Bedwetting is a common finding in children.  A child drinks fluids before bedtime, constipation, or an episode of emotional stress can cause a nighttime bedwetting accident.  For most children, nighttime bedwetting does resolve itself over time.  If nighttime bedwetting accidents become frequent; the child should be checked and evaluated for possible sleep-disordered breathing.

What is sleep-disordered breathing?

According to the American Academy of Otolaryngology (ENT), sleep-disordered breathing (SDB) is a general term for breathing difficulties during sleep.  It is a medical condition where part, or all, of the airway is blocked repeatedly during sleep. These are some of the symptoms of pediatric SDB:

·            Snoring

·       Irritability

·       Bedwetting-SDB can cause increased urine production at night, which may lead to bedwetting

·       Learning difficulties

What does a tongue tie have to do with sleep?

Dr. Richard Baxter’s article, Tongue-Ties and Sleep Issues, published from Dental Sleep Practice in winter 2018 discusses the following:

·        “A tongue that is held down by a tie is unable to rest in the palate.  The only place left for the tongue to go is backward, which closes off part of the airway.”  Snoring from upper airway resistance can be a warning sign of obstructive sleep apnea (OSA) or sleep disordered breathing.

·       “After tongue tie release, patient notices a deeper quality of sleep and the parents notice less snoring, less waking, and better mood in their child.”

Tongue Tie and Bedwetting 

Dr. Richard Baxter’s book, Tongue-Tied, discusses the association between tongue tie and bedwetting.

·       Sleep-disordered breathing causes lack of deep sleep in children and adults

·       Lack of deep sleep can cause bedwetting

·       Sleep-disordered breathing causes frequent arousals (interruptions), which can cause the child to have the urge to urinate

·       Recent systematic review of removing tonsils and adenoids showed that bedwetting improved in more than 60% of the patients and 50% had a complete resolution of symptoms.

·       Tongue tie release can allow the child to achieve deeper sleep levels and stop bedwetting

·       Removal of tonsils and adenoids, the application of maxillary expander (orthodontic treatment), and tongue tie release can all work together to improve sleep quality.

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for Laser lip and tongue tied frenectomy (releases) for infants, children and adults.  If you have any questions about lip and tongue tied frenectomy, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.

 

Aerophagia & reflux symptoms associate with lip and tongue tied babies

One of the complaints from breastfeeding mothers is that babies have difficulty in achieving a good latch at the breasts during breastfeeding. Dr. Ghaheri and Kotlow write blogs and articles on both the lip and/or tongue ties that restrict the movement of the lip and tongue and cause problems for the baby to latch on the mothers’ breasts incorrectly during breastfeeding. Some moms describe the latching as weak or shallow.  How does weak or shallow latching at the breasts affect the breastfeeding babies?  Some babies swallow an excessive amount of air, which reaches the stomach and causes abdominal distension, gassiness, and pain.  Some parents describe their babies having symptoms of reflux; difficulty sleeping when lying down, problems swallowing, spitting up, and constant crying among other symptoms.

What is aerophagia?

Aerophagia originates from the Greek word aerophagein, which means to “eat air,” is the excessive swallowing air (Chitkara et al., 2005; Courtiol, 2100; Fernando, 1998: Loening-Baucke, 2000).        Babies with lip tie attempt to latch the mother’s breasts; the upper lip frenum restricts the upper lip to flange outward and the baby will either pop off the breast completely or briefly relax and latch off the breast.  Tongue tie babies have a difficult time lifting the tongue; the frenum restricts the movement of the tongue and causes problems for the baby to latch onto the mother’s breast during breastfeeding. Tongue and/or lip ties may cause incorrect latching.  The consequences of an incorrect latch at the breast during breast feeding may include poor suck, poor seal around the breast, loud clicking noises, extended feeding times, poor infant weight gain, infant fussiness, and irritability during and after breastfeeding.

An inadequate seal around the breasts during breastfeeding may cause the baby to experience aerophagia, swallowing or sucking air into the stomach.  The babies may experience these symptoms:

·       abdominal distension

·       gassiness (flatulence)

·       belching (burping-swallow excessive air)

What is reflux?

*Reflux or GER (gastroesophageal reflux) in a baby may show up as irritability and pain, sometimes with constant or sudden crying, or colic-like symptoms.  Babies can be inconsolable, especially when laid down flat.

Signs & symptoms:

·       Difficulty sleeping when lying down

·       Arching their necks and back during or after feeding

·       Problems swallowing, gagging, coughing

·       Hiccupping and drooling

·       Feeding refusal or constant feeding

*Normal movement of the tongue is difficult or impossible if the tongue is tethered to the floor of the mouth     *Clinical Lactation 2011, Vol.2-4

Treatment

Aerophagia and reflux symptoms are experienced in lip and tongue tied babies and can be misdiagnosed as Gastroesophageal Reflux Disease (GERD).   Unfortunately, some babies are treated with prescription medications, such as Zantac or Prevacid to reduce the reflux symptoms.

* Dr. Larry Kotlow’s article, Infant Reflux and Aerophagia Associated with Maxillary Lip-tie and Ankyloglossia (Tongue-tie), suggests that a maxillary lip and/or tongue ties may be a contributing factor of babies’ inability to create an adequate seal for correct latching at the breasts during breastfeeding.

**There is a lack of literature and research looking at a potential causal relationship with aerophagia and reflux in breastfeeding infants.  More studies and researches are needed.

*Clinical Lactation 2100, Vol.2-4

**Int J Clin Pediatr.2016; 5(1):6-8

How to treat lip and tongue tied babies?

Both lip and tongue ties can be treated in quick procedure that is nearly painless, it usually may not require anesthesia.  The procedure is called frenectomy; the removal of frenum that connects to the lip or tongue.  Frenectomy can be performed with the following instruments:

·       Scissors-bleeding

·       Scalpel or sharp surgical knife-bleeding

·       Laser-minimal bleeding, faster surgical time, decreased postoperative pain, quick healing

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for Laser lip and tongue tied frenectomy (releases).  If you have any questions about lip and tongue tied frenectomy, please visit us at www.annaleedds.com or call for a consultation at                  626-335-5114. 

What are some of the problems caused by lip tie and tongue tie in adults?

 Are you an adult that is experiencing problems because of a dental lip tie? We can help. Here is more information on problems you may encounter as an adult with a lip tie.

·       Dental issues

-lip tie can trap food next to the teeth and make it difficult to brush and end up with dental cavities

-tongue tie causes restrictive movement of the tongue and is unable to clean the food particles off the back teeth and end up with dental cavities

-tongue tie, lip and buccal ties may cause gum recession. Strong muscles of the tongue, lips or cheeks pull on the gum tissues over time and exert a traumatic force that can cause the gums to recede.

·       Tooth grinding (Bruxism).  This is a hypothesis discussed in Dr. Richard Baxter’s book, Tongue Tie

-tooth grinding was thought to be a stress related problem.  The more stress you have, the more grinding is done during sleep.  The new thinking is that night time teeth grinding may be a sign of sleep-disordered breathing. This could be a tongue tie problem; the tongue is restricted with its movement.  When you sleep, the tongue falls backwards and blocks the airway.  It is hypothesized that the brain causes the teeth to grind and arouses the person to a lighter state of sleep. 

·       Other problems are migraine, sleep apnea, neck tension and posture

For more information on adult lip tie or to schedule your laser lip tie procedure, contact Dr. Anna Lee and her team today.