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Lip Tie in Babies - What Should You Do?

Updated: Jul 17

A lip tie is when the upper frenulum, a small piece of tissue underneath the upper lip attaches lower on the gums than normal. All newborns as well as adults have an upper frenulum but it is not considered a lip tie unless it attaches abnormally low on the gums.


Mothers are typically concerned about their baby having lip tie because depending on the severity, it could potentially affect nursing.


This article will explain how to tell if your baby has it and what you should do about it, if you even want to do anything about it at all. After all, there does appear to be a lot of controversy surrounding lip tie surgery. We will do our best to help you make the best informed decision as possible regarding the overall health of your newborn.



Table of Contents:



Does my baby have lip tie?

Only your pediatrician, a lactation consultant, or a pediatric dentist would be able to accurately diagnose a lip tie in your baby. They are the ones with the most experience in regards to what it looks like and whether or not it can negatively affect your newborn's well being.


With that being said, in case you wanted to be prepared before your consultation visit with one of the experts, here are some symptoms and what it can look like.


Symptoms

Your baby won't be able to tell you if they have it but here are some signs and clues that may indicate the condition is present.

  • Your baby makes a clicking sound during feeding.

  • Inability to latch deep enough during nursing.

  • Spitting out milk or choking on it.

  • Poor transfer of milk from breast to mouth during feeding.

  • Cluster feeding such as feeding a lot more often.

  • Poor weight gain and underweight.

  • Development of jaundice - when the baby's skin turns yellow.

  • Falling asleep during nursing

  • Unable to hold pacifer in mouth

  • Colic symptoms

As a breastfeeding mother, you may also experience some symptoms as a result of lip tie:

  • Nipple pain during latching

  • Creased, flattened, or blanched, cracked, bruised, and blistered nipples

  • Gumming or chewing of nipple

  • Baby slides off nipple while attempting to latch

  • Bleeding nipples

  • Plugged ducts

  • Mastitis or nipple thrust

  • Infected nipples


What a lip tie looks like

A lip tie may look normal to the untrained eye because the overall appearance of the frenulum looks basically the same. The only difference between a normal upper frenulum vs a lip tie is that the latter has the frenulum attaching LOWER on the gums than normal. Therefore, the main distinction lies in where the frenulum attaches. The lower it attaches, the more severe the lip tie is.


Here is a picture of what a normal frenulum looks like:

normal frenulum

Here is a picture comparing what normal vs a lip tie looks like:

  • The first picture is considered normal while the second and third portraits get progressively more severe with how tied the lip is.

Here are some additional lip tie pictures:


Classifications of lip tie

Lip ties may vary in severity depending on where the frenulum attaches it and there are four classifications.

  • Class I - normal with mucosal attachment

  • Class II - gingival attachment, inserting just above the two front teeth

  • Class III - papillary attachment, beginning to insert into anterior papilla

  • Class IV - papilla penetrating, completely inserts into anterior papilla

Here is a photo displaying all four classes of lip tie:



What causes a lip tie?

Just to reiterate, having a frenulum is normal but when it attaches lower than usual, that is considered abnormal and is called a lip tie. There are certain health conditions which may cause the attachment to be lower.


Some health conditions which were thought to have contributed to lip tie but has been proven to have no relation. These conditions were actually found to be MISSING a lingual frenulum.

  • Infantile hypertrophic pyloric stenosis

  • Ehlers-Danlos syndrome


The health conditions that did not cause lip tie but caused tongue tie instead:


In conclusion, if your baby does have a problem with the frenulum attachment, it may be worthwhile to look into whether or not there are hereditary disorders.




How does it affect my baby?

An upper lip tie primarily affects breastfeeding by altering latching and sucking mechanics, thus resulting in poor weight gain for the newborn. Since the upper lip is tied lower than usual, the baby is often not able to open as wide, which affects how they latch onto the breast. In addition to that, it also results in inefficient milk transfer.


Therefore, if your baby is not feeding as well and having trouble gaining weight, that may be a possible sign of this condition. It is certainly worthwhile to get a consultation and look into it.


It may also affect the mother as well because maternal self-confidence and self-efficacy are intimately intertwined with breastfeeding success. When there is a problem with breastfeeding, mothers will often think that they're doing something wrong.


Lip tie problems later in life

Mothers may be concerned about the immediate effects but lip tie may have lasting consequences throughout your child's life such as contributing to a diastema. A condition where you have a space between your two upper front teeth. The width of the space may vary from individual to individual but as long as there is a space, it is considered a diastema.


A lip tie may cause a diastema because the frenulum may attach so low onto the gums that it prevents the two upper front teeth from coming together. The frenulum is basically inserting itself between the two teeth, thus forcing the them apart.


Here is a picture of an infant where the lip tie is already wedging itself in between the two baby front teeth, thus causing a spacing.


Treatment for a diastema caused by a lip tie typically involves getting a frenectomy first followed by orthodontics to close the spacing. The frenectomy is a surgical procedure to remove the lip tie by cutting the frenulum. This is necessary because the lip tie is the primary cause of the spacing between the teeth. If you simply tried to close the spacing with braces or Invisalign, it would never close since the frenulum is preventing the teeth from touching.


Ultimately, if you're able to correct a severe lip tie early in life, you may be able to prevent your child from having a diastema later in life. What this could mean is possibly saving you a lot of money on braces later on or at the very least shorten the treatment time since you don't need to close the additional front teeth spacing.




Correcting upper lip tie with a revision

A lip tie revision is a procedure done to correct the low attaching frenulum by removing it. The revision is usually done with a diode laser or a tenotomy scissor and may be performed by a surgeon, pediatrician, or a dentist. The surgery is often very quick and painless since most infants don't even require any painkillers afterwards. At most they would require analgesia for the first 1-2 days only.


Here are the steps for a typical procedure:

  1. Elevation of the upper lip with gauze.

  2. Apply a small amount of numbing gel to the frenulum with a Q-tip.

  3. Cut the frenulum with either a laser or scissor.

  4. Return the child back to the mother.

The correction with a revision is a very quick procedure and babies often either breastfed immediately afterwards or fell asleep once returned to their mother. The procedure is often painless or minimally so because only numbing gel would be used and not a numbing shot.


There isn't a specific age where a lip tie should be corrected because it may be done at any time. If you do not correct it while they're a baby, they may have to get it done while they're an adult, usually prior to orthodontic treatment. Although treatment usually takes a bit longer if they get it done while they're older. The reason is because teeth are added into the equation and need to be taken into consideration.


Here is a video showing a frenectomy procedure on an older child:


Results after correcting the lip tie

Studies have shown that by releasing the upper lip tie, there is an immediate improvement in breastfeeding. The improvement is due to the fact that the lip tie restricts the upper lip from flanging to latch onto the breast during feeding.


Once the procedure is completed, most mothers notice that their babies can open their mouths wider, thus facilitating a deeper latch onto the breast. With the frenulum gone, the upper lips can flange unrestricted.




Controversy and Concerns regarding lip ties in infants

There's been a lot of controversy and concerns regarding correcting lip ties in infants because some healthcare professionals allege that there isn't enough evidence to support it.

  • This study, which was a systematic review in 2019 stated that evidence for routine upper lip tie release were poor and that the classification system of lip ties have been unreliable.

  • A second study stated that evidence for doing the procedure were generally "weak".

The poor evidence may be due to the fact that these tied lip revisions were mostly done on newborns and that makes it difficult to qualitatively assess how beneficial they were. You can't exactly ask the baby, if the procedure improved their quality of life since they can't even speak yet.


Concerns about a booming new industry

However another concern has been raised, which was that lip tie revisions were creating a lucrative new industry. The reason is because insurance typically does not cover this procedure so most parents will have to pay out of pocket for it. There is also the fact that the surgery is very quick and easy to perform. Perhaps all those factors add up to a lot of unnecessary lip tie releasing procedures recently.


Nonetheless, most healthcare professionals do seem to agree that in order for infants to feed successfully, they do need to latch onto the breast properly. Latching IS affected by soft tissue anomalies such as a lip tie.


Our opinion is that the procedure certainly does improve breastfeeding if the lips ARE indeed tied. However, there may be quite a few unnecessary procedures that may have been done, which probably raised concerns in the recent media. For instance, if the infant didn't have a lip tie but the mother was simply concerned about why her baby wasn't gaining weight and ends up getting talked into doing the procedure just to alleviate her concerns.




What If I don't correct it for my child?

The consequences for not correcting a lip tie would be slower weight gain and the possibility of forming a diastema later in life.

  • Slower weight gain. Since the condition affects latching and feeding, your child may have more difficulty gaining weight. Using a bottle in lieu of breastfeeding may help circumvent the issue because infants are able to feed from the bottle more easily than from the breast. That most likely has to do with the fact that the breast has a larger surface area while the bottle is smaller. Therefore it is easier to feed off of the bottle.

  • Diastema formation. A very low frenulum attachment may prevent the two upper front teeth from coming together since it is in the way. Therefore, the lip tie forces a gap to form and persist throughout adult hood as long as the frenulum remains as is.

Those are the only two major consequences for not doing a revision procedure for the frenulum. Aside from that, it does not affect the overall health of the baby's teeth nor gums.


Will lip ties go away on their own?

Unfortunately, babies do not outgrow lip ties because the only way to correct it would be to cut the frenulum. So, if you don't do anything about it your child will simply grow up with a tied lip.


However, having a tied lip isn't the end of the world because plenty of people have grown up with it. Its not as if you won't live past your infancy if you don't correct the lip tie. Therefore the condition isn't so serious that it is life threatening. At most, it may just be a cosmetic concern because a serious lip tie has a tendency to cause diastemas between teeth, which is a spacing.


If your child does end up with a gap between their front teeth, they can always get it corrected later on with a procedure called a frenectomy. Here is a photo of a before and after frenectomy procedure used to correct a lip tie and close the diastema.



With that being said, lip tie in adulthood does not necessary need to be corrected because it is simply a cosmetic concern. The low frenulum and diastema does not affect the way you eat or speak. It may lower your self esteem from a vanity stand point but that's the worse that it can do.




Takeaway

If your baby has lip tie, it may potentially affect how they breastfeed because it alters the latching mechanism onto the breast. The primary consequence of concern would be low weight gain and slower development. If your infant is gaining weight more slowly or they're not feeding as well, this may be a condition that you should look into.


However, please also be aware that there have been concerns raised by the medical community that a lot of lip tie revision procedures have contributed to a booming new lucrative industry. Please consult with your doctor first to check if your baby indeed has a lip tie and whether or not it affects their feeding. If it is very mild and does not seem to interfere with their latching, it may be better to leave it alone.


Nonetheless, you should also get a consultation with your pediatric dentist to see if it could potentially affect their teeth development. One of consequence of leaving a severe lip tie is ending up with a diastema or a gap between the upper two front teeth once the child reaches adulthood. If that is the case it may be worthwhile to explore doing the procedure and possibly save on money and time on orthodontic treatment later on.


The decision is yours to make!


Author: Written by Dr David Chen DDS, a long island city dentist.





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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!