A lip tie is not a major physical anomaly in a baby. It may not be painful either but may cause problems in the long run, when left untreated. The lip tie in babies can interfere with breastfeeding, and also affect the development of the teeth. However, it can be addressed with some simple treatment.
MomJunction tells you about the causes of lip tie in babies, diagnosis, and treatment.
What Is A Lip Tie?
A lip tie occurs when the soft membrane of the tissue behind the upper lip tightly attaches to the upper jaw, restricting the movement of the lip (1).
Normally, the thin sheet of tissue (medically called labial frenulum) extends from behind the upper lip to the front of the gums of the upper jaw. You can see the tissue on raising the upper lip.
But in a lip tie, the frenulum is thick and extends to the ridge of the upper gums, where the teeth appear. Some extreme cases cause the tissue to extend beyond the ridge and towards the upper palate. In such cases, it can create a gap between the teeth.
In a lip tie, it is difficult to lift the upper lip. Lip tie is also known as ‘tight labial frenulum’ due to the rigidity of the upper lip.
What Causes A Lip Tie In Babies?
The lip tie is caused by an abnormally connected tissue due to an underlying reason. A fault in the MTHFR gene, which is also responsible for the development of cleft lip, is assumed to be responsible for lip tie in babies (2). Since the condition is genetic, there is no known way of preventing.
How Common Is Lip Tie In Babies?
In most newborns, the frenulum and the gums are attached in some way (3). However, this gets corrected automatically as the baby grows.
What Are The Different Types Of Lip Tie In Babies?
There can be variations in the type of lip tie depending on the extent of attachment of the frenulum to the upper gum. The following are the various classes of lip tie created by Dr. Kotlov, a dental surgeon (4):
- Class 1: The attachment of the frenulum to the upper gum is minimal and not significant enough to cause any problems.
- Class 2: The frenulum extends further into the upper jaw but mostly attaches to the external gums.
- Class 3: The frenulum tissue attaches to the ridge of the upper jaw gums and occupies the space between the two front teeth of the upper jaw.
- Class 4: It is an extreme case of lip tie where the frenulum tissue extends beyond the upper gum and almost reaches the upper palate of the mouth.
This categorization is called Kotlov’s Classification of lip-tie. There are other scales such as the Stanford University’s scale to measure the extent of the frenulum’s attachment, but the Kotlov classification is more commonly used.
In spite of this classification, there is still some controversy about the extent of attachment that is considered normal and abnormal (3). To determine if the lip tie needs a remedy, doctors check for a few specific symptoms or signs.
What Are The Symptoms Of Lip Tie In Babies?
You may see a few signs during breastfeeding, indicating that the baby may have a lip tie.
Symptoms and signs in the baby:
- Poor latch while breastfeeding is often the leading sign of lip tie because the baby’s lips are unable to flange around the nipple correctly.
- Since the baby is unable to maintain suction on the nipple, they come off the breast sooner than they should.
- The baby makes clicking noises because of the poor latch, which causes air to pass through the lips.
- More intake of air leads to gassiness in the baby.
- The baby becomes colicky and fussy. It is caused by the constant hunger, gassiness, and the frustration of not being able to sustain a latch.
- The baby’s upper lip curls inward when the frenulum is too tight. The tightness tugs the upper lip into the mouth.
- Poor weight and height gain due to inadequate breast milk consumption slows down the physical growth of the baby.
Symptoms experienced by the mother:
- Nipple pain. The improper latch can cause discomfort and pain in the nipple. The baby may also attempt to bite the nipple to hold on to it, causing further pain.
- Flattened nipples. The constant incorrect latch distorts the shape of the nipple.
- Engorgement of breasts and mastitis. The milk remains in the breast since the baby is unable to feed properly. It leads to breast engorgement, which in turn can lead to issues like mastitis, the infection of milk ducts.
If you sense that the baby is unable to maintain the latch, then you may check for a lip tie.
Gently lift the baby’s upper lip to see the thin sheet of frenulum tissue beneath. If it appears to be attached to the ridge of the upper gums or goes beyond it, then the baby likely has a lip tie. If you notice some other symptoms or are not sure if it is a lip tie, then see a doctor.
How Is Lip Tie In Babies Diagnosed?
A pediatrician can diagnose the condition by visual inspection alone. If a baby already has a tongue tie (where the tongue is attached to the lower palate), then the doctor will also check for lip tie since the two conditions often occur together (5). The doctor may refer to a lactation specialist or a pediatric dentist for a more accurate diagnosis of the condition.
Experts state that lip tie is mostly a benign condition that tends to improve as the baby grows (6). In case it is not, they propose a treatment to deal with the symptoms.
How Is Lip Tie Treated?
The treatment of lip tie is determined based on the class of lip tie diagnosed. Here is what constitutes the treatment of lip tie in babies:
- Manual release of tightness: Lip ties that fall under the Classes I and II may not require any formal treatment. The doctor may suggest basic exercises where a parent can gently slide the finger underneath the upper lip to stretch the frenulum tissue. Long term practice can gradually release the tissue’s tightness and allow normal mobility of the upper lip.
- Frenectomy: In this procedure, the frenulum is cut through an operation. Most doctors use a laser to cut the frenulum, and hence the surgery is called laser frenectomy. The mother lies on a dentist’s chair with the baby on her belly. The doctor then applies a local topical numbing agent to the frenulum. No general anesthesia is used.
The frenulum is cut using a laser; stitches may or may not be needed. Less severe cases may require only one cut with medical scissors. The entire procedure takes only a few minutes and could cause mild pain to the baby.
Post-treatment, a few steps need to be taken for a complete recovery. Keep reading to know what you can do.
How Can Parents Help Post Treatment?
Here is what you can do to help the baby recover better after the treatment:
- Breastfeed immediately after surgery: Since the baby is on the mother’s lap during surgery, the doctor will recommend breastfeeding immediately after the operation. It soothes the baby and also checks the baby’s latch. Some infants may take a few days to gain the correct latch. So notice when the baby establishes the correct latch to the breast.
- Soothe the pain: The baby cannot have a pain killer. Therefore, parents will need to use other methods of soothing the baby’s pain. You can swaddle the baby, cuddle with them, give them a warm bath, read them a book or sing a lullaby to make them more comfortable.
- Be watchful of any complications: Watch out for any signs of swelling or bleeding from the lips. If you notice any changes in the lips or the baby still has a problem with the latch, then see the doctor.
You may not be able to use a pacifier or teething toy for a certain duration after the operation. Postoperative visits to the doctor are needed to check if the tissue is healing and the baby can latch on to the nipple correctly. Overall, the healing of the lips after a frenectomy is quick and the results are usually good.
In the section below, we answer some other important questions related to lip tie in babies.
Frequently Asked Questions About Lip Tie In Babies
1. How to feed an infant with a lip tie?
If the baby has a low-level lip tie, then the doctor may teach you ways to gently stretch the frenulum with your finger and increase the mobility of the upper lip. You can then adjust the baby’s lip on the nipple for a better latch. Babies with lip tie may find it easier to latch on to a bottle nipple. So you can feed formula or expressed breast milk through a bottle. Try different bottle nipples to find the one that works best for your baby.
2. Can a baby with lip tie have speech problems?
There is no significant risk of speech problems due to a lip tie. Also, most babies will be treated before they develop any speech prowess. A lip tie is highly unlikely to impact a baby’s speech development.
3. Does lip tie cause teeth problems?
Yes. Lip tie can cause a gap between the upper central incisors, which are the front two teeth on the upper jaw. This happens because the frenulum passes between the teeth, causing the incisors to shift their position naturally. A change in the position of the incisors may further impact the location of the other teeth on the upper jaw.
The good news is that the baby will be treated of lip tie even before they get the temporary upper central incisors, leaving little scope for any dental problems.
4. Is there a recurrence of lip tie?
The recurrence rate of lip tie is very low. Most babies develop normal frenulum and upper lip movement after a frenectomy. The baby may have to be periodically checked by a doctor, even after the healing of the tissue. It will help detect any recurrence early on.
Lip tie has the potential to cause lasting problems due to the single reason that it interferes with breastfeeding, which is essential for a baby’s growth. Despite it being a congenital problem, treatment of lip tie does exist, and the treatment gives excellent results. Some post-treatment care and subsequent observation are all that it takes to cure the condition of lip tie in babies.
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2. MTHFR gene; U.S. National Library of Medicine
3. C.S. Maria et al., The Superior Labial Frenulum in Newborns: What Is Normal?; National Center for Biotechnology Information
4. L.Kotlow, Tethered Oral Tissues; Lawrence A. Kotlow Pediatric Dentist Clinic
5. Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie; National Center for Biotechnology Information
6. W. Heo and H.C. Ahn, Upper lip tie wrapping into the hard palate and anterior premaxilla causing alveolar hypoplasia; National Center for Biotechnology Information