The release of a tongue or lip tie has been performed for years by various medical specialists or dentists. Often it concerns older children or adults with a functional limitation that requires surgical intervention. When drinking for babies or young children was difficult, formula was often used in the past. Nowadays people diagnose and treat rather at an early stage when there are (functional) problems. So it’s not so much a hype or trend, but has to do with early diagnostics. When functional problems are present, it is better to be treated at a young age than at an older age.

Depending on the size and spread over the jaws, there are two options:

Pearl of Epstein:

These are small thickened inclusion cysts on the palate, but can also occur on the gums or palate. Usually seen as multiple, white, rice grain large elevations in the vestibular (lying against the cheek) mucous membrane of the upper jaw (alveolaris processus). They are small cavities filled with fluid, (cystic nodule) covered by a thin epithelium (layer of skin) and filled with keratin (a type of protein).

The Epstein pearls are completely harmless, do not hurt, do not need to be treated and disappear spontaneously. Treatment is therefore not necessary.

“Bohn’s” nodules (hard bumps):

These are white-like bumps spread over the entire upper and / or lower jaw (see photos). The exact aetiology is unknown, but it is suspected that they arise as a remnant of the dental lamina or of heterotrophic salivary glands. They can be present over the entire lower or upper jaw or on the palate (palate). These hard bumps are benign and disappear over time. Treatment is therefore not necessary.

Pain and discomfort, see this FAQ.

Temporarily more throwing up because the baby drinks more effectively, the stomach may not yet have been used to the new amount so quickly.

There may be some swallowed blood after the treatment. That doesn’t do any harm. A little green / black solidified blood  can be in the diaper.

More saliva.

Temporarily bad smell from the mouth. This is because the ties are removed and scalded at the same time.

Temporarily more difficult to latch on, more painful latching on, refusal of breast or bottle, also look at the FAQ about remedying compensation behaviour.

Suction blisters can stay for a while, your child is used to drinking in a compensatory way and it can take some time before it is gone. It does no harm.

Your baby can be very grumpy the first 24-48 hours. Also read the frequently asked question(link) about it.

Fever; in fever, the body temperature is 38 degrees or higher. It is very unlikely that this is due to the treatment, rather though another infection. It is important that your child is not drowsy and continues to drink well. If refusing milk give milk from a bottle or with syringe.

For children under 3 months with a fever you should always warn your doctor.

Here we added some links from colleagues who made the effort of recording and sharing aftercare! Watch them several times, you also see how you massage the jaw muscles and cheeks. Help your child to relax more and stop compensating behaviour.

The older baby resists more, so try to do it as playfull as you can. An older baby also had to compensate for much longer with other muscles to be able to drink, therapy to let go of the compensation behaviour is often needed. In addition, guidance from a lactation consultant IBCLC or a speech therapist is recommended to improve feeding.

Lactation consultant IBCLC, Melissa Cole. This video , and this video to.

Older baby video Lactation consultant IBCLC Jennifer Tow.

When the oral and facial muscles are out of balance and/ or there is an incorrect swallowing pattern, you may have one or more of the following symptoms:

– mouth breathing;

– incorrect position of teeth, molars or jaws;

– in case that, after orthodontic or jaw-correcting treatments, the “corrected” deviation comes back (in part);

– thumb sucking, finger sucking, pacifier sucking habits which are difficult to be stopped;

– A clear problem with dental prosthesis not staying in place in the adult client, while it was perfectly manufactured;

– if there is “weak” lip tension;

– if there is a narrow and high palate;

– in the event of speech difficulties, such as lisping or hissing;

– in the event of difficulties in swallowing or eating;

– if there is an incorrect tongue position at rest (eg low tongue position at rest);

– TMJ complaints.

– Sucking habits: Sucking thumb or finger too often or too intensive (also in older children or adults). Tongue and lip sucking.  Sucking on a pacifier too long or too intensive or a bottle teat are also abnormal sucking habits. It is generally known that abnormal sucking behaviors leads to an abnormal position of teeth and / or jaws.

– Little chewing, babies get their food pureed and modern food is often processed and soft.

– Mouth breathing: The function of the nose consists, among other things, of moistening, heating and cleaning the inhaled air. With mouth breathing, this beneficial property is canceled. The consequences are often recurrent throat infections, tonsils or even middle ear infections. We often see with mouth breathing that as a result of the loss of pressure from the lips on the teeth, the front teeth stand up. There is also a narrow palate and drool to a greater or lesser extent. When mouth breathing one hyperventilates which results in less oxigen reaching the organs like the brains.

– Biting habits, eg finger, nail or lip biting; or clamping, grinding and the like. This can have a harmful effect on the jaw joint, causing muscles to be overloaded. Other muscle groups in the mouth may also be adversely affected.

– Deviant swallowing behavior: Deviant swallowing behavior is usually accompanied by tongue pressing, forward and/or to the side. The abnormal position of the tongue has major consequences for chewing food, forming a  bolus and swallowing. Finally, it has implications for speech. A different swallowing pattern almost always has consequences for the position of the teeth and the shape of the jaw.

– The age can vary. There are different opinions. Some say at 5 years, others at 8 years.

This primarily depends on the client’s motivation. One child can be made more aware of wrong habits than the other and can be treated sooner than the other.

–  The motivation. Long-term habits must be changed and new learned, which must then be incorporated into “normal” life. This requires enormous effort from both the client and the parents.

– The severity of the dental defect. The shape of teeth and jaws can be so different that nasal breathing is not possible. An inaccessible nose or, for example, seriously enlarged tonsils can also make nasal breathing impossible. Moreover, wrong mouth habits can only aggravate the deviation. It is clear that there must be good cooperation between doctor, dentist, myofunctional therapist and orthodontist or ENT doctor in these cases.

– The severity of the speech-language disorder. The extent to which the deviant mouth behavior influences normal eating, drinking and speech will also be a factor in determining when myofunctional therapy should be started

• Signs of restricted mobility of the muscles of the tongue and the upper lip:

Due to the tie the tongue can only move the front and sides a bit. The tongue cannot go up and back properly, difficulty latching on, drawing in the nipple deep. While very often at the same time the upper lip cannot flange out over the breast, because the tie pulls it inward. So the baby slides off easily. Resulting in small latch, letting go of nipple. Latching on and drinking difficult or only works with a nipple shield or bottle. Falling asleep at the breast or bottle, frustrated, doesn’t seem to want to drink, doesn’t empty the bottle.

• Signs of compensating due to restricted mobility of the tongue and lip tie:

Tries to hold on to the breast by clenching jaws together. Uses cheek muscles to draw milk. Mother experiencing pain especially at latching on. But not always painful, also just sucking really “hard” or “strong”. Chin quivers from jaw muscles tension. Sucking blisters on lips from friction. This compensating is weary for the baby and especially in compromised growth or premature babies it’s a shame it costs energy. Sometimes babies are called lazy drinkers.

Nipple should come out round, but comes out flattened, with blisters, discoloured and sore. “Raynaud” like symptoms from diminished blood flow to nipple.

• Signs of compromised ability to get sufficient milk:

Due to the baby’s restricted mobility, only suckles at the nipple and hardly at any breast tissue. There is too little milktransfer as a result. The baby draws in the nipple as if sucking in spaghetti, hangs on nipple like a “cliffhanger”, often pulling and moving the head in an attempt to pull out the milk, sometimes using hands to pull the breast in older baby’s, drinking suddenly painful when teeth come.

Baby doesn’t “empty” the breast (or bottle), drinks often to get enough milk. Plugged ducts, overproduction from drinking often, compromised production in the end.

Baby loses weight more than 7% in the first days, getting back to birth weight takes more than 10 days. Growth stagnates after weeks or months when production decreases. Babies don’t always show; they save energy by sleeping long for example. A sign could be very few poop diapers.

Baby only drinks the “easy” milk, during the milk ejection reflex.  Drinks short or very long. Only making the chin tug and drinking when MER or giving breast compression or supplementing at the breast.

• Signs of compromised possibility of making a good seal:

Due to the low tongue position, often high palate and the upper lip not flanging out completely over the nipple, bottle or breast, your baby cannot make a good seal and loses suction, you can hear clicking sounds. Also very loud drinking, gulping it down and choking. Complaints of swallowing air.
The swallowed air needs to go somewhere; it goes up or down. Burping, hiccough, spitting, windy, colic.  GER or reflux with or without spitting (hidden reflux). In hidden reflux the baby tries to keep the milk down by swallowing again, sometimes forgetting to breath momentarily. During feeding it can be very uncomfortable for the baby and can become restless.  It’s difficult to put the baby down to sleep. Parents walk with their baby until symptoms subside. The baby can experience pain from the stomach acid in the oesophagus. GERD. Sometimes medication is given which lowers stomach acid.

Thrush is often confused with tongue tie problems. Although you can see it both at the same time. The tongue may have debris in the papilla (from day of birth) due to the fact that the tongue hardly touches the palate so it doesn’t “rub clean”. Pinching and stabbing pain can be from thrush or compensating behaviour from tongue and lip tie. In tongue tie you can see white debris on the posterior part of the tongue behind the tongue tie, the front of the tongue rubs clean against the inside of the upper maxilla. Thrush is a “pearl white” shine or white plaques on the inside of the lips and on the mucous membranes of the inside of the mouth.

*Note that not all symptoms have to be present at the same time.

No fever is expected as a result of the treatment. A wound infection or inflammation either. Fever is a body temperature above 38 degrees Celsius. In the event of a fever in babies under 3 months of age, you should consult your doctor. It is possible that your baby has a virus or other infection. In case of muscle ache or discomfort after the treatment you can give acetaminophen.

After the release, you may notice things that may last a little longer, such as lip swelling, drooling, gagging, or other discomfort or peculiarities.

* Granulation tissue; This is a small lump of extra scar tissue that can form on the wound. If you suspect you see this, send a photo, it is not serious and if it is a hindrance to drinking it can still be removed.

* Drooling; Because the swallow has to be learned again after tongue tie release, it is possible to notice drooling for a while in a child or baby.

* Reattachment; After the treatment, the wound simply wants to heal with scar tissue.  With doing aftercare you hope the wound does not close too quickly or too tightly. If too much reattachment occurs, the tongue or lip mobility can be limited again. When you live abroad it is the adviceble to check the healing with somebody knowledgable in a week, that can also be done at our clinic if you can stay a few days, but has to be arranged with making the appointment for treatment. In The Netherlands you can call the Tongue Tie Clinic for an appointment.

* Muscle pain; After the treatment the adults and older children notice (muscle) pain or discomfort in the jaws, tongue and throat sometimes as well. See the FAQ about pain relief.

* Baby spits more; Because the baby drinks more effectively, it may be that the stomach is not used to the amounts and it spits back up, but it may also be that the baby is still drinking air for a while.

* Smelly breath / mouth; We sometimes hear this from parents and can last from a few days to a week, it’s ussualy no problem whatsoever.

* Swollen upper lip; This can last for up to 5 days after lipband treatment.

*  Quivering jaws remain visible longer; Because the tongue, after it has come loose, many of the muscles still need to be trained, it may be that the compensation continues with the jaw muscles, but compensation behavior may also need a chiropractor or manual therapist to remedy it. See the FAQ about compensation behavior and videos explaining this.

* You have to help lips flange out; The baby is not used to flanging the lip, this may be helped.

* Suction blisters still present; They can be present for longer, especially on the upper lip.

* Crying doing aftercare; What we hear from parents and notice at the aftercare consultation that the baby cries with the aftercare exercises, but stops as soon as you stop or start feeding or changing diaper and such.

* White plaques/debris on tongue still visible; Because the palate is often high and the tongue is not well trained to stay up, even at rest, the white plaques/ debris on the taste buds remains.

* Bottleteat; We notice that the teats with a broad base cannot go deeper into the mouth, so a teat that can go deeper and gives more mouthfilling, such as the smaller, narrower types, is often better.

* Baby stays upset longer than 48 hours, crying, drinking worse. In the older baby who has had to compensate for a long time with a tongue tie. Before the treatment, often these babies were fussy and drinking poorly and found there own “technique”. Treatment of compensation behavior is often necessary. See FAQ compensation behavior. People often give painkillers for longer. But one also has to take into account a normal virus infection occurs at the same time. You can go to the doctor with a fever, see the FAQ about fever.

* Gagging may still be present after the release.

* A baby cannot swallow the tongue after the release.

* Apnea are also observed in babies . It is not directly related to the release. Tongue tie can be related, read the research.

At the Tongue Tie Clinic we regurarly get the question why a child (still) drools after the treatment. Or that baby has little bubbles of saliva on the lips.
About 2000 times we swallow on reflex day and night. To be able to swallow saliva properly, a fully mobile tongue is required. With a tight tongue tie, the tongue cannot move up and back properly and swallow food, drink and saliva in a wave motion towards the esophagus. When the tongue becomes more mobile due to the treatment, a tongue has in fact never been able to make this movement (completely) and it still has to be learned. In a baby up to about 3 months everything goes on reflex but it can still take weeks to months to learn to swallow properly. After 3 months, a baby or child has already found its own way to swallow food and drink. It therefore takes some time before the tongue has learned a good / new swallow and drooling can occur or become worse. The brain has to also learn to control these movements. Oromyofunctional therapy OMFT can help the older child besides speech therapy. See the FAQs about OMFT. In addition, it is important that a child closes their mouth properly and breathes through the nose, and that they can close their lips properly. Parents can close their mouth when they see that their baby or child has an open mouth position by gently moving their chin up when he or she is sleeping or playing, for example. It is important that a pacifier is only used for comfort and falling asleep because when using a pacifier, the tongue is prevented from (learning to) properly swallow upwards and backwards towards the throat.

In older babies, children and adults with a tongue tie, compensatory oral habits may be present. During pregnancy, a baby swallows amniotic fluid with a tongue tie, which means that hiccups may already be present. An older child and adults have exhibited compensatory behaviors for years as surrounding muscles and tissues compensate for the limited functional movement of the tongue. Think of moving food in the mouth from side to side, swallowing well without choking, wiping your teeth after eating and talking. Often the patient swallows with his tongue forward instead up and back, which is called a tongue thrust. This can affect the position of the teeth, jaws and the overall body posture.

The preparation for a treatment is therefore twofold:

1. Compensatory movements in the head and neck region can be quite “stuck” and therefore better checked and treated by a special therapist before a tongue tie release. We hear from patients that they have this done by a physiotherapist, manual therapist, orofacial therapist, chiropractor or osteopath for complaints such as incorrect posture, stiff neck, jaw clenching, grinding and headaches. Treating a tongue tie alone is not sufficient if the surrounding muscles keep the compensating behaviour and restrict functional movements.

2. Treatment also improves if the patient goes to a specialized speech therapist in OMT (oromyofunctional therapy) before and after the treatment. This can help to analyze incorrect oral habits and swallowing and train or unlearn these. If an OMT speech therapist is not available, the Kieferfreund app is an option to train and practice (see www.kieferfreund.com and https://www.tonguetieclinic.com/tongue-tie-therapy/https://www.tonguetieclinic.com/tongue-tie-therapy/)

It is best to keep a minimum of 2 weeks between vaccinations and a possible release at the Tongue Tie Clinic.
Sometimes babies get a fever due to the reaction to the vaccination and sometimes they have muscle pain in and around the tongue after the surgery.
This is why it is not a nice combination for the baby.

Below are several videos about oral motor exercises.

Suction training before treatment.

Short oral motor exercises before treatment. This helps the baby to switch to a better drinking technique more quickly afterwards.

Oral motor exercises for older baby.

Important oral motor exercises. This baby shows that she doesn’t want mouth training for a while, but wants to be helped with cramps!

Weak sucking with teat training.

Oral motor exercises for gagging and high palate.

Respect signs that baby doesn’t want to exercise.

Stretch and relax tense lips.

Oral motor exercises, extra exercises to help relax tense jaw and cheek muscles.