Frenum, Frenulum and Frenectomy – How to effectively deal with them in 21st-Century America

If you are reading this blog, chances are that you or somebody you love have a ‘frenum’. What an adventure it was for us, when we found out our little daughter had one! We hope our experience can help you find a better way to treat it than the one we had to face. What is main stream right now in America’s medical system, in fact, is unfortunately not the most effective way. If you are a doctor, a dentist or an oral surgeon who wants to know what this article is about and is willing to read it with an open mind, I salute you for that, and I kindly encourage you to read through the end.

As we read on Wikipedia, a ‘frenulum’ (or ‘frenum’, plural: ‘frenula’ or ‘frena’, from the Latin frenulum, ‘little bridle’) is a small fold of tissue that secures or restricts the motion of a mobile organ in the body.

Frenula in the mouth can be:

-      Frenulum Linguae (under the tongue), commonly referred to as ‘Tongue Tie’

-      Frenulum Labii Superioris (inside the upper lip)

-      Frenulum Labii Inferioris (inside the lower lip).

An overly-short frenulum may require a medical procedure to achieve normal mobility. There are several ways to refer to this procedure, according to how it is performed. Scissors incision is called a ‘frenotomy’ or ‘frenulotomy’. Excising the tissue and then using sutures is called ‘frenuloplasty’. Finally, if the procedure is done by laser it is called a ‘frenectomy’ because the laser obliterates the tissue. Let me tell you more about our experience with frenotomy and frenectomy.

HOW IT ALL STARTED – ‘OUR ADVENTURE’ PART ONE

(Frenulum Linguae)

When our second daughter was born, in August 2009, I was in terrible pain while nursing her, so I went to see my lactation consultant, Lori, who had helped me to nurse my first daughter correctly.  When I told her that nursing Myla was actually more painful than it had been with Keira, she opened Myla’s mouth and immediately found the reason for that excruciating pain: a very thick frenulum linguae, under her tongue, commonly called ‘Tongue Tie’. (For the importance of a Certified Lactation Consultant during the first few hours of your baby’s life, please visit my blog drugfreelabor.wordpress.com).

Lori showed us a book with some pictures of babies with that problem and pictures of the specific soreness on the Mom’s nipples (different than the ones caused by a wrong positioning of the baby at the breast). In the same book, there were pictures of older children or even adults, whose frenulum was so thick it didn’t allow the tongue to move as freely as it should.

Lori also shared with us a very informative Powerpoint presentation by Dr Brian Palmer, where we could observe different kinds of frenula, their level of seriousness and how thick they can become with age, when not clipped at birth (http://www.brianpalmerdds.com/pdf/frenum_pdf.pdf).

We immediately opted for a clipping (frenotomy) to be done as soon as possible, considering my pain during breastfeeding and Myla’s obvious impediment in even sticking her tongue out of her mouth. Imagine how uncomfortable it is to have your tongue stuck to the bottom of your mouth! Some babies have serious problems breastfeeding (see the story of the baby from Hawaii, below), others might develop a speech impediment that could affect not only the normal development of their personality and self-esteem, but also their education and their whole life (see Connor’s Story, below).

Well, what seemed as obvious to us seemed not-so-obvious to everybody else! This is where our ‘adventure’ started.

When we took Myla to the pediatrician’s office (our pediatrician was having a baby herself, so we had to see another doctor at the same practice), she claimed that ‘tongue-tied babies are very common, and their sublingual frenulum goes away with time’. True? Well, the book we had looked at and Dr Palmer’s study showed that, in some cases, they do not go away at all, at least for the kind of frenulum our daughter Myla had.

When we voiced our position and asked for a referral to a specialist who would clip Myla’s frenulum, the pediatrician said she didn’t have any referral to give us, as no doctor in that practice endorses clipping frenula in babies. I mentioned my pain in breastfeeding and she suggested that I ‘suffered through that until Myla’s frenulum was gone, or choose to give her formula.’ When we left that office, we were in a mixture of disappointment, anger and frustration.

Once home, we called Lori again, who sighed (she had already imagined that such an answer could come from a pediatrician, regarding the treatment of a frenulum) and gave us the number of a midwife who could do the procedure on our baby. The clipping, she reassured us, was totally safe. And so it was. We called the midwife, Pam (http://azbirthathome.com), set up an appointment that same day, drove to her office and had it done in less than 3 seconds. Myla cried when she had it clipped, and it bled a little, but, as soon as I put her at my breast, she nursed in a way that already seemed different to me. She was totally peaceful after that. My breast healed in a week and she has nursed beautifully for 14 months.

‘OUR ADVENTURE’ PART TWO

(Frenulum Labii Superioris)

About one year later, at the end of August 2010, Kevin and I were playing with our daughters in our living room and, for the first time, we noticed that Myla had a ‘strange’ smile: her lips would cover her upper front teeth completely, and none of us in the family has that problem.

Instinctively, I pulled her upper lips up and, there it was: a thick piece of tissue in between her teeth, which linked her gums to her lip much lower than what all of us had. Kevin and I looked at each other and instinctively knew that this frenulum too was there when she was born. However, this one was much thicker than the one we had clipped. ‘Oh, boy! Will the midwife be able to clip this one too?’, we wondered.

That same night, I spent hours on the internet, trying to learn more about frenum/frenulum and how to get rid of them. I found some feedback from people that had it removed at their dentist’s office from an oral surgeon and all of them said, “The sooner you do it, the better!” The parent of a 6-month-old boy said it was ‘a walk in the park’, while a 70-yr-old woman said it was so painful to have the frenectomy done in order for her dentist to put dentures in her mouth (the frenum was ‘in the middle’ and needed to be removed), she wishes she had not done it at all and had rather stayed with no dentures and no teeth! None of them, however, specified what kind of procedure they had done (if with stitches or not) – they just called it ‘frenectomy’.

The day after, I called Lori, our lactation consultant, and she said that this frenulum could not be just clipped, as it was already thick, and suggested that we went to see an ENT (Ear-Nose-Throat specialist) she had just visited herself for family reasons and had had a good experience with.

In order to see a specialist, however, you have to first obtain a referral from your doctor, so I went to see our pediatrician (the one who was giving birth a year before). I explained the situation to her, saying that we were sure this frenulum was already there when Myla was born and now it had got thicker. I also said that Lori, who she knew very well, as she had referred me to her two years before, was suggesting that we went to see a specific ENT, and we were willing to go show him Myla as soon as possible.

To my surprise, our pediatrician said there was no reason to be so upset over something ‘so small’ if compared to Myla’s heart murmur and that we should focus on seeing a cardiologist first. She added that frenula usually go away with time, that this one was not creating Myla any feeding problem, therefore, in a couple of months, I could just show it to a pediatric dentist and see what he might think.

Once home, I told my husband what she had said and asked him, ‘Do you think that we are making a fuss over anything and that, this being only ‘esthetical’, we should let it be?’ He was very upset about our pediatrician’s response, and said, ‘Absolutely not! This frenulum is NOT going to go away, as we well know and have seen in the book and in Dr Palmer’s study. What are we waiting for? That she turns 14, has a huge gap between her teeth, not to mention a much thicker frenulum that doesn’t even allow her to smile normally, and that she needs to remove it then, and get braces at a huge financial expense on our part? Nonsense! If we take it off now, she might need braces anyway, but if we leave it there, she will need them for sure. To me, the answer is obvious: let’s get it done Now!’

Having decided that, I called our pediatrician’s office again, told the secretary we had decided this was important to us and wanted it checked by a specialist as soon as possible, and asked to have the referral to the ENT I had been advised about. The secretary said she would talk to the doctor and let me know.

In the meantime, that evening, I kept on researching information online and found some different kind of frenectomies for labial frenula. Youtube.com has excellent videos, so I found there were at least three ways to the procedure: Z-plasty surgery, the traditional way with scalpel and scissors and stitches and, lastly, laser surgery.

A few months before, our pediatrician had given me her personal e-mail address, as she was changing practice and that was the way to communicate with the patients who wanted to follow her. Therefore, inspired by the information I had found, I shared it with her through e-mail and I also sent her Dr Palmer’s Powerpoint presentation.

The morning after, I received a phone call from the pediatrician’s secretary, who told me, in a very dry tone, that I was not supposed to use the doctor’s private e-mail address and that I had to bring Myla back in, if I wanted any referral from them at all. I was so frustrated and discouraged after that! I had sent her that e-mail with the best of intentions and the answer I got was not at all what I had expected. Rather, the opposite!

My husband was furious and said, ‘You stay home. I’ll go’. The doctor ended up not giving my husband a referral to the ENT Lori had suggested, but a list of other ENTs. Therefore, we called the ENT’s office we had been advised on the first place, we fixed an appointment and then called the pediatrician’s office and asked them (with every ounce of patience we had left, as I am sure they felt the same way with us) to fax their referral to this specific ENT. If I had a specific request, why couldn’t that be satisfied? Why is everything so complicated, in 21st-century America’s medical system??

When we went to see him, he said that 90% of tongue-tied babies have an upper labial frenulum too (as we had thought) and that he clips both at birth or during the first months of life, no anesthesia needed. However, Myla being older than 4 months of age (13 months old), he would need to put her under general anesthesia, use scalpel and scissors, put a couple of stitches and be done in a few minutes. When I asked him how bad he thought her frenulum was, he said, “Significant. And, no, it will not go away with time.”

He sent us home with the papers ready to be filled out with Myla’s information for the procedure. The cardiologist told us her heart murmur was very normal and he could barely hear it, so he approved the general anesthesia for the frenectomy.

However, something held us back: the videos I had watched on youtube.com showed that laser surgery was so much easier! Why go through general anesthesia on a little child, when you can have it done in local anesthesia? At this point, our questions were, ‘Is it possible to have laser surgery on a 13-month old? And, if so, who could do it?’

That same night, I thought that asking the leading expert in frenula was the way to go. The leading expert for us was Dr Brian Palmer, who had developed such a detailed study on the problem. Maybe he would address us on the right way. So, here I was now, writing an e-mail to this very important doctor, while a little voice in me was saying, ‘Here we go again! Now HIS secretary will call you, to tell you NOT to use his personal e-mail ever again!’

Well, less than 24 hours later, Dr Brian Palmer in person sends me the following e-mail:

Sept 17, 2010

Hi Alessia

I am retired now.  Someone you might want to contact is Dr. Larry Kotlow.  He has done, and is currently doing, research on tight frenums.  He may be able to consult with you or he may know someone in your area who may be able to help.  His contact information is: Lawrence A. Kotlow, D.D.S., P.C.[…]

Hope you find help for your daughter.

For Better Health!

Brian Palmer, DDS

What a great man! I am sure the medical history of the future will give him thanks for all his research on the topic of frenula! Certainly my family and I will!

The day after, Saturday September 18th, I receive this other e-mail:

Alessia:

Brian Palmer forwarded your e-mail onto me for comment. I would go ahead and have a laser frenectomy with no more than local anesthesia performed by an oral surgeon who knows how to do this as soon as possible to prevent further problems. If you live anywhere near Albany, New York Dr. Kotlow performs this procedure very often and is an expert on the subject, perhaps the world’s expert. You can contact him at kiddsteeth.com.

Alison K. Hazelbaker, PhD, IBCLC

That same day, though, I had brought Myla to a periodontist’s, to ask if he performed laser frenectomies. He said he did, but only on children who were 10 years old or older. He would not take the responsibility of perfoming it on little ones, as they move too much and it can be dangerous. He also suggested that we waited until her new teeth came out, and see if the frenulum would get thinner at that point. If it didn’t, he would consider doing it on her then, when she would be 5 or 6 years old, but not before then.

Therefore, even though Dr Hazelbaker’s e-mail gave me encouragement, I wrote:

Dr Hazelbaker,

thank you very much for the referral. Unfortunately, we live in Phoenix, AZ and it wouldn’t be easy for us to reach Albany, NY. Our girl is 1 year old and both an oral surgeon and an ENT told us that a local anesthesia wouldn’t be enough, as my girl is too little and would move too much for them to perform a laser frenectomy. Therefore, we were thinking of waiting until she’s 5 or 6 and then get that done. Hopefully, then, she’ll be ‘wise’ enough to stay still during the shot and the procedure. If you have any suggestions, please feel free to send them our way.

Thank you so much for your time.

This was her reply:

I would strongly encourage you to get a consult with Dr. Kotlow. He does laser surgery on this age child all the time. I am sure he would speak to you on the phone. I also strongly encourage you NOT to wait until she is 5-6. By then she may have developed all manner of compensations like speech delay and dental problems. Now is the time when you have the power to prevent problems from developing.

Alison K. Hazelbaker, PhD, IBCLC

Reassured by her words, I picked up the phone and called Dr Kotlow. He talked to me directly, which I so highly appreciated, and explained that very few doctors and oral surgeons, if any, want to accept the fact that frenula need to be removed early and that laser frenectomies on babies or kids of any age, as well as on adults, are totally safe, fast and give great results with a very short recovery time, if compared to any other procedure. He added that people fly to his office in Albany, NY from all over the place and can fly back home the very next day. The procedure itself lasts only 5 minutes or so. I thanked him so much for reassuring us, and then I gently asked him if he knew of anybody who performed laser frenectomies in Arizona. He answered, ‘Nobody in Arizona that I know of. In California, I know Dr James Jesse. You can contact him and, if he can’t help you, you can call me again. Good luck’.

Another great man! After talking to him, we felt so confident that we were moving in the right direction, doing what was best for our little daughter. But, man, wouldn’t all this be much easier for your family if your pediatrician and your dentist knew too??

When I called Dr. James Jesse, his daughter and assistant was, too, very kind. She explained that:

- only very little local anesthesia was needed on the frenulum, then laser, the whole thing lasting about 5 minutes;

- Tylenol only if the child complains too much after the procedure. When they follow up after 24 hours, parents 99% of the times say the kid is doing great and needed no Tylenol or other drugs at all;

- two weeks from the day of the procedure, you can barely see a scar on that point!

I ask the magic question again, “Anybody in Arizona?” she says she doesn’t think so, but then asks Dr Jesse and he gives me the phone number of a classmate of his in Scottsdale that might do it. (What a great man and professional he is as well, like Dr Palmer and Dr Kotlow! So hard to find, in today’s age!).

I called the doctor in Scottsdale, but his assistant says, “No, he doesn’t use laser. And, wow, on a 1 year old? Oh no, we don’t treat patients that young!”

Our new pediatrician defined Myla’s frenulum ‘pretty significant’ and sent a written request to our insurance, to see if they could cover the procedure. In his letter, he mentioned that ‘indications for the surgery include: prevention of potential gum recession, speech articulation defects and front-tooth diastema’ and that laser surgery is to be preferred because, ‘in comparison to traditional surgery, does not require general anesthesia, saving medical risk to this young child, as well as medical costs; perioperative complications and pain are also potentially less’.

While waiting for a reply from our insurance, I called the 22 oral surgeons on their list in the state of Arizona. 19 of them told me they don’t perform laser frenectomies (some of them doubted the fact that frenectomies can be performed with laser, especially on children this young), 1 performed Z-plastic surgery with general anesthesia and 2 very confidently told me that there is no way that laser can be as effective as what they perfom, which is scalpel-and-scissor incision in general anesthesia.

Another pediatric dentist right by our house bluntly told me that he would never put his own kids into such a ‘distress’ as a frenectomy, especially at this young age, and that “the only intelligent thing to do is wait until her new teeth come out.” When I mentioned laser, he literary said it is ‘dangerous’ on kids so little and that the frenulum ‘comes back’ if treated with laser. “Well”, I said, “pretend she’s 10 today and I’m back and the frenulum is still there. Will you remove it, or would you send me to somebody else?” At my words, he lost his patience, left the room, came back with a phone and called somebody, evidently the oral surgeon he works with, in those cases. To everything the surgeon would say, the dentist would add, “I told her! Yes, I told her!” and, after hanging up, he said, “As I told you very clearly already, there is no need to remove a frenulum at this early age! Wait until her new teeth come out and then we’ll see. I am pretty confident the frenulum will be gone by then. Removing it at this age, and with all the risks involved, just wouldn’t make sense!”

At this point, we just realized that a great part of doctors and oral surgeons do not have the right information at hand on the matter of frenula and frenectomies. This is the ‘why’ of this booklet: to raise awareness that, YES, there is a better way! And that the sooner it gets done, the better.

The result from our insurance came back, saying that “the procedure’s expenses cannot be covered by the insurance, as the frenulum does not interfere with feeding, therefore it is only ‘esthetical’ and has to be paid in full by the patient”. However, the procedure was not too expensive, under $400, so that same day we called Dr Jesse in California, scheduled the procedure for the following week and got it done.

On, Monday, January 3rd 2011, at 8 am, Dr James Jesse performed a laser frenectomy on Myla. Total length of the procedure, from injection of local anesthetic to end: 6 minutes. The laser procedure itself: 1 minute and 25 seconds!

As soon as my husband let go of Myla (he was holding her down during the frenectomy), she stopped crying and enjoyed the popsicle that Dr Jesse’s assistant had nicely given her. We couldn’t believe how fast and simple the whole procedure was!

That same evening, we were back home. Myla had been happy as always during the 6-hour drive back to Phoenix, watching dvds with her big sister in the back seat, having another popsicle on the way and an ice-cream after dinner.

As promised, the day after, Dr Jesse’s assistant called us to check that everything was ok. Myla had slept very well that night and had not complained at all about her booboo (she just pointed at it once, saying, ‘Booboo, Mommy’, and, after my kiss, never mentioned it again). No Tylenol was needed.

We pulled her lips up and held them for 10 seconds about 6 or 7 times a day for one week, as suggested by Dr Jesse. On day 10, we could barely see the scar. Today, after exactly 1 month after the procedure, you can’t even tell a frenum, a frenulum or a frenectomy happened there! We all enjoy her beautiful smile with her teeth out, not covered by her lips, and her big diastema (gap between her front teeth) is already closing, helping the other two front teeth get in a better position than the lateral one they were growing in before.

And, I must add, the whole procedure is very inexpensive, so the fact that our insurance did not cover it was not a big deal. Whichever the price, laser frenectomies, especially when done early in life, are so worth every penny spent to have them done! How much is your child’s smile worth to you?

ADDITIONAL INFORMATION

Some information I have found on the web:

(FROM PubMed.gov)

J Periodontol. 2006 Nov;77(11):1815-9.

Evaluation of patient perceptions after frenectomy operations: a comparison of carbon dioxide laser and scalpel techinques

Haytac MC, Ozcelik O., Department of Periodontology, Faculty of Dentistry, Cukurova University, Adana, Turkey.

Abstract

BACKGROUND: A frenum that encroaches on the margin of the gingiva may interfere with plaque removal and cause tension. Frenectomy is the complete removal of the frenum that can be made by scalpels or with soft tissue lasers. The aim of this article was to compare the degree of postoperative pain, such as discomfort and functional complications (eating and speech), experienced by patients after two frenectomy operation techniques.

METHODS: Forty patients requiring frenectomy were randomly assigned to have treatment either with a conventional technique or with a carbon dioxide (CO2) laser. The postoperative pain and functional complication ratings of each patient were recorded using a visual analog scale on days 1 and 7.

RESULTS: The results indicated patients treated with the CO2 laser had less postoperative pain and fewer functional complications (speaking and chewing) (P <0.0001 each) and required fewer analgesics (P <0.001) compared to patients treated with the conventional technique.

CONCLUSIONS: This clinical study indicates that CO2 laser treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique. Considering the above advantages, when used correctly, the CO2 laser offers a safe, effective, acceptable, and impressive alternative for frenectomy operations.

PMID: 17076605 [PubMed - indexed for MEDLINE]

———————————————————

Photomed Laser Surg. 2008 Apr;26(2):147-52.

Evaluation of patient perceptions of frenectomy: a comparison of Nd:YAG laser and conventional techniques.

Kara C., Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey. mcankat@hotmail.com

Abstract

OBJECTIVE: The aim of the randomized controlled clinical trial described here was to determine the anxiety levels of patients prior to frenectomy using the Nd:YAG laser and conventional technique, and to compare the effects of these two methods on the degree of postoperative pain, discomfort, and functional complications (eating and speech).

METHODS: Forty patients with mucogingival problems due to labial frenums (both maxillary and mandibular) were included in the study. Ratings of preoperative fear and postoperative pain and functional complications for each patient were recorded using a visual analog scale at 3 h, 1 d, and 1 wk post-surgery.

RESULTS: The results indicated that patients treated with the Nd:YAG laser had less postoperative pain and fewer functional complications (p < 0.05).

CONCLUSION: The results suggest that in the population studied, Nd:YAG laser treatment of soft tissue disorders provides better patient perceptions of success than those seen with conventional surgery.

PMID: 18341414 [PubMed - indexed for MEDLINE]

———————————————————

(FROM SimpleStepsDental.com)

‘A diastema also can be caused by an oversized labial frenum. The labial frenum is the piece of tissue that normally extends from the inside of your upper lip to the gum just above your two upper front teeth. In some situations, the labial frenum continues to grow and passes between the two front teeth. If this happens, it blocks the natural closing of the space between these teeth.’

….Now, knowing how much self-consciusness a big diastema can cause in teenagers growing up and even in adults who often prefer not to smile in pictures or to cover their mouth while smiling or laughing in front of other people, not to mention the much more serious health problems a frenulum can cause, why don’t pediatricians, dentists and oral surgeons naturally search for a better way? They are very busy with a million issues, and I salute each one of them for everything they do for us every day, but I also hope and pray that this article and this blog can help spread the information on laser frenectomy and the advantages of doing it early in life.

In our opinion, there is no better way to treat a thick frenulum than Laser Frenectomy, right here, right now, in 21st-century America. The fact that Dr Kotlow and Dr Jesse perform this procedure is a blessing, and the ‘good news’ need to be spread!

Dr Brian Palmer, Dr Lawrence Kotlow and Dr James Jesse have studied the topic deeply – now it is up to us who have the results in our hands to help them with raising awareness on a problem that seems so little, but can affect many young men and women’s self-esteem, health and even finances, when we consider braces, speech therapist and such.

My best wishes of good luck to you, if you are starting your adventure right now! And a call to ‘join the cause’, if you have had a personal experience with frenula and frenectomies and are willing to share your information with others. Remember, a battle for a cause that can improve people’s lives, bringing them physical and psychological well-being, is always a battle worth fighting!

If you wish to share your story, so it can be posted on this blog, please send an e-mail to Alessia Mogavero: alemogo@yahoo.com. We are looking forward to receiving your testimony and read what you have to say on frenum, frenulum and frenectomy!

Sincerely,

Kevin and Alessia Mogavero

Video-interview with Dr. James Jesse just minutes after the laser frenectomy on our daughter:

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A chat with Dr Santilli, DDS

This morning, April 16th 2014, I had a telephone conversation with Dr Melissa Santilli, DDS, who performs Laser Frenectomy in Cross Roads, Texas.

It was refreshing and comforting to see that more and more professionals like Dr Santilli are appreciating the value of using laser in their dentistry, and how important it is to remove frenums (both tongue tie and upper frenums) early in life.

I want to share some of the things we talked about with you, by taking some of what Dr Santilli writes on her website (parenthesis added by me):

“One of the most important things that usually happens after the birth of the baby is breast feeding to help create a bond between mother and child, as well as provide immunity for the baby and prevent mastitis in the breast tissue.  A physical issue that can prevent this from happening is the lingual frenulum, which is a band of tissue that attaches the tongue to the floor of the mouth.  This phenomenon is called ankyloglossia, more commonly known as “tongue-tied.” Sometimes this tissue is unnecessarily tight and restricts the tongue from touching the top of the mouth.  The tongue is very important for latching on and suckling motion during breast feeding, otherwise, the baby may start damaging the nipple tissue by chewing and also experience weight loss from inefficiency to obtain nutrients from the mother.

(At Honey Dental), we use topical numbing gel and advanced laser technique to remove the excessive band of tissue to relieve the tongue, this procedure is called laser frenectomy.  We do not use scalpel or scissors.  We specifically invested in having an advanced laser unit because of less chance of reattachment, more comfort for the baby, no post-op bleeding, little post-op chance of infection, fast and efficient treatment, and predictable healing.

Breast feeding is already challenging without the added issue of ankyloglossia, (we are a resource to help you and your baby if you ever face this situation).  Sometimes this problem may not be detected early, so the child may grow up with slight to severe speech issues due to the tongue’s restricted movement.  We would love to evaluate the child or even adult for this procedure that can change his or her life.

I totally agree with Dr Santilli and with all the wonderful and trusted Laser practitioners listed on our blog (‘Who performs laser frenectomy…‘). I pray that you can find one close to you!

Thank you.

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NEW! Tongue-Tie Conference in New York State!

“An Inspiring Day of Tongue-tie Education”

http://bit.ly/1gHVj7A

Pioneer of Oral and Maxillofacial Surgery Scott A. Siegel, D.D.S., M.D., F.A.C.S., F.I.C.S. and Keynote Speaker Catherine Watson Genna, B.S., IBCLC will be presenting the latest information related to breastfeeding challenges due to Tongue-tie.

WHEN:  Monday, April 28th, 9am-4pm
WHERE:  Crest Hollow Country Club, 8325 Jericho Turnpike, Woodbury, NY

For more information, follow this link: http://bit.ly/1gHVj7A
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WHO PERFORMS LASER FRENECTOMY TODAY ? (U.S., CANADA, NEW ZEALAND)

The DDS (Doctor of Dental Surgery) and DMD (Doctor of Dental Medecine) practitioners who perform Laser Frenectomy on patients of any age today, to my knowledge, are:

UNITED STATES OF AMERICA

- East Coast:

Dr Lawrence A. Kotlow, DDS, PC (Member IATP, International Affiliation of Tongue-tie Professionals)
340 Fuller Road, Albany, NY 12203
phone: 518-489-2571
website: kiddsteeth.com

Dr Scott Siegel, DDS, MD (Member IATP)
510 Broadhollow Road, Suite 130, Melville, NY 11747
phone: 631-465-0300
website: www.drscottsiegel.com

- South:

Dr Brian A. McMurtry, DDS, FAGD
10816 Black Dog Lane, Suite 100, Charlotte, NC  28214
phone: 704-392-3883
website: www.charlottelaserdentist.com

- Mid-West:

Dr Fred S. Margolis, DDS
1770 First Street, Suite 360, Highland Park, IL 60035
phone: 224-927-9321
website: www.fredmargolisdds.com

Dr Ted Reese, DDS, MAGD
7218 US 31 S, Indianapolis, IN 46227
phone: 317-882-0228
website: www.calmingfears.com

Dr Melinda Miner, DDS and Dr Daniel I Miner, DDS
Miner Family Dentistry PA
1010 Downing Ave #10, Hays, KS 67601
phone: 785-625-2200
website: www.minerfamilydentistry.com

(Tongue-Tie only:)
Dr Greene Colvin, MD, ENT and Dr Victoria Lim, MD, ENT
Desoto ENT Care
5960 Getwell Road, Suite 212-D, Southaven, MS, 38672
phone: (662) 895-6455
website: www.desoto-ent.com

Dr Greg Notestine, DDS (Member IATP)
2149 N Fairfield Rd, Beavercreek, OH
phone: 937-431-916
website: www.smiles4udayton.com/

- South-West:

Dr Laila B. Hishaw, DDS
5920 N. La Cholla Blvd, Suite 110 – Tucson, AZ 85741
phone: 520-544-4171
website: www.TucsonSmilesaz.com.
(Check out Dr Hishaw’s article in this blog)

Dr David Winn, DDS
6475 Wall Street, Suite 201, Colorado Springs, CO 80918
phone: 719.260.9000
website: academylaserdentist.com

Dr High Oser, DDS
1135 Keller Pkwy, Keller, TX 76248
phone: 817-431-5514
website: www.wowdentistry.net/

Dr Julie A. Martinez, DDS, PC
9006 Forest Crossing Drive, Suite A, The Woodlands, TX  77381
phone: 281-367-6558
website: childrensdentistwoodlands.com

Dr Melissa Santilli, DDS
11350 US Highway 380, Suite 140, Cross Roads, TX  75028
phone: 940-228-2250
website: honeydental.com

(for babies up to 8 months of age:)
Dr Stacey Cole, DDS
4812 Bryant Irvin Court, Forth Worth, TX 76107
phone: 817-731-9291
website: www.svcole.com

- West Coast:

Dr James T. Jesse, DDS
328 East Commercial Road, Suite 104, Loma Linda, CA 92408
phone: 909-799-9988

Dr Bobak Ghaheri, MD
Gateway Medical Office
1111 NE 99th Ave, Portland, OR 97220
phone: 503-488-2600
website: www.orclinic.com/provider/BobakGhaheri

CANADA

Dr. Peter Lam and Dr. Chris Lan
339, 1851 Sirocco Drive SW, Calgary, Alberta T3H4R5
phone: (403) 246-8555
website: westmarketdental.com

Dr. Jimmy K. H. Chan, DMD
#37 – 1199 Lynn Valley Road, North Vancouver, B.C. V7J 3H2
phone: 604-985-2912
website: www.drjimmychan.ca

NEW ZEALAND

Dr Hisham Abdalla, DMD, Laser&Cosmetic Dental Surgeon
Nokia Building,
Street Level (by Vector Arena)
32 Mahuhu Crescent
Auckland CBD, New Zealand
Phone: +64 9 377 2012
Fax: +64 9 307 2382
Link to Website: www.lasersmile.co.nz/cosmetic-dental-services/tongue-tie-release-laser-surgery/

Also, if you live in New Zealand, feel free to contact the Lumino dental practice closest to you: lumino.co.nz/

If you know of any other professionals who perform Laser Frenectomy anywhere in the world, please send us an email! alemogo@yahoo.com

Thank you and God bless!

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Success Stories with Laser

(BEFORE:) On March 11th, 2013, Gaby writes, “Hello, I live up in Washington state.  My son has an upper lip tie and I just came to realize this about a month ago.  No pediatric dentist here seems to want to touch this with a 10 foot pole!  I know of Dr. Jimmy Chan in BC, but we don’t have our passports yet, LOL!  Thank you for your help!”
(AFTER:) On Sept. 25th 2013, she writes, “Hi Alessia! We called Dr. Chan’s clinic and made an appointment with him.  It was a 5 hour trip up and a border crossing, but totally worth it. First off, Dr. Chan was WONDERFUL!!!  His bedside manner is fantastic and his office staff is to die for!  He checked Alex and confirmed that he had a stage 4 (!) lip tie and a stage 1 PTT, the procedures would cost $600 in total.  They strapped Alex to a papoose board; the procedure literally took about 5 minutes and afterwards he asked me to latch Alex on to see how it felt.  OH MY GOODNESS, THE DIFFERENCE!!!!  It was like night and day.  No pain whatsoever.  All of his gastrointestinal problems cleared up immediately as well, and I mean the very next day.  No more choking and vomiting while eating and no more constipation!  At one point before the procedure, he was so backed up even the radiologist was impressed!  So, now that we are 4 months post procedure, the lip tie area looks great!  The under the tongue area reattached a little, but I hear that happens.  Dr Chan said that the most important thing was function.  I weaned him about a month ago and he packs his mouth full like a little chipmunk when he eats, so the reattachment can’t be that bad. I totally recommend Dr. Chan.  He is absolutely wonderful.  We went up for a 2 week evaluation after the initial procedure and he waived the office fee as we paid out of pocket.  I would totally do it again in a heartbeat.  If we decide to have another baby and it has the same problem (God forbid) I would take them immediately (especially now that I know what to look for).  So, there is our story!  Alex is saying lots of words, at least 10+ right now, and TONS of baby jibber jabber.  He sticks his tongue out and is totally happy and well adjusted.  Best wishes!!Gaby and Alex.”

On July 24th 2013, Gail writes, “Dear Kevin and Alessia, it is with sincerest thanks that I write to you about my daughter’s (Violet) story.  My daughter’s top front teeth starting coming in around 13 months of age.  It was then that we noticed a large gap between her teeth.  So large that it looked like the two teeth on the bottom row could fit in between them!  While putting her to sleep one night, I was researching possible causes (as no one else in my family had a large gap) and came across your website. I am SO grateful that I did.  As I read your story, I had a gut feeling that this was the cause of my daughter’s gap. I confirmed it the next morning by pulling up her lip and seeing two thick “cords” between her teeth.

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After reading your testimonial and some other research, I was determined to have the laser frenectomy performed as soon as possible.  I discussed it with my husband and family and began to called pediatric dentists in our area to no avail. My husband contacted Dr. Ted Reese in Indianapolis, Indiana, about a 5 hour drive from our home. Dr. Reese’s staff were very helpful. We drove to Indiana and stayed in a hotel the night before.  The next morning we got to the office, filled out the paperwork and were taken into the back.  My daughter sat on my lap for the entire procedure.  First, Dr. Reese checked her mouth and said it was a very thick frenum. Next, they swaddled her into a blanket so she didn’t move her arms and used a topical numbing agent followed by a small numbing injection into the gums.  Finally, he performed the procedure.  The laser was a machine connected to a tool the size and shape of a large pen (not too intimidating at all).  My daughter cried (mostly because of the restraint) up until the point they put the mouth suction in and then she chewed on the suction for a few minutes and then it was over!  About 10 minutes on my lap total.  We gave her tylenol only a few times after that.  She had very little bleeding the first 10 minutes and then none.  She was drinking from a sippy cup and using her pacifier as soon as we were walking to the car.  We paid out of pocket, but they also submitted to both our dental and health insurance in case either one would cover it and reimburse us.  Here is Violet two days after the procedure:

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The laser procedure was exactly 2 weeks ago and now her mouth is completely healed:

DSC_3876

We are very happy with the results!  Dr. Reese and his staff were extremely nice and made us feel very comfortable! Thank you again for all of your help and informative website! Gail & Jeremy”.

On April 28th 2013, Janelle writes, “Thank you for writing this.  I live in Portland, Oregon and my son was born with tongue tie and a very thick lip frenulum.  We were lucky enough to have a great lactation consultant who referred us to an ENT that does laser (Dr Bobak Ghaheri, MD, ENT). He got me in the same day because he realized how important to my breastfeeding it was to fix as soon as possible.  He personally dealt with tongue tie with his own baby and, even though he didn’t learn a lot about it in medical training, he saw how much of a change in breastfeeding it made with his wife.  So we had it fixed by 4 months old.  I’m glad I read your blog because i have gotten negative feedback from my pediatrician on doing it.  Your story just validated in my mind that we did the right thing.  And nursing has gotten raised too. Thank you again, Janelle.”

On April 15th 2013, Leah writes, ” Hello - Thank you for creating such a useful blog. It has been a very valuable resource! I wanted to share that I was able to find a very qualified DDS, Dr. Ted Reese, here in Indianapolis, who did an excellent job on my daughter’s (age 2.5) very thick maxillary frenum (classified as a grade IV). The office staff was amazing and the laser frenectomy took less than 3 minutes. Prep was about 20 minutes. He used a little nitrous oxide gas and also gave her juice with a mild sedative mixed in. I felt very comfortable with the whole process and the staff was very experienced and professional. All in all, we were in and out in about an hour. She was back to herself the same day. Hope this helps anyone in the Mid West looking for an option. Kind Regards :) “.

On February 28th 2013,  Gemma writes, “Good Afternoon from NZ, Alessia. My daughter is now 5 months today YAY and thriving on breastmilk :) After reading your blog, we searched the internet and found a place in Auckland that would do it which is around 8 hours drive from here (they told us they were the only place in NZ that did laser for babies of this age and for $1000+ NZD). I thought there must be somewhere else, so calling around 20+ dentists in Wellington (capital of NZ) we found a dentist called Lumino http://lumino.co.nz/ that did it (we went to Burton Brown in Wellington CBD) and they asked us to go to a lactation consultant to see how bad it was. It was the worst she has ever seen. she is now using her photos when doing clients and seminars.

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She also checked for tongue tie, which we also knew she had, but we only thought it was minor as it wasn’t right at the end. Well not the case at all either. It was so bad she had no lift in her tongue at all so was having trouble swallowing. she thinks the only reason why she was gaining weight at all was because this was my second child so didn’t have to bring in breast milk and i have a huge supply and it pours out. I also showed her your blog which she said was great. So, we did it with laser. Our daughter went straight on the breast after. All up costs including lactation consultant $500 NZD. We got it done by 10 weeks of age and she started to put on weight straight away.  Not a great start to life but doing well now. Thank you so much for all your help, Again Thanks so much – you made my life so much easier with your blog as it was a very scary time for me and baby. Gemma and Shane.”

On February 26th 2013,  Luxi writes, “I just took my 2 month old daughter to see Dr. Jesse last week, he was AMAZING! She had both a severe upper lip tie and a severe posterior tongue tie. He was the first doctor that believed me. It has made a huge difference in breastfeeding. We are going back tomorrow after realizing that our 2 year old also has a posterior tongue tie, which explains why she has a thrust. I HIGHLY recommend him!”

On February 21st 2013, Sophia writes, “Just wanted to leave a note to thank you for making this information available. I just discovered that my baby needs a frenectomy and ever since I’ve been searching online for information. Your website has been the most helpful and we just went to Dr. Jesse’s office to get the procedure done today. My baby is already doing better and I couldn’t believe how quick the whole thing was. THANK YOU!!!”

On February 15th 2013, Carol writes, “We went to Albany last week and she’s doing great. She had severe ties on upper lip and tongue. Dr Kotlow is wonderful. Thank you for your support, advice, and encouraging words! We already see tremendous differences.”

On December 13th 2012, Anna writes, “Just went to Dr.James Jesse today with my 23 month old!! They were amazing! My daughter had both lip and tongue tie fixed for ONLY $400 total. His staff helped me hold my daughter still. Dr. James Jesse was so nice and explained everything he was doing and was very patient despite my daughter moving around and even biting him several times. There was no bleeding, within 1 minute after it was done my daughter was happily eating a ice pop. It was as if nothing had even happened. I am so happy he provides this service WITHOUT putting the kids to sleep and we need to spread the word!!! This was night and day from when my son had this done with another doctor (who didn’t use laser), he was put to sleep, and he bleed for days, was in a lot of pain and cost almost $2000 total, and the tongue tie even grew back for him so now we need to have it done again. DEFINITELY taking him to Dr. James Jesse. He told me in the 15 years he has done this with laser only about 3 patients have had it grown back and needed to get it redone. And he said that if it were to grow back for any reason he would not charge anything. What’s also great is that you can get an appointment almost immediately because it is so quick he schedules these things in between his other patients. I called on Monday and booked an appointment 3 days days later, could have gotten it the next day if my schedule had permitted. Thanks for this blog that helped me find him!”

Thank *you* so much, dear Moms and Dads, for writing to us! I encourage any reader who has a story to tell to send it our way: alemogo@yahoo.com. Thank you! :-)

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Feeding Problem and Speech Delay: Jaxson’s Story

On February 22nd, 2014, Anne Marie writes:

“Dear Alessia,

     I was reading your story and the other parents stories and thought I’d share mine.  My son Jaxson is 20 months old and does not eat solid food (just pureed food) and only says one word “eat”.  Probably because I am constantly asking him to eat…LOL.  I have been concerned that Jax would not eat solid food since he was 12 months old.   Anytime you presented any kind of food to him that wasn’t pureed he would turn his head away or close his lips tight.  If I was able to get solid food in his mouth he would gag violently.    I would offer him puffs, small cut up fruit, cheese, cookies, pretzels, ect…  You name it I tried it.

I voiced my concern with my Pediatrician a few times and he kept saying if Jaxson is not eating by 2 years old then we can be concerned…. REALLY?!?!?  I immediately started looking for a new Pediatrician.  I found a new Pediatrician I liked and she agreed with me that Jaxson needed feeding therapy and referred me to a speech therapist she knew.  She said it was hard to find a feeding therapist and she was the only one she knew in our area.  I called and of course she didn’t take my insurance.  So I decided to have my son evaluated by the county at 16 months.  The therapist felt that he did not qualify for the services because he needed to lack in more than one area, which he did not.

Two months later I heard a commercial on the radio saying “does your child have trouble eating certain foods?” and I thought YES!  I called L.I. Speech therapy MO and made an appointment for another evaluation.  At this point Jax is 18 months.  The therapist did feel that Jaxson needed feeding and speech therapy and thankfully my Insurance would cover 100% of the treatment!  This was great news and I felt such relief that help was FINALLY on its way.  I was told that we needed to wait 4 weeks before we started therapy because my Ins co had to review the evaluation.

Three weeks into the 4 week wait period I noticed something I never noticed before.  Jaxson’s web on his top lip was connected to the middle of his two front teeth.  I could not believe that I never noticed this before and that the Doctor’s never discovered this!  It was really thick and tight!  I was texting with my friend who also has a baby,  we would always talk about Jaxson’s feeding/speaking issues and I told her about what I found.  She said “oh that sounds like a lip tie”.  I immediately googled “lip Tie” and I couldn’t believe my eyes!  It looked exactly like Jaxson’s mouth.  I called my Pediatrician and made an appointment for my husband to take Jax in to see her (I had to work).  My husband said she was like “oh, yeah it’s no big deal.  The dentist will just cut it when they put braces on him”.  Again I am in shock and again I am searching for a new Pediatrician.

I e-mailed Jaxson’s feeding therapist telling her about my discovery asking if she thought that had anything to do with Jaxson’s eating and speaking delays.  She said it is possible and I should definitely look into a Frenectomy procedure.   Thankfully I don’t need a referral through my Insurance so I asked  Jaxson’s feeding therapist if she could recommend an oral surgeon.  She referred me to Lynn Pierri DDS,MS.  I met with Dr. Pierri  and she agreed that Jaxson needed a Frenectomy and she could do the procedure with a laser and the whole thing wouldn’t  take 5 minutes.

We have the Frenectomy scheduled for March 19th  (about a month away) and I am hoping that this procedure is the answer to our prayers.  Reading all of the success stories gives me great comfort and hope.  Especially the one from “MR” in Sleepy Hollow, NY.  Her son’s situation seems the closest to mine.  And the fact that her son started talking up a storm 6 weeks after the procedure gives me hope.  Thank you for sharing your story.

Regards,

Anne Marie”

I look forward to adding Anne Marie and Jaxson’s story among our Success Stories! We are praying for you, guys! :-)

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Laser Frenectomy for babies and children, in Arizona

On September 27th 2012, I received confirmation from the office of Dr Laila Hishaw, DDS, in Tucson, AZ, that she has been using Laser Frenectomy with success in the past few months. You can contact Dr Hishaw at 520-664-9000 and you can check out her website: www.TucsonSmilesaz.com

Here is Dr Hishaw’s letter, on March 10, 2012:

Dear Alessia,

Thank you for contacting my office as a referral source.  My partner, Dr. Priya Abramian, and I are pediatric dentists in Tucson, Arizona who believe in the necessity of lingual and maxillary frenectomies in newborns to aid in the comfort and efficiency of nursing for both the mother and child. 

I have been practicing for 12 years but can’t say that I have been performing frenectomies for all those years.  To be honest, it was just last year that one of my parents suggested I look at Dr. Larry Kotlow’s website to learn more about maxillary frenectomies.  She shared with me her struggles with finding a dentist who would listen and empathize with her on the pain she was experiencing while nursing her infant.  

I explained that her failure in finding a dentist was probably not because they could not perform the procedure, rather, they were not taught the indications nor the clinical procedure on infants.  There is a lack of curriculum taught in dental schools and residencies on the adverse effects of “tongue and lip tie” on breastfeeding, so a lot of this training is done by attending lectures and reviewing literature.  As a mother of three, who nursed all her children for 12 months (including my twins) I know first-hand the importance of nursing and support breastfeeding mothers wholeheartedly.  However, I was one of the lucky ones that did not have difficulty or pain, so I never realized the limitations a short-frenum could have on newborns until the parents of my patients told me.

I gained a wealth of knowledge from Dr. Larry Kotlow before my first case, but I have continued to further my knowledge by reading articles, reviewing cases by Dr. Brian Palmer online and attending a hands-on lecture hosted by Dr. Kotlow at his Albany, NY practice.  We have had much success using electrocautery but are looking forward to purchasing our very first laser this month!

An example of our work:

Before:

Pre-operation

After electrocautery:

5 days after operation:

What should you expect?  If you are traveling a distance, we will schedule your consultation on the same day of the child’s surgery.  We do not sedate our infants.  Local anesthetic is used on infants older than six months and sugar water is used on newborns.  We ask that parents bring their swaddling blanket or we will use our papoose board to restrain them from sudden movements.  Two assistants will be present, one to assist the doctor and the other to immobilize the child’s head.  Only one parent is allowed in the operatory during the procedure. The doctor will have the mother nurse immediately to evaluate how the child is latching. Detailed post operative instructions on care and stretching exercises will be reviewed and given to the parents.  A two week follow-up is recommended, however, for patients who travel quite a distance, we have followed up via phone and photos.

If you would like to learn more about us and our office, please visit our website at www.TucsonSmilesaz.com.

We look forward to meeting you and want your kids to “Grow Up Smiling!”

All the best,

Laila B. Hishaw, DDS
Board Certified Pediatric Dentist


Dr Laila Hishaw


Dr Priya Abramian

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Raising Awareness on Laser Frenectomy

Dr Fred Margolis (www.kidsmyl.com) informed us that a 3-day conference organized by the ALD (Academy of Laser Dentistry) was held in Scottsdale, AZ in April 2012.

Both Dr Margolis and Dr Kotlow were featured speakers at this important event, explaining hundreds of dentists and orthodontists why and how the use of Laser can help with the treatment of frenums. Raising awareness on the advantages of Laser: what a beautiful thing!

For more info on the ALD, please follow the link: http://www.laserdentistry.org

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