage without going crazy. :)

 

You mention her sensitivity issues, and both of my dds who had the attached frenulums have sensitivity issues (sensory processing). Fortunately, they seem to have become more manageable over time.

 

Hoping all goes well for your family. :grouphug:

[Dobela]

Thanks everyone for your input. I really needed some outside opinions as well. The whole idea has caught me off guard. I wouldn't consider it at all since her speech is fine, but with her continued eating problems, well, that makes me look at it differently. She has had weight gain issues in the past and even had periods of weight loss connected to aspiration issues. I just don't want to impeede progress if it is that easy, but I also don't want to have her go thru anesthesia unnecessarily.

 

Just a lot to research and pray about I guess.

[mrs.m]

Go see an ENT, mostly because your insurance will be more likely to pick that up rather than an oral surgeon! My DH had it done as an adult and it was not bad at all. He had some issues with the frenulum all through his life but didn't know what it was until DS was diagnosed as a baby. They numbed him and did a quick clip. He said it felt like he had a canker sore but it healed up really quickly--2 days max!

[Dobela]

Go see an ENT, mostly because your insurance will be more likely to pick that up rather than an oral surgeon! My DH had it done as an adult and it was not bad at all. He had some issues with the frenulum all through his life but didn't know what it was until DS was diagnosed as a baby. They numbed him and did a quick clip. He said it felt like he had a canker sore but it healed up really quickly--2 days max!

If it isn't too personal, do you mind sharing what those problems he experienced were?

[Barb_]

My oldest had a terrible time with a short frenulum. Her tongue would swell up and become inflamed at times because she would get irritated with it (in her sleep, maybe?) and rub it against her teeth. She had speech issues as a child. Her dentist didn't want to refer her to have it clipped because he didn't believe it would help, but at 13 she had it done and she's had no problems since then. Although waiting that late cause her a lot more pain than if she'd had it done earlier, because of the greater nerve growth we've been told.

 

Barb

 

ETA: We had it done with an ENT. No Ins. problems

[mrs.m]

If it isn't too personal, do you mind sharing what those problems he experienced were?

 

It would get irriated when he did a lot of talking and eating things like Ice Cream cones. He always requested it in a bowl, now he can have a dipped cone! He got a few canker sores under the tongue too. He's also had a lot of dental issues which I wonder if they were related. No evidence to prove that though. He has not had speech issues and the snip didn't change anything other than his comfort. He says he would have been ok leaving it but since DS was getting snipped, they did his too! He honestly thought everyone had an iritated tongue. :tongue_smilie:

[keptwoman]

We had DDs clipped when she was about 6 months old. We had known it was tied since birth, but we couldn't find a Dr who would clip it in their office so we waited a bit later and she had it under a general anaesthetic by a pediatric surgeon. I think the anaesthetic took longer to adminster than the tounge took to clip. As soon as she woke, I put her to the breast and she was fine, little blood and no side effects.

Tight frenulums (both tounge and the one between the upper lip and jaw) can cause issues with adult teeth by misaligning them so we would never have left it.

[Dobela]

It would get irriated when he did a lot of talking and eating things like Ice Cream cones. He always requested it in a bowl, now he can have a dipped cone! He got a few canker sores under the tongue too. He's also had a lot of dental issues which I wonder if they were related. No evidence to prove that though. He has not had speech issues and the snip didn't change anything other than his comfort. He says he would have been ok leaving it but since DS was getting snipped, they did his too! He honestly thought everyone had an iritated tongue. :tongue_smilie:

Thank you!

 

We had DDs clipped when she was about 6 months old. We had known it was tied since birth, but we couldn't find a Dr who would clip it in their office so we waited a bit later and she had it under a general anaesthetic by a pediatric surgeon. I think the anaesthetic took longer to adminster than the tounge took to clip. As soon as she woke, I put her to the breast and she was fine, little blood and no side effects.

Tight frenulums (both tounge and the one between the upper lip and jaw) can cause issues with adult teeth by misaligning them so we would never have left it.

Thank you as well. DD3 also has a tight upper frenulum but we were told by our dentist that we should only have that one clipped if we wanted to prevent a gap in her teeth later. Clipping it was purely cosmetic.

[keptwoman]

Thank you!

 

 

Thank you as well. DD3 also has a tight upper frenulum but we were told by our dentist that we should only have that one clipped if we wanted to prevent a gap in her teeth later. Clipping it was purely cosmetic.

DD's baby teeth were in before we clipped it, both centre bottom teeth were pulled in towards the centre by the power of the frenulum. We didn't want that to happen to her adult teeth. Her adult teeth are in now and straight :)

 

If you google teeth and frenulum, you can see what a tight upper frenulum can do. I've kept an eye on DD's because it was quite tight, but it seems to have loosened and is not affecting her adult teeth.

[Tiramisu]

Thank you!

 

 

Thank you as well. DD3 also has a tight upper frenulum but we were told by our dentist that we should only have that one clipped if we wanted to prevent a gap in her teeth later. Clipping it was purely cosmetic.

 

Dh had his upper lip frenulum cut as a child for dental reasons. An orthodonist told us dd#2 may have to have hers cut. However, as more of her permanent teeth grew in the gap between her two front teet caused by the frenulum closed. She has beautiful teeth. Now dd#3 doesn't have the tongue tie problem, just the upper lip. Her teeth also have the gap so I'm watching to see if her closes as well.

 

If the tongue's movement is limited due to the tongue tie AND the upper lip is tight, I think there's probably more potential for the self-cleaning action of the tongue and mouth to be impeded and more crevices for food to hide, all leading to tooth decay. Lovely. Just another happy thought to consider for us with children with the double frenulum problem. :D

[sleepymommy]

If possible, I would look into a laser frenulectomy. Ds6 had it when he was 4 or 5 yrs old and I also had it done along with him. He never had any speech, nursing or feeding issues so I actually never even noticed it until then. His tongue did not stick out at all and the reason we chose to go ahead and have it done is because I had read somewhere about other issues (allergies, etc) that are often, but not always, related to tongue tie.

 

We had the laser frenulectomy done at a dentist's office with just local numbing. The procedure itself was painless, it didn't start to hurt until the numbing started to wear off. Dh was very against anything involving general anesthesia. Ds recovered rather quickly (much faster than I!), his mouth hurt for about 2 days and he ate a good amount of fruit juice and water popsicles.

 

Hope this helps!

[Mergath]

My dd had hers done when she was fourteen months old. Hers was considered a moderate tongue-tie. Up until that point, she couldn't even babble or make consonant sounds. We had the procedure done under general anesthesia- it was very quick, she healed within a couple days and had no side effects- and she was babbling within three days.

 

I've had a minor tongue-tie my whole life, and while it hasn't caused any serious problems, I do have to work harder to produce some sounds. I actually had to scratch some baby names off the list when I was pregnant because I just couldn't say them. If there's a chance your dd could have problems later on, I'd say go ahead and have it done.

[mycalling]

I had mine done at 14yo and they cut out the entire thing plus some tightened muscle at the edge of the tongue. It was horribly painful and I wish I had had it done as a child as the muscle would have developed properly. (The muscle part was done months after the frenulum after trying to stretch it naturally.) BTW, I never had speech issues except S's and my tongue-tie was considered slight. It had already messed up my adult teeth. (It was cosmetic...not fun being the heart-shaped-tongued teenager!)

 

Three of my sons are tongue-tied. One had his entire frenulum cut out under general at 2yo...hardly any discomfort afterward. By 2yo it had already messed with his lower baby teeth and his speech, but by 6yo his speech had caught up and now his adult teeth have grown in straight.

 

We chose not to clip our second tongue-tied son and at 4 his speech was so delayed he was hard to understand. He tore his entire frenulum from his tongue from falling with a vacuum pipe in his mouth two days before starting speech!:scared: It had been so tight that there was no trace of it on the base of his mouth. It literally disappeared flush down there. A year later, we are still working on muscle tone in his tongue.

 

Our third son just turned 2 and I have been thinking about getting his clipped. He has no speech issues or feeding issues, but I know how it will mess up his teeth. Also, no speech issues at 2 does not mean he won't develop speech issues as the harder sounds are expected at 3 and 4yo.

 

(Meanwhile, both of my non-tongue-tied sons can pick their noses with their tongues!:glare: Odd they're complete opposites.)