Frequently Asked Questions about Tongue Ties & Frenectomies

Though the release of a RTOT is almost always smooth, there are always associated risks that cannot be eliminated and may occur in a small number of cases. These complications include but are not limited to post-surgical bleeding, infection, swelling, pain, damage to adjacent structures such as salivary glands, nerve, muscle, and skin. Such complications may require care from an additional healthcare provider such as an oral surgeon. A common complication is re-attachment of the frenum. Genetics also plays a strong role in healing, such as the formation of a scar, keloid, or overt fibrous tissue formation.

Many kids with restricted tethered oral tissues “survive” but we want your child to Thrive! Yes, some children adapt, but they often have long term problems that you would never know were associated with a restricted tethered oral tissue. These may include sleep disorders, ADHD, sleep apnea, head and neck tension, eating problems, speech difficulty, frustration with communication, difficulty focusing, to name a few. Releasing a tie as an infant can have immediate alleviation of feeding symptoms but can prevent a number of other issues as your child grows.

For infants, Dr. Lentfer applies topical gel to numb the tissues before the procedure. For older children, nitrous oxide is often employed along with topical gel and local anesthetic as indicated for age. Once proper anesthetic is administered, Dr. Lentfer uses her state-of-the-art CO2 Solea laser to release the restricted tissues.

For children who are over 18 months and uncooperative to a point where it is unsafe to complete the release in office, or the parents want their child to be asleep for the frenectomy, Dr. Lentfer offers general anesthesia for release of a restricted tethered oral tissue. Dr. Lentfer can provide in office anesthesia, surgery center, or treatment at River Bend Hospital

Though coagulation occurs quickly, some bleeding often is present when the lingual release is performed. Teenagers and older can often tolerate suture placement, as indicated, but for younger children and infants, sutures are not needed. Though Dr. Lentfer allows one parent in the treatment room if desired, it is not recommended the mother be present when infants are having the procedure completed as this can induce stress for the mother and inhibit ability for milk to let down if attempting to nurse after the procedure.

The most important part of the healing process is the team involved. Lacatation consultants, Cranio-Sacral therapists, occupational therapists and speech therapists are key in your child’s success. Dr. Lentfer will discuss your team members before the procedure and make sure you have the proper support for your child to have a successful healing process. In addition, stretching post op is very important. Dr. Lentfer will review stretches with you and show you a video (available here) at your consultation visit to make sure you are prepared for post op care. This is not a pain free procedure.

Though laser technology has made this less painful with faster healing, expect your child to have some discomfort for a few days to a few weeks. DO NOT expect an instant fix to your child’s problems associated with their RTOT. This is a process. Dr. Lentfer is the mechanic, she can get the car started, but your team members and parents will help your child learn how to drive the car.

Dr. Lentfer encourages waiting until 1 week old before the procedure but has performed them on children as young as four days old. The procedure can be performed at any age, it just depends on their symptoms and needs.

Dr. Lentfer requires a referral for every frenectomy she performs. This is key in making sure your support team is established. Once we receive the referral, we will get you scheduled for a consultation.  If the procedure is indicated, we will then schedule you for treatment at another date. We recommend infants not feed for 90 minutes prior to treatment to prevent spit up and also keep the infant hungry to encourage nursing post procedure. Not all babies want to nurse after the procedure is completed, as it is a stressful thing for such a small human, but by leaving them hungry, this will increase the chance they may try to latch. After the procedure, stretches are key as well as following up with your support team. Dr. Lentfer will see you ten days post-operative as well to make sure tissues are healing well. For older children, there is no specific pre-operative instruction but post-operatively, stretches as well as following you with team members still holds true.

There are a number of reasons to release a RTOT. The first sign of a RTOT is often problems with nursing. Research is showing almost 1 in 4 infants have some form of lingual restriction. Does this mean 1 in 4 infants need a release? No. But if your infant is struggling to nurse, please go thru our infant assessment form and see what symptoms your baby and you have as these may be indicative of a restricted tethered oral tissue.

In addition to nursing problems, a restricted lingual frenum can be associated with a number of other functions such as dental development and growth, eating, speech, and airway restriction which can be associated with sleep disorders which is of course associated with a number of problems.