For families that have been blessed with babies in the past few years, they may have heard some discussion regarding infants and the ill-effects of tongue and lip ties on feeding, speech and the development of the teeth and face. Of late, there has been an alarming surge in practitioners recommending surgical releases. As a mother and an orthodontist, I have been very concerned by what I have read and heard about what has always been a controversial topic.

Newborns can be challenging and difficulties can arise with feeding, sleeping or from general restlessness. Vulnerable new parents will naturally seek help and information. In difficult and desperate times, a ‘quick fix’ treatment can be very appealing. Social media sites are often used to advertise and promote clinical procedures.

What are tongue and lip ties? And are they a problem?

Tongue and lip ties are known as lingual and labial frenums respectively. They are a normal part of the oral anatomy and can vary widely in appearance for infants. Confusion often arises, as it isn’t always made clear that it is actually normal to have a tie. That is, infants are meant to have them! In a small percentage of babies with severe feeding issues, an abnormal tie may be diagnosed and surgical intervention may be helpful.

What is a frenotomy? 

A frenotomy involves cutting the infant’s or child’s tongue tie or frenum using scissors or a laser. Parents are often recommended to regularly tear the infant’s healing wounds by sweeping the area with fingers to encourage a certain type of healing.

Why are concerns being raised now? 

Due to the large increase in frenotomies being provided or recommended by dentists, the Australian Dental Association (ADA) has published recent articles at both the State and Federal level. Dr Gary Smith (ADA Queensland president) provided a warning to dentists. He considers the use of social media by dentists to advocate this procedure as professionally inappropriate because it carries the risk of ‘exploitation of children’ during a time of vulnerability.

Last month’s ADA federal publication featured an article by Dr Patrishia Bordbar (Oral and Maxillofacial Surgeon), a true expert on this topic. She stated that there is “no consistent scientific evidence” that the release of tongue and lip ties improves breastfeeding and facial development. Despite this lack of evidence, the number of frenotomies performed by dentists are on the sharp increase. She is also concerned regarding the misinformation disseminated on this topic, often coming from commercial websites with a vested financial interest. This misinformation has led to the suggestion that these normal anatomical structures should be routinely managed surgically.

Frenotomy risks

As with any surgery, frenotomies are also associated with significant risks and unintended consequences to infants such as:

• Bleeding

• Infection 

• Damage to nearby salivary ducts

• Dehydration (due to refusal of oral feeding)

What is our opinion?

We all have children of our own and our work involves caring for children of all ages. We strongly believe that good quality evidence in medicine and dentistry is vitally important and should be respected. Therefore, we must express our concern regarding the recent rise in recommendations for surgical frenotomies. If in doubt, please seek advice from your medical GP or paediatrician. All health professionals have a responsibility to the public to provide balanced and accurate information regarding any procedure (ie risks, costs and benefits). Such discussions are even more important when dealing with our most vulnerable – infants and their parents.