Laser Frenectomy FAQ
(also known as tongue-tie or lip-tie revision)
Dr. Evy is the first pediatric dentist in the Austin and San Antonio area to establish a strong network of healthcare providers (lactation consultants, midwives, speech language pathologists, pediatricians, nurses, etc…) to provide comprehensive diagnosis and treatment for tongue-tie and lip-tie.
What is tongue-tie or lip-tie revision?
It is a surgical procedure during which the lip-tie and/or tongue-tie are removed with a soft tissue laser.
Do I need a referral from another doctor?
We highly advise you to have a referral from a pediatrician, lactation consultant, speech language pathologist, or another healthcare professional that has been working with you to rule out other problems. A study from Australia in 2015 (Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments, Kent et al. Int. J. Environ. Res. Public Health 2015, 12, 12247-12263; doi:10.3390/ijerph12101224) reported that “The most common attributed cause of nipple pain was incorrect positioning and attachment, followed by tongue-tie, infection, palatal anomaly, flat or inverted nipples, mastitis, and vasospasm. Advice included correction of positioning and attachment, use of a nipple shield, resting the nipples and expressing breastmilk, frenotomy, oral antibiotics, topical treatments, and cold or warm compresses. Pain was resolving or resolved in 57% of cases after 18 days (range 2–110).”
Therefore it is essential that you and your baby are receiving the most comprehensive care to fully resolve all the problems associated with difficult breastfeeding. If you have additional diagnostic information from another provider please let us know.
How young is too young to have my baby evaluated for a lip- or tongue-tie?
It is never too young to have your baby evaluated. It is best to have the procedure at a younger age rather than waiting because your baby can form habits that may require additional therapy in the future and a restricted tongue can cause a cascade of events leading to poor development of the oral-facial structures and abnormal breathing patterns.
Will the first visit be considered a consultation or an exam visit?
It will be an exam visit since it does include a physical examination of the oral cavity, which is needed for full diagnosis and treatment plan recommendations.
Do you have a referral network for bodywork or other therapists?
Yes. Dr. Evy started a support group with lactation consultants, speech language pathologists, midwives, cranio-sacral therapists, pediatric chiropractors, and myofunctional therapists.
Will just having the surgical procedure conducted on my baby help correct my breastfeeding issues?
Yes, in most cases, if there are no other problems with the cranium, head, neck, or back, and your baby is a newborn at the time of the surgery. If there are other problems contributing to an improper latch, changing the anatomy of the lip-tie or tongue-tie by surgical removal alone will not fully alleviate all the symptoms. We suggest you continue to work with your lactation consultant and other healthcare professionals.
Will any pain medication be given to my baby before conducting the procedure?
Yes, in most cases. Dr. Evy has a low-risk, specially compounded topical anesthetic and local anesthetic available for injection when necessary. Dr. Evy will address this question in a more individualized way once she has examined your baby. For older children, adolescents, and adults, topical and local anesthetic are used for comfort during the procedure.
Can I breastfeed my baby prior to the procedure?
Yes, however, if you are planning on having the surgery done in the same visit, we recommend you feed your baby only a small amount of breastmilk and then wait until after the procedure is completed for a full feeding to prevent regurgitation of the milk.
What options do I have for sedation or general anesthesia for my toddler?
Once the doctor has examined your toddler, she will be able to give you the treatment options available. If your toddler is younger than 16 months, we are almost always able to treat him or her by swaddling. A child between 16 to 23 months may need to wait until age two when oral sedation based on your child’s weight can be used. If a child has other dental issues that need to be addressed promptly, general anesthesia may be used to treat both decay and any restrictive attachments of the lip and tongue. Dr. Evy usually does not recommend general anesthesia to treat a tongue-tie or lip-tie. Children that are 3 years of age and older can oftentimes be treated with nitrous gas only, few require oral sedation. Dr. Evy will present you the most adequate option for your baby/child at the time of your visit.
Is it possible to treat my child without use of sedation, nitrous oxide gas, restraint, or verbal behavior management?
This will depend on the child and the situation. For very young, anxious children with extensive treatment needed, it is not possible to treat without sedation, some sort of passive restraint or verbal guidance. For older children and/or small treatment plans it may be possible to treat without any of the above.
For children that are younger than 3 years of age or those with complicated medical histories, who require immediate or extensive treatment, it is usually necessary to use general anesthesia since they are usually not candidates for in-office oral sedation due to age and weight.
For babies and infants, it is necessary that they are restrained by you the parent or legal guardian so that the doctor can conduct the dental examination. It is normal for children this age to cry and be guarded. It is important that you remain calm and are supportive following the doctor’s recommendations so that the visit can be a short as possible and your child’s apprehension is short lived.
How long does the appointment usually last?
The examination may take 20-30 minutes including showing you the stretching exercises, giving you all the information about the procedure, and answering questions you may have. The procedure takes a small amount of time and we bring your baby to you once we are finished. It is important that you read as many materials as possible prior to your appointment including this FAQ as it will answer many of your questions.
Am I allowed to stay in the room with my baby while the procedure is being conducted?
No. Due to state laser guidelines and regulations, we have you wait in our special breastfeeding area or in the reception area during the procedure. We invite you to trust us and know we will take care of your baby.
Will my baby bleed extensively?
No. The laser cauterizes and since there are no major arteries or veins within the tie (frenum), there usually is very minimal or no bleeding.
What will happen if I do not conduct the post procedure exercises?
The risk of re-attachment is higher if the exercises are not conducted as instructed. At the one-week follow-up visit, Dr. Evy will give you feedback on how your baby is healing and make recommendations accordingly. The stretches are meant to be quick, effective, and with gentle to firm pressure. Dr. Evy and/or her team will show you how to do these exercises during your visit.
Is my baby going to be in pain after the procedure? What can I use for pain management?
On the day of the procedure babies don’t usually experience discomfort. Discomfort can set any time between day two and day five after the procedure. The majority of babies do well and only become temporarily fussy during stretches. We recommend skin to skin contact with your baby and allow your baby to latch on to you as much as possible. You can also place small shavings of frozen breastmilk in your baby’s mouth and allow it to melt, use rescue remedy, or arnica. We have a homeopathic tongue-tie remedy at our office that contains several herbs to help your baby with discomfort. PLEASE REFRAIN FROM APPLYING ANY OINTMENTS TO THE WOUND.
What else can I expect post-surgery?
Some babies sleep more in the days following the surgery and breastfeed less often. Some babies have shorter and more frequent breastfeeding episodes. Increased drooling has been observed as a side effect of the surgery, but it returns to normal as your baby heals.
Does my insurance cover the procedure?
We do not know. We usually don’t find out until your claim is processed by your insurance company. We highly recommend you contact your insurance plan and ask about coverage prior to the procedure. We only verify insurance prior to your appointment date. Please be sure you provide us with your information at least the day before your scheduled appointment. We do not verify insurance on the day of your appointment and it is your responsibility to file your insurance claim if we do not receive your information in advance.
Does my baby need to be active on dental insurance for the procedure to be covered?
Yes. An insurance plan will usually not consider a claim for reimbursement if your baby is not active on the plan on the date of service.
Does medical insurance cover the procedure?
We are a dental office and we are not in contract with any medical insurance plans, so we encourage you to call your specific insurance plan to find out. We do not file any claims to medical insurance plans.
Will you bill my medical insurance?
We are a dental office and we do not have medical contracts with your medical insurance plan and therefore we are unable to file your claim for you. We encourage you to contact your insurance plan for any additional questions.
Helpful Articles and Videos on Frenectomy
- An overview of a typical visit with Dr. Evy for tongue-tie/lip-tie evaluation and surgery.
- For a variety of articles from Dr. Kotlow, a dentist with 30+ years of experience in treating tongue-tie and lip-tie, please visit his website here.
- In their Spring 2004 Newsletter, the American Academy of Pediatrics talked about how tongue-tie can affect breastfeeding in a negative way. Read more.
- More research can be found in the article on “Short Lingual Frenulum and Obstructive Sleep Apnea in Children” Huang et al. Int J Pediatr Res 2015 in a 2015 issue of the International Journal of Pediatric Research
- “Association of breastfeeding and three-dimensional dental arch relationships in primary dentition” Sum et al. BMC Oral Health 2015
- “Histological Characteristics of Altered Human Lingual Frenulum” Martinelli et al. International Journal of Pediatrics and Child Health 2014
- O’Callahan, et al., The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding, Int. J. Pediatr. Otorhinolaryngol. (2013)
- “Biomechanics of milk extraction during breast-feeding” Elad et al. Proceedings of the National Academy of Sciences. www.pnas.org/cgi/doi/10.1073/pnas.1319798111
- “Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effect on Milk Removal and Sucking Mechanism as Imaged by Ultrasound” Donna T. Geddes, Diana B. Langton, Ian Gollow, Lorili A. Jacobs, Peter E. Hartmann and Karen Simmer Pediatrics 2008;122;e188; originally published online June 23, 2008; DOI: 10.1542/peds.2007-2553
- About Frenectomy
- Tongue Tie Laser Surgery
- Laser Tongue-Tie Release
- Tongue-tie procedure providing relief for some babies
- The Effects of Lip and Tongue Tie on Breastfeeding (Dr. Kotlow Interview)
- Laser lip and tongue ties surgery on infants with breastfeeding problems (Dr. Kotlow)