Lip Ties

In the world of parenting, we constantly seek the best for our children. When it comes to their health, it’s natural to be attentive and concerned. However, recent debates surrounding lip ties have left many parents perplexed and frustrated. Different medical providers seem to hold differing opinions. Are we dealing with a genuine medical issue or an unnecessary frenzy? In this article, we will delve into the research and clinical consensus to empower you with knowledge to make informed decisions for your little ones.

What is a Lip Tie? 

The superior labial frenum is a fold of connective tissue that attaches the upper lip to the front surface of the upper gum. When the frenum is overly tight or thick, this can potentially hinder the mobility of the upper lip. 

Commonly Mentioned Signs and Symptoms of Lip Tie 

1. Difficulty latching onto the breast or bottle nipple.
2. Poor weight gain or slow growth.
3. Irritability or fussiness during feeding.
4. Clicking sounds while feeding.
5. Excessive gas or colic-like symptoms.
6. Increased cavity risk due to poor oral hygiene around upper front teeth.
7. Maxillary diastema (gap between upper central incisors). 

Frenotomy/Frenectomy: Is Lip Tie Release the Solution? 

Surgical or laser removal of the frenum is the standard procedure performed to release tongue and lip ties. This procedure’s prevalence has seen a tenfold increase from 1997 to 2012 and gained even more popularity since. This surgery is primarily justified as a means to enhance and facilitate breastfeeding; however, there is little evidence linking specific appearances of the labial frenum to successful latching or feeding. Additionally, our understanding of what is considered “normal” or “abnormal” regarding upper lip tie is limited.

Lip Tie: What is Considered Normal? 

In 2017, researchers from Stanford University concluded that all newborns have some degree of maxillary frenum attachment. In fact, the study found that a majority (83%) of infants exhibited significant upper lip ties without any signs and symptoms. On the other hand, newborns with a short and thin frenum above the mucogingival junction (indicating no upper lip tie) accounted for only 6% of infants. ¹ Furthermore, another study published in the International Journal of Pediatric Dentistry revealed that upper lip ties naturally become less prominent with age (with or without lip tie releases). Younger children naturally have more pronounced lip ties (attaching to the gingival margin or worse) compared to older children (attaching to or above the mucogingival junction). ² This idea is further supported by Townsend et al.’s finding that as baby teeth erupt, the height of the maxillary alveolar structure increases and the upper lip tie attachment naturally moves higher up on the alveolar crest.³  

Below are pictures of my own son taken at 8 months and 20 months, respectively. Notice that at 8 months, the frenum was attached all the way down to the gingival margin (even extending through the papilla to the palate). By 20 months, the attachment had risen halfway up the gingival ridge without any intervention.

What Can Experts Agree on About Lip Tie? 

In 2020, medical experts appointed by the American Society of Pediatric Otolaryngology worked to establish Clinical Consensus Statements (CCS) on tongue and lip ties, a first of its kind. The following statements reached a consensus regarding lip ties: ⁴

• It is normal for an infant to have an upper lip frenum. 
• Upper lip tie is an inconsistently defined condition. 
• The relationship between upper lip tie and breastfeeding difficulties is unclear. 
• In some communities, upper lip tie is being over-diagnosed. 
• Upper lip tie release in children with baby teeth will not prevent a diastema (gap between upper central incisors). 

Factors Contributing to Overdiagnosis of Lip Tie

In recent years, there has been a rising concern about the overdiagnosis of lip tie. It is essential to explore the factors contributing to this phenomenon.

• Parental Pressure and Online Information
  • One significant factor behind the overdiagnosis of lip tie is the influence of parental pressure and readily available online information. Parents often turn to the internet to seek answers when faced with feeding and speech difficulties. However, the abundance of misinformation available can be overwhelming and may lead to incorrect self-diagnosis, potentially exaggerating the prevalence of lip tie.
• Lack of Standardized Diagnostic Criteria
  • Another challenge is the lack of standardized criteria for diagnosing lip ties. Different healthcare professionals may have varying opinions on the severity of the condition and when intervention is necessary. This subjectivity can contribute to discrepancies in diagnosis and potential overdiagnosis.
• Profit Motives in the Healthcare System
  • In some cases, profit motives within the healthcare system can influence the overdiagnosis of lip tie. Laser companies often market frenotomy (the procedure to release lip ties) to dentists as a lucrative and straightforward procedure to increase revenue. This financial incentive can lead to unnecessary procedures being performed. Additionally, many self-proclaimed experts advocating for tongue and lip tie releases are also Key Opinion Leaders (KOL) who often receive financial benefits from laser companies and own tongue and lip tie release centers, creating a financial conflict of interest.

Exploring Alternatives 

While some infants genuinely benefit from intervention for lip tie, it is crucial to explore alternative approaches before opting for surgical procedures. Here are a few alternatives to consider:

• Lactation Support and Techniques
  • Working with a certified lactation consultant can be highly beneficial for resolving breastfeeding challenges. They can provide guidance on latching techniques, positioning, and overall breastfeeding support. By addressing these factors, the need for surgical intervention may be reduced.
• Tongue Tie Evaluation
  • When diagnosing lip tie, it is also essential to assess the presence of a tongue tie. In some cases, a tongue tie may contribute to feeding difficulties. By considering both lip and tongue ties together, healthcare providers can make more accurate assessments and provide appropriate interventions.
• Speech Therapy and Oro-myofunctional Exercises
  • For older children with lip tie, speech therapy and oro-myofunctional exercises may help improve muscle coordination and function. These interventions focus on the proper movement of the lips, tongue, and facial muscles, which can mitigate the impact of lip tie on speech and oral functions.

Conclusion

The overdiagnosis of lip tie is a complex issue with significant implications. While lip tie can genuinely affect some infants and children, it is important to consider alternative explanations and approaches before opting for surgical intervention. Collaboration between healthcare professionals, standardized diagnostic criteria, and increased awareness among parents can help provide clarity to the issue of lip tie. 

References 

1. Santa Maria C, Aby J, Truong MT, Thakur Y, Rea S, Messner A. The Superior Labial Frenulum in Newborns: What Is Normal? Glob Pediatr Health. 2017 Jul 12;4:2333794X17718896. doi: 10.1177/2333794X17718896. PMID: 28812052; PMCID: PMC5528911.
2. Boutsi EA, Tatakis DN. Maxillary labial frenum attachment in children. Int J Pediatr Dent. 2011;21:284-288.
3. Townsend JA, Brannon RB, Cheramie T, Hagan J. Prevalence and variations of the median maxillary labial frenum in children, adolescents, and adults in a diverse population. Gen Dent. 2013 Mar-Apr;61(2):57-60
4. Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020 May;162(5):597-611.

Why Should You Choose Union Pediatric Dentistry in Denver, Colorado?We understand the importance of your child’s oral health and are committed to ensure their thriving smile is well cared for. Led by Dr. Mike, our board-certified pediatric dentist, our skilled and knowledgeable team is dedicated to safeguarding your child’s dental well-being and guiding you through their significant milestones. We recognize that every child is special and deserves tailored dental care that meets their unique requirements. As parents, you can rely on us to be there for you and your family at every stage of your child’s growth and development, promoting a healthy and radiant smile for years to come!