My Child Has a Lip and Tongue Tie, Now What?

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Kevin: Good day, everyone.  Welcome to the latest edition of Ask the Experts, brought to you by Dental Success Today.  My name is Kevin Kowalke and I have the privilege to be able to tap into the brilliance and the wisdom of Dr. Saadia Mohammed as we explore the best ways of raising a healthy and happy child.  Dr. Saadia has been in private practice since 1998 with a fellowship at Yale New Haven Hospital.  Dr. Saadia is a board certified pediatric dentist, a member of the Academy of Breastfeeding Medicine, member of the American Academy of Pediatric Dentistry, member of the International Association of Tongue Tie Professionals, member of the Academy of Applied Myofunctional Sciences, member of the Academy of Laser Dentistry, and fellowship certified biolaser trainer and a certified myofunctional therapist.  All in all, Dr. Saadia is a renowned expert when it comes to nurturing a happy and healthy child.  Dr. Saadia, welcome to the call.

Saadia: Thank you so much, Kevin.  I’m excited about this phone call.

Kevin: Well, I’m glad you’re excited.  I am super excite and as you know, Dr. Saadia, this is a really big personal topic for myself because my wife and I are expecting our first child.  So, now I get to say to Julie, “Julie, look at all this amazing information that we get from one of our most favorite people.”  So, I personally appreciate you making the time to do this with us today.

Saadia: Absolutely and how is Julie doing?

Kevin:  She is doing amazing.  Thank you for asking.  We’re on the home stretch.  We’re at about 100 days to our due date and so we are so excited to welcome our baby girl to the world here pretty soon.

Saadia:  Excited for you.

Kevin: Thanks.  Today, I would love to spend time asking you about several topics that came from moms who have questions about their babies.  So, the first question I would love for you to begin answering is, what exactly is a frenum?

Saadia:  A frenum is a normal fold of tissue that holds the muscle to the mouth.  There are seven frenums in the mouth.  If you were to take your tongue and run it all around your mouth, you’ll feel one on the side of the cheek on the top, one in the middle on the top that’s usually the lip, then one on the other side, so the right and the left, which are called the buckles.  Then the lower buckles are in the mandible area, which is the lower jaw, and there’s one in the midline on the lower jaw and then there’s one under the tongue.  Most commonly people are just aware of the lip and tongue tie but there are actually seven frenums.

Kevin:  That’s really amazing.  As you were describing that, I was just sensing that in my own mouth and who would’ve known?  See, that’s why we have people like you who can make sure we know exactly what’s happening here.  So, I love that.  I love that you started off by explaining that.  The next question that is in line with this is, so how does a mom know if her baby is tongue tied?

Saadia:  So, usually it depends on what kind of symptoms is the mom having or the baby having?  When the mom is trying to nurse her baby and she’s having any kind of nipple pain and when she takes the breast out of the baby’s mouth, the nipple looks pinched or creased or bruised or it’s really painful for her to breastfeed, she thinks she has a low milk supply, she’s getting constant infections, she’s very frustrated, the baby’s slipping off the nipple, those are a lot of the signs that tongue ties have.  To actually examine the baby for a tongue tie, the mother can do it but it’s best done by a professional who knows what they’re doing.

Kevin: Yeah, that’s really great advice, Dr. Saadia.  I would like to think you would say you can never be too cautious, right?  So, if a mom even has a little bit of a concern, you’d suggest taking the time and going to see an expert, right?

Saadia: Absolutely. I did talk about the mother’s symptoms but the baby’s symptoms are really important too because sometimes mothers will come into my office and they’ll have no symptoms, but the baby’s having a whole list of symptoms.  The baby’s got a very poor latch, they’re clicking, they’re leaking milk down the side of their mouth, there is snoring of the baby.  Babies should not be snoring.  There’s inadequate weight gain or weight loss.  The baby’s very irritable, very colicy, very gassy.  Baby kind of falls asleep while nursing and he’s gradually sliding off the breast, chewing or biting on the nipple, choking or squeaking when feeding, spilling milk during feeds.  All of these signs are not normal and it’s not a matter of, “Oh, don’t worry, the baby will get it.”  None of those.  Breastfeeding should not be painful.  That’s one of the biggest myths out there.  “Oh, that’s normal.  You’ll get used to it.”  I can’t tell you how many times I’ve heard that.  Breastfeeding should not be painful.

Kevin:  Yeah, we’re definitely going to get to that in a second here because I would like to transition into something that you had mentioned, but I want to just be very clear to everybody who’s listening right now, that was a really great list of things to be aware of and to pay attention to which, let’s face it, we can’t be too proactive when it comes to our babies and especially when we want to raise a baby who’s very happy and very healthy.  So, thank you for sharing all that and so along with the topic of the tongue tie, how would a mom know her baby has a lip tie?  I know there’s obviously a difference there.

Saadia:  There is a difference.  The symptoms can be very very similar in a baby who’s nursing, but obviously a lip tie which is typically meaning a top lip tie, is when the lip can’t flange onto the breast and classically, the mother will have like a lipstick shaped nipple, a bruised nipple.  The baby will have a little blister on their upper lip.  Their mouth will be open during sleeping.  They’ll be snoring a little bit and it’s very very common that lip and tongue ties will go together.  They can be separate but, most of the time, a tongue tie will go with a lip tie.  Once in a while, the lip tie is more apparent.

Kevin:  Yeah and that’s great to know and thank you for clarifying that and also associating the two together so that mom can be really careful with everything that’s happening.  I would love to now transition into what you made mention of, which is breastfeeding here.  Obviously this is a very sensitive and often talked about topic.  I know many moms say it hurts to breastfeed.  Why is that exactly?

Saadia:  The correct way a baby should latch on should not be causing the mother any pain at all and it should not be causing the baby any distress.  It should be a nice flange.  The lips should be flanged onto the nipple and the baby’s tongue should gently massage the nipple so that it can release the milk.  What happens is when there is tethered oral tissue which is another name for lip or tongue ties or buckle ties, just a big name, tethered oral tissue, also short is known as TOTs, when there’s any TOTs, the baby will compensate and they will actually gum the breast versus actually kind of doing a very gradual suckling of the nipple.  Obviously that hurts.  That’s where typically the pain will come in.

Kevin:   Yeah, that’s interesting to say because I know, obviously I’m not a mom, but since we’re about to have a baby, Julie and I talk about a lot of things and we’re very open about all the things we talk about and she has brought up topics that her friends have talked to her about and those kind of things and many have talked about breastfeeding as far as that hurting.  So, it’s interesting for me to hear you say that that really shouldn’t be the case.  Now, there are a lot of people out there who have varying opinions on many different aspects of breastfeeding, as you’re well aware.  The internet has given anyone and everyone a voice, although obviously we must be very careful who we take that advice from.  I’d love for you as a true expert in the field of pediatric dentistry, does breastfeeding really cause cavities?  I know people have opinions on this all over the board.

Saadia: I’m so glad you asked that because that is one of the biggest myths that’s out there.  Pediatric dentists, we’re partially responsible for putting that myth out there.  It’s not the breastfeeding that causes cavities.  Breastfeeding is a very healthy and an excellent thing for the baby.  It’s when there are tethered oral tissues, meaning there’s a lip tie, a tongue tie, and the transference of milk is not being done correctly, because in a correct latch, the milk should be transferred to the back of the mouth and goes down there, but when there’s tethered oral tissue, the baby’s compensating and the milk is pooling around the teeth and very typically, it’s pooling around the upper front teeth and it will cause cavities because of the tethered oral tissue, also known as classically the lip tie.

Kevin: That is so interesting and thank you for clarifying that and for allowing people to really truly understand the cause rather than have it be something very general, because I know I've seen information on the internet and all over the place too and, of course, I come to you for my information on this and so it’s nice to have this solidified and for everybody else to hear it as well and Dr. Saadia, I have to tell you, this has been a great call as you’ve shared such valuable information already with our audience.  So, the last topic I would like for you to address if you would, what happens if a child’s oral tissue is left untreated once a mom knows that there might be an oral health issue taking place?

Saadia: So, I’m so glad you asked that, Kevin, because there are certain mothers who are just supermoms, as I call it, and no matter how much tethered oral tissue the baby has, they have persisted and they have breastfed that baby.  They’re just supermoms.  So, they get past that and we already spoke about the potential of cavities on the teeth.  That happens very commonly and that causes distress to a lot of parents, but a lot of the other things that don’t really get talked about and are fascinating is airway issues.  So, the tongue is supposed to serve to protect the airway.  When there is a tethered oral tissue or a tongue tie, depending on what kind of a tongue tie it is, it can actually fall back into the airway and cause snoring, cause sleep apnea in the child, and cause a lot of problems leading even into the baby not getting enough sleep or a child not getting enough sleep, not having the focus to wake up in the morning and be sleepy through the day, and these kids are typically not doing well in school and very commonly will get labeled with some kind of a disability, which is extremely distressing.  I've seen a number of these in my own practice and all you have to do is release that tongue tie, put them through some myofunctional therapy, and they are a different child.  It is amazing.  It’s very interesting though, now that our physician colleagues, sleep medicine colleagues, and ENT people are actually recognizing this and are actually vocalizing the fact that sleep apnea is related to tongue ties and the whole host of things it’s causing, things like diabetes, fatty liver, cardiac issues.  It sounds a little crazy, but if you think about it, if you don’t get a good night’s sleep, how many things in your body is it going to affect?  Imagine that going on for a lifetime pretty much and nobody talks about it.  You’re not sleeping well at night, everything else gets impacted.  Sleep is so critical.  So, airway issues are probably one of the biggest most impressive things that totally get ignored.  Speech issues obviously, very commonly affected.  You can’t move the tongue or the lip around adequately, you can’t enunciate certain things.  GI issues, well, you would think that, oh, why is the tongue causing GI issues?  Well, the fact is, the tongue is a very very important player in chewing.  A lot of children who have tongue ties will either have aversion to certain types of food because they just don’t want to eat it.  They’ll be very gaggy because they can’t chew properly and as the food goes down their throat, they’re like a big piece of food is going down the throat, so they’ll gag.  Mastication, which is chewing, that’s when the first step of digestion happens and it happens in the mouth.  If improper chewing is happening, the first step of digestion is not taking place, so consequently, will you have GI issues?  Absolutely, you’re going to have GI issues.  You’ll have reflux.  A lot of times, you’ll have a lot of air aphasia which means you’re swallowing a lot of air.  This is in babies especially, you’re swallowing a lot of air and it’s coming up as reflux.  As the kids get older, sometimes it’s actually reflux.  Of course, orthodontic problems, because the tongue, the lip, the cheeks, they should all be in the mutual position so that the teeth can come in correctly.  When one or two or all of those are in an imbalance, meaning there’s a tethered oral tissue in one area causing undue muscle forces, guess what?  The teeth are not going to come in right and increased risk of dental decay, of course.  Anytime there is tethered oral tissue, you have the potential for food to sit trapped over there.  A lot of kids with tongue ties or people with tongue ties are not normally going to move their tongue around when food is stuck up between their teeth and self-cleanse it and guess what?  They will get cavities.  Another big one, increased risk for SIDS or sudden infant death syndrome and airway issues, lots of babies who have tongue ties.  Especially these days, people say “Oh, the baby should be on their back.”  Well, the new information or the correct information is, children with tongue ties should actually have a lot more tummy time, so they can strengthen a lot of their upper neck muscles and not have the problem of airways.

Kevin: This is all just so fascinating and I’m certain that everybody on this call has picked up some little tidbit, if not a lot. [Laugh] So, I can’t thank you enough for sharing all this.  I actually have one additional question that just came to mind really after listening to all the information you’ve shared here.  In your opinion, Doctor, how soon should a mom take her baby to go see somebody like yourself who truly is an expert, who could really help and educate and put them on a good plan for the health of the baby?  What do you recommend from that standpoint?

Saadia: So, my honest recommendation is bring the baby as early as possible.  If you suspect that there is a lip or tongue tie, bring the baby in early.  When I get to see a baby fresh, newborn, couple of days old, they usually have the best outcomes.  As much as nobody wants to do anything to cause a new baby any pain, it is the best and easiest time and I've had plenty of mothers who the first baby, they waited because they didn’t know.  The second baby, they brought me in as soon as the baby was born and they will say, “Oh my goodness, what a difference.”  Yes, it can be done at any age and stage, but the body is always good about compensating and to undo all of that muscle memory of something which was a problem and how the body was compensating is so much better when there isn’t any kind of muscle memory.  Fresh baby, there’s no muscle memory.

Kevin: Right, that’s great and such a great public awareness message for all the moms out there to understand that it’s never too early to really start to think about all of these things and really give your baby the best shot at being healthy, which if the baby’s healthy, the baby’s going to be happy.  Let’s face it, that’s what we all want, some of that.  Dr. Saadia, excellent information today.  It’s always great to come together.  You’re one of my favorite individuals, you know that.  We’ve developed a really great relationship here and thank you so much for sharing such valuable information with everybody who’s listening in.  I can’t thank you enough.

Saadia: Thank you so much, Kevin.  This is one of the topics I am most passionate about because when I can help a baby really achieve their highest potential, that makes a world of difference and the ripple effect is huge.  If I help the baby, I help the mother, I help the father, I help the siblings.  That is just one of the most nearest and dearest things to me.  I am so passionate about this and I’m also very happy that we can get this out, like you said, as a public service message because I can’t tell you how many parents have come to me and said, “Why has no one told me this?”  So, please let’s get this out and people out there, if you have any questions, feel free to contact our office and find out more about this.  Let’s release all babies and let them achieve their highest potential because that’s what every single child deserves.

Kevin: That is such a great way to end a great call.  I’m 100% with you.  So, thank you for giving of your time.  I know how busy you are.  I know how valuable your time is and for sharing this message.  Let’s hope that this really gets out there more and more and more.  I know you have a very big passionate desire to be the person who is leading the charge on this.  We’re happy to help you, of course, to get this message out too, anything that we can do, and we’re so excited.  I want to thank everybody who’s taken the time to listen in on the latest edition of Ask the Experts brought to you by Dental Success Today.  Dr. Saadia would love to hear from anyone who has a thought or question on today’s subject.  You can hear, the passion is in her voice.  She lives for this or really anything else related to raising a happy and healthy child.  So, the best place to go find out more information and follow the great work of Dr. Saadia is really on her practice Facebook page which is, when you’re on Facebook, it’s  You’ll definitely find her information and all the wonderful things that they post there.  You can also submit questions, if you have a very specific question that might be a little bit lengthy, to contact@, and if you’re really excited after hearing all this information and saying, “This is right for me”, I would say just call Dr. Saadia’s office and schedule an appointment right away.  You can call (561) 477-3535.  Dr. Saadia, did I get all that correct?

Saadia: You got it 100% correct.  Thank you so much, Kevin.  You are amazing.

Kevin: You’re welcome.  Thank you and you’re amazing too and I am so excited to get the feedback and the response from all this great information and now we have this recorded so that we can now share this with anybody who ever brings up this question, I can say, “Listen, you’ve got to listen to Dr. Saadia because she’s a renowned expert on this and you won’t believe the information she shared.”  So again, thank you so much for that.  Thank you for your time and until next time everybody that we’re together…[Audio ends.]

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