Adult Lip and Tongue Ties

     

What is lip tie?

Lip tie is a band of thick tissue that connects the underside of the lip to the gums and restricts the normal movements of the lip.

What is tongue tie?

Tongue tie is a band of thick tissue that connects the bottom of the tongue’s tip to the floor of the mouth and restricts the normal movement of the tongue.

What are some of the problems may be caused by tongue and/lip ties?

1.      Airway obstruction

·       In his book, “Tongue Tie,” pediatric dentist, Richard Baxter, D.D.S., discusses that the tongue is held down by a tongue-tie, the tongue often falls backward during sleep and blocks the airway.

·       When the airway is blocked, the body tries to open up the airway by protruding the lower jaw and grinding teeth.  It is a body’s defense mechanism of arousing the person to breathe when the airway is obstructed. (88, 89)

88.  Kostrzewa-Janicka J, Jurkowski P, Zycinska K, Przybylowska D, Mierzwinska-Nastalska E. Sleep-Related Breathing Disorders and Buxism. Adv Exp Med Biol 2015; 873:9-14.

89.  Jokubauskas L, Baltrusaityte  A.  Relationship between obstructive sleep apnoea syndrome and sleep bruxism:  a systematic review. J  Oral Rahabil 2017; 44(2): 144-53

2.      Chewing

·       Tongue tied restricts movement and function of the tongue.

·       Tongue cannot move food from side to side for sufficient chewing, swallowing and complete digestion.

3.      Swallowing

·       The tongue assists in swallowing 1200-2000 times per day.  Tongue tied restricts swallowing which prevents saliva/food to be swallowed normally and may lead to digestive problems.

4.      Cleaning of the Mouth

·       Tongue tied restricts the tongue from lifting and sweeping the food stuck between the cheeks and teeth.  Tongue is restricted and unable to clean the back teeth and the palate.

·       Lip tied can trap food between the lip and the teeth and make it difficult to brush.

5.      Facial development

·       Tongue tied keeps the tongue in a low position, so the palate does not receive its natural resting pressure from the tongue to form a broad and flat palate. Mal-alignment and mal-occlusion of the teeth may occur and affect the facial development of the person

6.      Obstructive Sleep Apnea (OSA)

·       Dr. 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.

7.      Speech

·       Movement of the tongue is important for pronunciation of words and linking the words into sentences.

·       Tongue tied restricts the tongue to move freely and reach the palate to sound out letters, words, and phrases

8.      Problems with posture, neck and back pain

Tongue tied may cause the head to tilt low and forward. The poor posture affects the sternocleidomastoid muscle, trapezius muscle and surround muscles and may cause the following problems:

·       Neck and back pain

·       Headaches and migraines

·       Shoulder pain

Note: dental problems caused by lip and tongue ties are discussed in the 2-24-2019 blog

What is frenectomy?

To remove the thick band of tissues that connects to the lip or tongue.

·       Labial frenectomy (aka frenectomy of lip)

·       Lingual frenectomy (aka frenectomy of tongue)

Indications of adult frenectomy

When the lip and/tongue tied is overlooked in an infant, future health problems can occur as an adult.  Lip and/tongue tied may be the cause of one or more of the problems discussed in this blog.  Consult with your dentist or general surgeon (ENT specialist) for evaluation and diagnosis.

How is frenectomy surgical procedure performed?

·       Scissors-bleeding

·       Scalpel or sharp surgical knife-bleeding

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

How long will the procedure take?

·       The amount of time needed for the frenectomy procedure depends on the technique used.  The entire procedure may be 30 to 60 minutes; includes pre-treatment preparation, post treatment instructions and the actual surgical (incision) procedure may take only a few minutes.

Post treatment care after the frenectomy procedure

·       Pain-relief medication may be needed

·       Salt water rinses for the next 5 days, 2-3 times per day

·       Soft food diets for 3-5 days; avoid hard, crunchy and spicy foods

·       Gentle tooth brushing

·       Follow-up visit

Orofacial Myofunctional Therapy before and after frenectomy

·       Pre- and post-frenectomy orofacial myofunctional therapy (OMT) helps re-educate the tongue and orofacial muscles during movement and at rest to create new neuromuscular patterns for proper oral function, including chewing, swallowing, speaking, and breathing.7

7 Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Cappasso R, Kushida CA. Myofunctional Therapy to Treat Obstructive Sleep Apnea; A Systematic Review and Meta-analysis. Sleep. 2015 May 1; 38(5):669-75. Doi: 10.5665/sleep.4652

If you are suffering from any problems related to lip and/tongue ties.  Dr. Anna Lee is here to help you with the diagnosis and treatment. 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.  If you have any question about lip and tongue tied frenectomy, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.

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.

 

Periodontal Disease = Gum Disease

Periodontal disease is also known as gum disease is a bacterial infection of the gum tissues and bone that hold the teeth in place.  It is caused by the bacteria in plaque, a sticky and colorless film that forms on the teeth. The early stages of gum disease can often be reversed and maintained with proper brushing, flossing and regular dental cleaning & check up with the dentist.  Gum disease that is left untreated would lead to tooth loss and other periodontal complications and problems.

This is the American Academy of Periodontology (AAP) classification of Periodontal Disease:

Type I  Gingivitis

·       Earliest stage of gum disease

·       No loss of attachment, no bone loss

·       Bleeding on probing may be present

·       At this early stage in gum disease, damage can be reversible since there is no bone loss.

·       Proper brushing, floss and regular dental cleaning help to remove plaque

Type II  Early Periodontitis

·       Pocket depths or attachment loss: 3-4mm.  Bone loss is present.

·       Periodontal pockets are formed as the dental tissues (gums and supportive ligaments) begin to pull away from the tooth.  These pockets trap bacteria and causes gum infection

·       Localized area of gingival recession; gums pull away and exposes the root

·       Bleeding on probing may be present

·       Damages caused by gum disease is irreversible

Type III  Moderate Periodontitis

·       Pocket depths or attachment loss: 4-6mm.   Bone loss is present.

·       Bleeding on probing

·       Furcation involvement

·       Teeth show mobility (loose)

·       Damages cause by gum disease is irreversible

Type IV  Advanced Periodontitis

·       Pocket depths or attachment loss: greater than 6mm.   Bone loss is present.

·       Supporting tissues and bone are destroyed. 

·       Bleeding on probing

·       Furcation involvement

·       Teeth show increased mobility (loose).  Some teeth are so loose that they may need to be extracted.

·       Damages caused by gum disease is irreversible

Signs of Periodontal Disease

·       Gums are red, swollen or tender

·       Gums that bleed during brushing or flossing

·       Teeth that look longer due to gum recessions

·       Formation of deep pockets between teeth and gums

·       Loose or shifting teeth

·       Persistent  bad breath or bad taste in the mouth

·       Changes of the teeth fit together when biting (occlusion)

·       Changes of the fit of the partial denture

Gum disease can occur at any age.  If gum disease is detected and treated at early stages, it can be reversed and maintained.  Currently, there is no cure for gum disease. 

If you notice any signs of periodontal disease, please contact Glendora Dentist, Dr. Anna Lee for a dental checkup.  You don’t have to lose teeth to periodontal disease.  Dr. Anna Lee can help to save your teeth. Call and schedule a free consultation at 626-335-5114 or visit us at www.annaleedds.com

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. 

Periodontal Disease Bacteria Linked to Alzheimer’s disease

A recent study published in the journal Science Advances found evidence linking bacteria associated with periodontal disease and Alzheimer’s.  Researchers analyzed brain tissue, spinal fluid and saliva from Alzheimer’s patients; both living and deceased and found the bacteria, P. gingivalis may play a role in the development and progression of Alzheimer’s.  However, Alzheimer’s experts not involved in the research caution that not enough research has been done to prove the association between periodontal disease and Alzheimer’s.

Research studies: possible link of Periodontal Disease and Alzheimer’s

·       *In January 2019, a new study published in the journal Science Advances, found a potential link between P. gingivalis, the bacteria associated with periodontal disease and Alzheimer’s.  **The co-founder of Cortexyme Inc., Dr. Dominy and his team found P. gingivalis in the brain tissue, spinal fluid and saliva from Alzheimer’s patients, both living and deceased.  The Cortexyme team did a mice study.  The team swabbed the gums of healthy mice with P. gingivalis every other day for 6 weeks to cause gum infection.  The team later detected P. gingivalis in the mice’s brain tissues along with dying neurons and higher than normal level of proteins that cause Alzheimer’s.

*American Academy of Periodontology. Perio.org   Article January 28, 2019                                                                      **Science Magazine January 23, 2019

·       *Researchers at the University of Illinois, Chicago (UIC) College of Dentistry performed a study on wild mice.  The mice received 22 weeks of repeated oral application of the periodontal bacteria.  The researchers found that the mice had more brain inflammation and fewer intact neurons due to degeneration than those mice without oral application of periodontal bacteria.                  Keiko Watanabe, D.D.S., Professor of periodontics at UIC said, “Our data not only demonstrate the movement of bacteria from the mouth the brain, but also that chronic infection leads to neural effects similar to Alzheimer’s.  Periodontal bacteria may kick start the development of the Alzheimer’s.”

*Dentistry Today  October 4, 2018

·       *Mark I. Ryder, DMD, Professor of Periodontology at the University of California, San Francisco noted that the presence of P. gingivalis increased the production of amyloid beta (plaque buildup in the brain) which contributes to Alzeimer’s.  Dr. Ryder confirmed the mice study that P. gingvalis can travel from the mouth to the brain and can destroy brain neurons.

*American Academy of Periodontology.  Perio.org  Article January 28, 2019

Gum Disease is a common condition for older adults

Richard Kao, DDS, PhD, president of the American Academy of Periodontology (AAP), encourages older adults to maintain diligent oral care and treat periodontal disease to help mitigate Alzheimer’s risks.  Dr. Kao said, “Periodontal disease increases to 68 percent for people age 65 and older…visiting a periodontist can help identify any disease and treated as needed, potentially diminishing the risk of developing Alzheimer’s.”  

More research is needed

P. gingivalis is likely to be one of a variety of pathogens that contributes to the amyloid beta (plaque buildup in the brain) that causes Alzheimer’s.  More studies are needed to support the link between periodontal disease and Alzheimer’s.  An upcoming FDA phase II clinical trial will assess and add further insight to the link between periodontal disease and Alzheimer’s.

Dr. Anna Lee is a General & Cosmetic dentist in Glendora, CA.   Periodontal disease can occur at any age. If you notice any signs and symptoms of periodontal disease, please call for a consultation.  You can visit us at www.annaleedds.com or call to schedule for an appointment at 626-335-5114. 

*Visit our website to read about periodontal disease on Dr. Lee’s blog.