What is a Frenectomy?
A frenotomy of frenectomy is a procedure that consists of releasing the frenum under the tongue or upper lip to allow for better range of motion. Children may be born with a combination of conditions called a tongue-tie (ankyloglossia) and/or a lip-tie causing restrictions in movement that can cause difficulty with breastfeeding, and in some instances, other health problems like dental decay or spacing, speech and airway difficulties, and digestive issues. These issues can generally be corrected by a simple procedure done with our soft tissue laser.
Laser Frenectomy – How Does It Work?
A soft tissue laser does NOT cut, it is more a “vaporization” of tissue that occurs with light energy. There is very little discomfort with the laser. There is almost no bleeding from the laser procedure. Lasers sterilize at touch therefore have less risk of infection. The healing is very quick – a laser stimulates bio-regeneration and healing. The result is beautiful tissue, less chance of relapse.
Tongue-Tie – What Does It Really Mean?
Ankyloglossia, or tongue-tie, is the restriction of tongue movement as a result of fusion or adherence of the tongue to the floor of the mouth. A tongue-tie is therefore caused by a frenum that is abnormally short or attached too close to the tip of the tongue.
Normal tongue function is important for multiple reasons. Among the many benefits, normal tongue function will allow a baby to latch adequately and breastfeed efficiently, promote normal speech development make it possible for a child to self-cleanse the mouth during eating, allow adequate swallowing patterns, allow for proper growth and development. Challenges that can occur with a tongue-tie:
- Inability to open mouth widely affects speech and eating habits
- Inability to speak clearly when talking fast/loud/soft
- Clicking jaws
- Pain in jaws
- Protrusion of the lower jaws, inferior prognathism
How Can A Lip-Tie Affect My Child?
A lip-tie occurs when the upper lip remains attached to the upper gum. Challenges that can occur in children and infants with moderate to severe lip-ties:
- Spacing between the maxillary central incisors, a large gap can form called a diastema
- Difficulties with brushing and flossing
- Increased risk of dental decay
- Repeated trauma to the maxillary frenum because it is so low and prominent
- Pain with breastfeeding
- Inability to adequately flange the maxillary lip upward during breastfeeding, affecting an infant’s latch and ability to create a good seal
Why Does It Hurt When I Breastfeed My Baby?
Many mothers are often told, or mistakenly assume, that if they cannot successfully breastfeed, there is something wrong with them. In fact, this is often not true. Infants may be born with a combination of limiting conditions called a tongue-tie (ankyloglossia) and/or a lip-tie.
Why Have The Tongue-Tie And/Or Lip-Ties Released For My Baby?
- To help make breastfeeding more successful
- To help relieve the pain of breastfeeding and regain healthy nipples and breasts
- To stimulate milk production by adequate stimulation
- To help achieve satisfactory bonding between a mother and her baby
- To ensure adequate feeding and growth of the baby
- To avoid serious long term issues with palatal development, tooth spacing, dental caries, speech impairments, social stigma
What Can I Expect After The Laser Frenectomy Is Done?
Breastfeeding immediately after the procedure is encouraged as breast milk contains amazing healing properties and the simple act of breastfeeding will reassure and soothe the baby. It is possible that latching may be a struggle at first since we are using a small amount of anesthetic to complete the procedure. The numbness will wear off about 30-45 minutes after the procedure. Do not be alarmed if latching is difficult at first. Posterior tongue-ties may require a few weeks of practice before seeing the benefits of the frenectomy. We recommend to be thorough with the prescribed post treatment exercises and to work with the lactation consultant and possibly a bodyworker (cranial sacral therapist, pediatric chiropractor, etc.) to increase the chances of success.
You may use Tylenol, Ibruprofen (if 6 months of age or older), coconut oil or other homeopathic measures to help with discomfort. Starting a few days after the procedure, the wound(s) will look gooey white and/or yellow in appearance. This is a completely normal inflammatory response. The body’s natural way to make a band-aid to completely unfold the diamond so that you can visualize the entire diamond. The fold of the diamond across the middle is the first place it will reattach.
Q & A Session on Frenectomy
Q: Do I need a referral from another doctor?
A: No. We are considered a primary care provider so you do not need a referral from another doctor or specialist. However, we recommend that you have an evaluation with a lactation specialist, IBCLC, prior to making an appointment for your baby. In addition, if you do have additional diagnostic information from another provider we encourage you to share that with the doctor during the exam visit.
Q: How young is too young to have my baby evaluated for a lip or tongue tie?
A: It is never too young to have your baby evaluated, we examine newborns all the time sometimes babies are only a day old. It is best to have your baby revised if it is indicated at a younger age rather than waiting since your baby can form habits and compensations which may require your baby to have additional therapy. In some cases, additional therapy is needed to fully rehabilitate the oral-facial structures regardless of the age.
Q: Will the first visit be considered a consultation or an exam visit?
A: It will be an exam visit since it does include a physical examination of the oral cavity, which is needed for full diagnosis and treatment plan recommendations.
Q: Will just having the surgical procedure conducted on my baby help correct my breastfeeding issues?
A: Caring for you and your baby is truly a team effort and we highly recommend that you continue to work with your (IBCLC )lactation consultant. For some babies, if there are no other problems with the cranium, head, neck, or back, and your baby is a newborn at the time of the revision, the likelihood of additional nonsurgical therapy is low. However, if there are other problems contributing to an improper latch, changing the anatomy of the frenum (lip tie or tongue tie) by surgical removal alone will not fully alleviate all the symptoms. Some babies require additional therapy, i.e speech language pathology therapy for suck, swallow, range of motion, lateralization of tongue, & strengthening training, craniosacral therapy to release tensions deep in the body to relieve pain and dysfunction, or chiropractic treatment for possible nerve interference and to correct subluxation/misalignment that may exist.
Q: Will any pain medication be given to my baby before conducting the procedure?
A: In most cases, yes. Dr. Banks/Durickas has a safe specially compounded topical anesthetic and local anesthetic available for injection when necessary. Dr. Banks/Durickas will address this question in a more individualized way once she has examined your baby. For older children, adolescents, and adults, topical and local anesthetic are used for comfort during the procedure.
Q: Can I breastfeed my baby prior to the procedure?
A: Yes, you can, however if you are planning on having the surgery done in the same visit, we recommend you wait until after the procedure is completed to prevent regurgitation and possible aspiration of the milk by your baby.
Q: How long does the appointment usually last?
A: The examination alone may take 20-45 minutes including showing you the stretching exercises, giving you all the information about the procedure, and answering questions you may have. Usually the more informed you are prior to visiting our office, the shorter the appointment is but we encourage questions even if you think you know everything about tongue-tie and lip-tie laser revision. The procedure itself takes a small amount of time and we take your baby to you immediately once we are finished.
Q: Am I allowed to stay in the room with my baby while the procedure is being conducted?
A: Due to state laser guidelines and regulations, we have you wait in our special breastfeeding area or in the reception area during the procedure. In addition, Dr. Banks/Durickas prefers to focus fully on your baby so that we may finish the procedure quickly. We invite you to trust us and know we will take care of your baby. If the procedure takes a little bit longer than anticipated it usually means it is because we are being as careful as possible and properly removing the tie(s), especially when revising a baby that moves excessively and has very thick or deep ties.
Q: Will my baby bleed extensively on the area being revised?
A: Usually not. Since the laser cauterizes the arteries and veins of the area being revised and since there are no major arteries or veins within the tie (frenum), there usually is minimal or no bleeding observed. If there is, it is minimal and by the time we place your baby in your arms there is no longer any bleeding visible.
Q: What will happen if I do not conduct the post procedure exercises?
A: The risk of re-attachment is higher than if the exercises are conducted as instructed. Some individuals claim exercises don’t play a major role in re-attachment; however, well-respected doctors such as Dr. Kotlow and Dr. Ghaheri recommend them to increase the success of the revision. At Kitsap Kid’s Dentistry, we have seen how proper exercises have produced amazing results. At the one-week follow up visit, if Dr. Banks/Durickas suspects re-attachment has occurred already, she may mechanically separate or open the revision area which may set you back another week in healing time.
Q: Is my baby going to be in pain after the procedure? What can I use for pain management?
A: On the day of the procedure babies don’t usually experience discomfort. The discomfort usually sets in on day two and can last up to day five post-revision. However, every baby is unique and therefore every baby experiences the healing process and the level of discomfort differently. We recommend skin to skin contact with your baby, allow your baby to latch on you as much as possible whether for feeding or just for soothing/comfort. You can freeze some breast milk and place small shavings of it in your baby’s mouth and allow it to melt. You may also use natural coconut oil during the stretching exercises. Some parents report using rescue remedy, or arnica with success. In addition, based on your baby’s weight, you will have a calculated dose of infant’s Tylenol in your post-op instructions should your baby develop a mild fever or need it for pain management.
Q. What else can I expect post-revision?
A: Some babies may sleep more in the days following the revision and breastfeed less often, we suspect this is their way of dealing with the healing process. Some babies may have shorter and more frequent breastfeeding episodes. You may notice a great latch on the day of the revision and then not as great during the days following the revision due to soreness setting in and new oral musculature starting to be used post-revision when the tongue has more freedom to move. This is similar to training for a marathon with one leg having restrained musculature, if those muscles are freed you will not be able to run the same way until you re-train and strengthen those muscles that have now been freed. Many times the tongue needs time to adjust or even need re-training if it has been compensating for a while. Remember, sucking begins in-utero so even though your baby may be a newborn, he/she may still need time to adjust or he/she may need to have therapy to strengthen the oral musculature.
In addition, your baby may also cry during the stretching exercises and this is normal considering you are stretching tissue in an open wound. You may see minimal bleeding during the exercises but this is usually not a concern since it stops quickly, very few parents have reported bleeding. Increased drooling has been observed as a side effect of the surgery but it returns to normal as the wounds heal.
Q: Does my insurance cover the procedure?
A: We usually don’t find out until your claim is processed by your insurance company. Over time, we have learned that each plan is unique with different stipulations, deductibles, and coverage (certain insurance plans require (or highly recommend) a pre-authorization prior to the procedure). We highly recommend you contact your insurance plan and ask about coverage for the procedure. Keep in mind, we are a dental office and therefore we only bill claims to specific plans. Therefore, when contacting your insurance plan, have them look at dental codes coverage. We are NOT contracted with any medical plans including any HMOs and do not file any medical claims.
Please understand that we file dental claims as a courtesy. We are not responsible for how your insurance plan handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will cover in your dental claim. We cannot be responsible for any errors in filing your insurance as we file claims as a courtesy to you. We highly recommend you contact your insurance plan to check the status of a claim. Please remember any estimates in your treatment plan are just that, an estimate, and we will not know how much your insurance reimbursement is until your insurance plan processes your claim.
Q: Does my baby need to be ACTIVE on dental insurance for the procedure to be covered?
A: Yes. An insurance plan will usually not consider a claim for reimbursement if your baby is not active on the plan on the date of service. We are only contracted with specific Dental plans. Please see previous question.
Q: Does medical insurance cover the procedure?
A: We do not know. We are not in contract with any medical insurance plans including any HMOs. We encourage you to call your specific insurance plan to find out. Some dental insurances do not reimburse for an infant frenectomy, even if it is performed to aid in proper nutrition, grown, and development for the baby. The purpose of relieving the lip and/ or tongue tie is to allow for proper swallow or latch. In the case that your dental insurance does not cover the frenectomy, or if your plan does not have an allowance for the frenectomy procedure, you may wish to bill your medical insurance company. Our office will not be able to bill your medical insurance on your behalf, although we can provide you with some helpful guidelines. Please note that payment for your child's frenectomy procedure is due in full, based on your estimate, at the time of your child's appointment. Should you choose to bill your medical insurance company, they will reimburse you directly. Please feel free to discuss any financial considerations with our front desk team before treatment.
Q: Will you bill my medical insurance?
A: No. If your insurance approves and reimburses for all or part of the procedure, they should reimburse you directly. We do not have a contract or negotiated fees with any medical insurance and we do not receive any reimbursement from them.