Alyssa’s story, 16 months old, Wisconsin, USA

Hi Alessia

I wanted to send you our story to post to your blog…  Here you go and thanks again for starting this blog!  It was because of you that our daughter has a beautiful smile now!  I’ve also attached “before and after” pictures so feel free to use those. Also, i also just wrote letters to all of the practioners that told us “no we would wait until age 7” telling our story and encouraging them to educate themselves on pediatric laser dentistry as an option!
We live in Wisconsin and discovered our 14 month old daughter had a very abnormal frenum (it was very thick and attached between her teeth creating a huge gap in between her front teeth). After hours upon hours of research and phone calls to dentists/surgeons, I discovered this blog and Dr Kotlow’s work and our true journey began! Thank you Alessia for sharing our stories with others so everyone that has a child with an abnormal frenum can have the knowledge and power to get it corrected now, with laser dentistry!
After many visits with quite a few different practitioners (her pediatrician, who referred us to a dentist, who referred us to a pediatric dentist, who referred us to an oral surgeon that refused to see us because he doesn’t do the procedure until age 7, to another oral surgeon, and another laser dentist practice), we were left feeling very frustrated because everyone was completely against doing this procedure before age 7. All of them agreed her case was very severe and that she will need something done, but refused to do anything now because they would put her under general anesthesia and use a scalpel, and said that she couldn’t handle the “healing time” and her arms would have to be boarded for days so she wouldn’t pull on her lip and rip the stitches. I emailed Dr Kotlow for advice and within minutes received a reply reaffirming my thoughts on laser frenectomies being the way to go, and with a recommendation to Dr Margolis in Chicago IL (http://kidsmyl.com) who was trained by Dr Kotlow and he said “he will take great care of your daughter”. We scheduled her procedure for a few weeks later in Chicago. FYI – We paid out of pocket for the procedure but is it VERY reasonable so it wasn’t an issue (our health insurance denied the claim, and we did not have dental insurance on our children).
The day of her procedure we were in and out of the dentist office within less than an hour. Dr Margolis swiped some numbing cream on her gums, and the actual laser procedure was over within 7 minutes (no other anesthesia was used). She cried during the procedure while I was holding her arms, but immediately after she drank milk and had her pacifier. Her recovery was so fast it boggled our minds! We only gave her two doses of Tylenol that day and she did not need anything for pain after that. Within 10 days her mouth had completely healed and the gap between her front teeth had almost fully closed. We are so grateful to those pediatric dentists that perform this procedure with lasers!
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Serious Speech Delay caused by Tongue Tie ~ Connor’s story

Following, is a letter Dr. Palmer received from a very thankful mother because her son had a life-changing experience when he had a frenectomy.  This is a true, but a very scary story, because it illustrates what little healthcare providers know about frenums.

January 24, 2008

Dear Dr. Palmer,

I wanted to thank you and tell you my son’s story.  My son was born in Feb. 2001, and by 22 months was only saying one word: go.  

It was clear to my husband and I that he was very intelligent, but we worried. His doctor recommended that we have him evaluated by Early Intervention. When the speech evaluator visited, I brought up the subject of Connor’s tongue. I had noticed that, when he stuck his tongue out, it never really extended out of his mouth, and I wanted to know if that could be causing the speech problem. She said that it would have no effect.  I was a bit confused by that, but deferred to her “expertise.”  

He was assigned a speech therapist who came twice a week.  After three months with no progress, she said to me “Have you thought about getting his tongue checked by an ENT doctor?”  I was furious that she had waited three months to mention it, and mad that the evaluator had dismissed my concerns.

At this point, he was 26 months old.  I took him to an ENT doctor to be checked.  She told me that, yes, he had a tight frenum, but that there was “no established literature” about the effect on speech, and that it would have no effect.  She suggested that I might want to get it fixed before his teen years “so that he would be able to kiss properly,” and even suggested that I have it done by a dentist in the dentist’s office!  It was clear to me that she wanted no part of giving me a diagnosis of any kind or providing any treatment to my son.

I immediately started talking to everyone that might know something about it, and searching the internet.  My Early Intervention coordinator gave me a phone number of a couple who had been told to wait a year to perform the operation, and regretted it.  I also found and downloaded your frenum document (2003).

Between those two inputs, I was given the courage to stand up to the doctor.  I went into her office and said “I want this surgery done, and I want you to do it as soon as possible.”  She did not argue, and scheduled the surgery for the following month.  It was performed without a hitch.  For six weeks, he didn’t utter a single sound.  He was constantly moving his tongue and mouth around with a fascinated look on his face – exploring his new possibilities.

Meanwhile, my son was up to his neck in therapy of all kinds.  His new speech therapist was telling me that my son was severely autistic and would never function in a normal classroom.  The therapist advised me to take him to a neurologist.  Fearing that I would be accused of negligence if I didn’t, I took him to the neurologist.  The appointment occurred during my son’s six weeks of silence following the operation.  The neurologist immediately discounted the speech therapist’s opinion because “it’s clear to me after two minutes with him that he understands every word I’m saying.” He was very alarmed at my son’s lack of speech.  When I explained everything about the tongue and the recent surgery, the neurologist said “That’s irrelevant.”  He wanted to hospitalize my son overnight for heavy testing.  I refused, and he was not happy about it.

In the meantime, after the six-week silence, my son started using every word in the book. He’s now turning seven, and you can’t keep him quiet for five seconds.  I have received comments from teachers that his vocabulary and diction are excellent.  It took us two more years to completely escape the well-meaning machine of special education, thankfully just before he started kindergarten.  He is currently ahead by two years in reading and math skills, has many friends and is a joy to us.

I cry whenever I tell this story, from great relief.  If I had not seen your presentation, talked to the right people and stood up to all the various doctors and therapists, I am terrified to think what might have happened to my son, and what might be happening to countless other kids.  Please continue to do whatever you can to spread the word about these issues.  If you reach even one other parent like me, it’s worth it.

Thank you, thank you, thank you!  I can never thank you enough.

MR

Sleepy Hollow, NY

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Near-death case caused by tight Frenum ~ 3-month-old baby, Haiti

Monday, July 11, 2011

Hello Alessia,

The baby in Haiti was three months old when I was consulted about her near-death situation. She was a twin. Her twin was thriving and breastfeeding well. This baby was not breastfeeding well, dehydrated, failure to thrive and had gained NO weight since birth…three months.

When I  arrived in Haiti, her Mother and Father were invited to meet with me at the guest house where I was staying. It was night time and, since that location in Haiti had no electricity at night (and very little during the day), I had to assess the baby by candle light and flashlight. Sure enough, she had a tight frenum. It wasn’t until  two days later that a physician,  who had just arrived in Haiti and had the proper instruments, was willing to listen to me and agree to try to perform a frenotomy. He had never performed one before and thought it an “out-of-date procedure”. None the less, he agreed and  performed the procedure. The baby was immediately put to breast and her Mother’s eyes became almost the size of saucers! She was immediately able to tell the baby was breastfeeding  correctly. The next day when we weighed the baby she had gained 40 grams overnight! She continued to gain 40 grams a day and slowly began to recover. Had her tight frenum not been clipped when it was, this baby would have died in a matter of just a few days. A 40-gram weight gain overnight as compared to no weight gain in three months was attributed solely to the frenotomy, which allowed correct movement of her tongue so she could breastfeed correctly. She is now over six years old and long ago caught up to her twin in weight and height.

Thank you,

Mary Grace Lanese

Maternal and Child Health Coalition of Greater Kansas City

http://www.mchc.net/

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Why wait?? ~ Kyle’s story

Hey Kevin! Did you know our son Kyle was also tongue-tied when he was born? We had to ‘fight’ for him too, although not to the extent it sounds like you did with Myla! I knew something was different as soon as Kyle tried to nurse the first time in the hospital, right after he was born. But, Riley had never really taken to nursing so I didn’t really know what/how it was supposed to be like. We moved when Kyle was 2 months old, so at his 4 month check with his new doctor, the first thing she said was, “Did you know he is tongue tied?” I answered “I KNEW something was different!” She recommended we just to wait till he was 5-6 yrs old, and if he had speech problems to take care of it then. Duh! Why wait and even RISK speech problems!!! She did insist we wait until he was at least a year old since it wasn’t causing any issues with him eating. We had him evaluated and then had it clipped when he was 13-14 months old. It was at the hospital under anesthesia, by an ENT. It only took a few minutes in surgery, no stitches at all. But, I was a WRECK and so nervous! I never even heard of laser surgery, what a great option! Hopefully it will become more the “norm” so parents don’t have to go through this with their kiddos at all!

I’m not sure if Kyle had a tight frenulum on his upper lip, but my guess is he probably did. If he did, then he and God took care of it! :) Kyle was just learning to walk and was pushing one of those walker toys around one day when he slipped. He came down on the handle, mouth first, and ripped/tore his upper frenulum! It bled for a bit then stopped. He ate ok that night, but when I checked on him before I went to bed his crib sheets were covered in blood! Talk about freaking out! (and of course Roger was out of town on a trip! LOL) I had a friend come stay with Riley while another friend and I took Kyle to the ER. 2-3 hours later when the dr finally saw us, the bleeding had stopped, he was acting fine, so they sent us home. So far he hasn’t had any speech/dental issues. But, he does have one of his top center teeth that is taking a LONG time to come in! I just looked at that area and I am wondering if there might be a small piece of tissue, a remnant of that frenulum, that might be blocking it from coming in! The kids have their regular dental appointments next week, so I will ask and have it checked!

Thanks for posting this and spreading the word about these situations! I am sure it will help someone! :)

Kimberly Hopkins Henderson, Woodbridge, VA

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Posterior Tongue Tie and other important resources, by Alison Blenkinsop, UK

I am very pleased to have been invited to write on this blog, and to promote it to others in the UK. I am a retired midwife and former International Board Certified Lactation Consultant (IBCLC) with experience of treating tongue-tie.

After many years of frustration in the UK, when lactation consultants and others trying to get help for tongue-tied babies wrote many articles and reports, and undertook research, in 2005 the National Health Service recommended frenulotomy for breastfeeding problems associated with tongue-tie (ankyloglossia). It is now much easier for tongue-tied babies to be treated in the UK, although there can be long delays which jeopardize breastfeeding.

Of particular international importance is research by lactation consultants Carolyn Westcott and Monica Hogan with Mr Mervyn Griffiths of Southampton hospital. You can read about it here: click to follow link, and the NHS guidance here: click to follow link. (We hope the guidance will be extended to include bottle-feeding problems, which many of us have encountered.) At present, King’s College Hospital in South London is undertaking research into posterior tongue-tie, a rarer presentation and much harder to treat and resolve, as the tie is partly or wholly submucous, and may not even be seen (though it can be felt), and the tongue often appears shortened.

The UK Baby Friendly Initiative has a list of places where tongue-tie can be divided. click to follow link. Lactation Consultants of Great Britain website has details of LCs offering a private frenulotomy service: click to follow link

I would like to commend for reading IBCLC Catherine Watson Genna’s Supporting Sucking Skills: click to follow link. Ultrasound films by Peter Hartmann’s colleagues show very clearly the disruption of tongue movement when ankyloglossia is present. The research is here: click to follow link.

 A Facebook page called ‘Tongue Tie Babies Support Group’ has recently been set up: click for Facebook page, or, from your Facebook page, go to “search” and write ‘tongue tie babies’.

I have written a light-hearted book on breastfeeding called Fit to Bust- a comic treasure chest, in support of Baby Milk Action (the UK arm of IBFAN. click to follow link), which includes two songs about tongue-tie. You can read about my book and a story of a mother with two tongue-tied children (Polly – a Strong faith) on my website.

Let’s continue to share these stories and information to ensure that parents, maternity and paediatric health care staff understand this condition, so that all babies with tongue-tie and feeding problems can be treated quickly.

Alison Blenkinsop, Aldershot, UK  http://www.linkable.biz/

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Tongue-Tie case in the UK ~ Brandon’s story

My son Brandon was born on 27/02/2004.

When he first cried, I noticed that his tongue looked very strange! but I didnt want to look silly, so I asked my husband to go get a midwife and tell her that his tongue looked strange.. One came over, said “oh yes, he has tongue tie” and then went again. As the midwife wasn’t concerned, nor was I, as I had never heard of tongue tie before.

When I was feeding him, it felt like wire strippers on my nipples! it was excruciating.. but I was just told that it would settle down soon.. when Brandons weight began to drop, I was told that I had to give him bottles, but I didn’t want to, so instead of giving up I decided that I needed something to keep me occupied while he fed.. So I decided to teach myself how to use a computer, and the internet.

Once I had mastered the internet and google, I googled tongue tie, and suddenly found out why it hurt so much! and why I was having so many problems..I then found out that years ago babies tongues were snipped if they were found to have tongue tie, and that some midwives would keep a long fingernail for this purpose!! But I also found that snipping of tongue ties was no longer common place since bottlefeeding had become so popular, If a baby couldn’t breastfeed then it didn’t matter they could just have a bottle!! I did not agree!!! I desperately wanted to breastfeed Brandon as I had been unable to breastfeed by 3 daughters for long, (I now know that this was due to bad advice and ‘care’ from health professionals, not my fault!) So I decided that I would somehow get his tongue snipped!!

Now with a baby who needed to feed almost constantly, and with me choosing to use the computer as distracion from the pain, I was getting good at using the computer!! And decided to set up a msn group called ‘tongue tie babies support group’, with pretty pages and everything!!! As I could see that there was not much advice out there, and to find someone who knew what I was talking about, let alone someone who had experienced having a tongue tie baby was nigh on impossible..

Now what happened after i set up my group is all kind of a blur, probably due to serious sleep deprivation, stress, pain, the fact that it was almost 8 years ago now and I have since had 2 more children!! so I will try to make this as accurate an account as possible! i think it was Pam Lacey ( miss you Pam xx) (PAM WAS A WONDERFUL LACTATION CONSULTANT WHO DIED LAST YEAR) who first joined my group and told me that there were private consultants who snipped babies tongue ties.. I was really excited and willing to do anything… Now this is a bit blurry!! i think Pam then told me about Alison Blenkinsop who was a lactation consultant, and who might know where i could get Brandons tongue snipped, so i contacted Alison and we spoke quite a bit through Email and on the phone, and she told me about Mervyn Griffiths (PAEDIATRIC SURGEON WHO HAS DONE RESEARCH), who snipped tongue ties!! I would need to go to Southhampton, to a private clinic, great, but was not looking forward to the train journey!! but there was a light at the end of my pain filled tunnel now!! At this point, I think Brandon was having to have some bottles, as his weight gain was non existant..

During all of this, I had learnt about some great organizations, like the ABM and the La Leche League, I was never told that there were actually people who could help!!!! I also learnt that my massive desire to breastfeed my child wasn’t as insane and crazy as i was being led to believe!!!

Anyway, what happened next was great, someone.. either Pam, Alison, or Mervyn I think (IT WAS ME!) told me that an old professor (Prof Whitelaw) was willing to snip Brandon’s Tongue tie, in Southmead hospital!! At the time, I just thought, ‘Yay! no massive train journey!!’ It wasnt until I got to the hospital to have his tongue snipped that i realized what a big deal this was!! And not until I had my second son in 2009 did I realise what I had achieved…

Anyways, We got to the hospital and met with Professor Whitelaw, who explained how a tongue tie procedure was carried out, Brandon would be swaddled, his mouth would be held open, and his tongue would be snipped with blunt scissors.. sounded scary, but he reassured me!! He then told me that a tongue tie division had not been carried out at Southmead hospital for 50 years!!! and that the only reason he knew how to do this was because he was an old doctor!! I was truly greatful to him… He asked if it was ok if students watched to learn how to do this, i said of course, and the room suddenly filled up!!!

A before picure was taken (I am not sure if it was filmed or not…), I then held Brandon while his tongue was snipped, it took seconds, then I was told to feed him… Brandon instantly stopped crying, and fed… it wasnt painful!!!!! An after pic was taken, I thanked professor Whitelaw lots!! signed some forms to say images could be used for training, and went home…

Channon, UK

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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]

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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]

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(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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