In the field of pediatric dentistry, a significant number of myths and misconceptions about tongue ties persist, affecting the understanding and decisions of parents and caregivers. Dr. Fatina Shtivelman, a board-certified pediatric dentist with extensive experience and a personal connection to the subject, offers insights into these common fallacies. Here, Dr. Shtivelman debunks the widespread myths surrounding tongue ties, utilizing her comprehensive knowledge and expertise. It explores the critical importance of accurate diagnosis and timely treatment of tongue ties, emphasizing their role in successful breastfeeding, speech development, and overall orofacial health.
Dishing out this gem of information, the mission is to arm parents with the superpowers of knowledge, enabling them to leap to informed decisions in a single bound and to champion the cause of early intervention and robust support for the little ones grappling with tongue ties.
What are some of the most common misconceptions or myths surrounding tongue ties in your practice?
As a board-certified pediatric dentist, the education I received in school and residency about lip and tongue ties was all of five minutes from one lecture. I initially became passionate about learning and helping mothers struggling with breastfeeding because of my experience. My son Julian was born with a lip and tongue tie. I was having a hard time emotionally and physically trying to feed him. I was determined to breastfeed him because of what I felt would benefit him. Julian was born with a significant anterior tongue tie with limited tongue movement. He latched at the hospital, and the lactation consultant explained that I needed to continue working on it at home. Once I came home, I was still very uncomfortable with bleeding nipples and a baby who was constantly crying. It was extremely draining on me. Nursing him would take over an hour each time. I said to myself, “This cannot be normal.” I spoke with friends and worked with a second lactation consultant. She recommended a nipple shield which helped to reduce my pain, but feeding time still took forever, and I was still experiencing discomfort. I knew I had to seek more help because I couldn’t continue doing this daily.
I didn’t understand the difference between a shallow and deep latch at that time. The importance of lip and tongue mobility helps many things, including the ability to latch easier, milk expression, painless and efficient nursing, decreased stress for mom, and decreased frustration for the baby. When I decided to have the lip and tongue tie procedure done, it was like night to day. Many of my questions were answered, and my insecurities went away as we were both thriving and much improved. The third lactation consultant we worked with, Andrea Syms-Brown, helped us immensely.
The biggest misconception is that “the baby will grow out of it.” This is counterintuitive since proper lip and tongue movement is important for nursing, feeding, speech, and orofacial development. With the proper consultation, education, and early diagnosis, the answers to many of these issues can be solved, and many new mothers will have an easier time. Many times, even though a baby can nurse, lip and tongue movement restrictions can interfere with feeding. Babies become agitated quickly because they cannot use their tongue to lift and swallow. If the tongue does not go into the proper position during feeding, they are more likely to develop jaw and airway issues, including snoring and grinding. Speech-related issues may occur, too, if the tongue is restricted from being in the correct position causing improper articulation, lisps, or speech delays. Knowing what I know now, I believe all babies should be evaluated for lip/tongue ties to allow proper development and be able to thrive during these years of life.
How does a tongue tie affect breastfeeding, and what are some misunderstandings parents may have about this issue?
A tongue tie affects breastfeeding because the tongue has restricted movement. This restricted movement does not allow the baby to latch properly. A shallow latch is more painful for the mother and leads to an inefficient milk transfer. As a woman, I have a very high physical pain tolerance, but this was something I never experienced. Between the bleeding nipples and my son “gumming” because of his frustration, it hurt so much that I felt like I was seeing stars. As a mother, you want to do what’s best for the baby, so you close your eyes, take deep breaths and keep going.
Many people think the tongue tie will go away. Dr. Baxter, who has written a book and course on tongue ties, said it best:” A restricted tongue is like trying to run with your feet tied together.”How can you be fast, efficient, and keep up with someone when your feet are tied together? You can’t!!
There’s often debate about whether tongue ties require treatment. Could you clarify when intervention is necessary and when it might be optional?
There is a lot of debate about this topic, but I have seen firsthand the benefits of early diagnosis, education and making the necessary referral to address the issue. If a baby is born with webbed fingers, the doctor immediately makes a referral because you can see it, and an evaluation is performed to fix the issue. Since lip and tongue ties are in the mouth and are not always as obvious initially, the intervention tends to happen only when an issue arises. If there is difficulty breastfeeding due to latch issues, speech concerns, difficulty brushing, or tooth decay, a consultation is necessary to review the options and tongue and lip release done to alleviate these problems. Function is the key, and if the restrictions do not allow proper function, a release is recommended. If there are no significant functional issues, the baby can latch, is gaining weight, the mom is not experiencing discomfort, and the function is normal, I often monitor and reevaluate if needed.
Some people believe that tongue ties only affect infants and breastfeeding. Could you discuss other potential impacts of untreated tongue ties across different age groups?
Mothers also seek us out when starting their babies on solids. With little ones, picky eating, gagging, and a preference for only softer foods are the main reasons mothers bring their children in for a consultation. Tongue/lip restrictions also do not allow for proper oral-facial development and strengthening of the oral muscles, which is needed for speech and language development.
Toddlers and young children come in mostly because of speech delays and articulation concerns. As I mentioned earlier, Julian had a significant tongue tie, and his first lip/tongue procedure significantly helped with his nursing. However, he also had speech delay and articulation concerns, and the fluidity of his speech was an issue. This led to a lot of behavioral issues since people couldn’t understand what he was saying. If people can’t understand a child, many times, a child will start hitting, biting, or pushing to communicate and meet their needs. This is extremely concerning as a parent, and I now understand how important it is for a child to communicate and allow them to continue to flourish and grow.
Speech difficulties can affect school-aged children and teenagers socially and academically. Many children are perceived as quiet or sometimes more withdrawn, creating self-esteem issues due to their lack of ability to communicate effectively.
Are there any alternative treatments or therapies you commonly recommend or encounter for tongue ties, and what misconceptions might surround these alternatives?
Absolutely!! I think it’s important to note that a team approach is the best approach!! Creating a team with lactation consultants and speech therapists is best. Working with a lactation consultant will help to develop the proper latch after the release to minimize the discomfort for the mother and make breastfeeding a rewarding experience. Working with feeding and speech therapists is also key for proper follow-up care for feeding, speech, and language development. Having a myofunctional therapist on your team can be beneficial as well. They help ensure the correct stretches and exercises are being done to improve muscle function and coordination of oral muscles while also minimizing scar tissue that can occur. Craniosacral therapists can perform massages to help to alleviate tension in the baby. When the nervous system is relaxed, you can perform tasks more naturally and easily.
