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How To Spot Tongue/Lip Ties & Get FREE Expert Advice

Affiliate Disclosure | in Motherhood | by | with 450 Comments

 how to diagnose tongue and lip ties

Yesterday I smiled at a a green-eyed blonde . . .

In gorgeous leather riding boots while wiping a Charlie Chaplin-style snot mustache from Micah’s lip. Wait! I forgot to tell you the best part: I wiped the snot blob with my sleeve. Oh yes, I am one of THOSE moms. The one who does NOT have a bandaid, wet wipe or [insert responsible mom paraphernalia] when zombie ducks attack. The one who can’t even get fake ducks all in a row and is still getting the hang of this mothering thing.

If you are feeling this way about breastfeeding, read on. Yesterday we covered why tongue and lip ties are often sources of misery like colic, reflux, low milk supply, early weaning, tooth decay, frequent night wakings and gapped teeth.

Today I’m going to show you how to make an informal at-home diagnosis, get a consult with the leading expert in the U.S. for FREE, and seek out treatment options. What you learn could be the vital piece of information someone around you needs to help them on their journey or relieve regret and guilt when things don’t go as planned. As Joy shared yesterday, understanding ties can be a very powerful thing:

“My son was born almost 8 months ago… I FOUGHT with everything I had to BF him….I cried, I searched the internet, I prayed, I talked to friends, lactation consultants and finally gave up and have been EP’ing [exclusively pumping] since 4 1/2 months… your article popped up in my feed this am and I clicked on it thinking it would tell me that I needed to pump more and eat this and eat that blah blah blah… MY SON IS LIP TIED!!!! and NOONE caught it!!! (%&#(&#$(&%(%$ is all I have to say right now… the guilt I felt was killing me… I am sure when I wake up tomorrow I will be relieved beyond words that it wasn’t about me as a mother or my milk supply… “(emphasis mine)

Let’s get started, shall we?

Step One: Make An Informal Diagnosis

Click here for a step-by-step exam guide.

Step 2: Get a FREE Email Consult From the Leading Tongue/Lip Tie Specialist in the U.S.

If you have a question or concern, Dr. Kotlow is willing to take a look at a quality photograph for FREE. Here’s how:

1. Take a photo of your child’s upper lip (pulled up) and tongue.

2. Make a list of your symptoms and your baby’s symptoms

3. Email the photos and symptoms to Dr. Kotlow at kiddsteeth@aol.com

Keep in mind that he’s not going to be able to give you a good firm diagnosis without actually examining the baby as well as knowing all of your symptoms. However, he can take a look and say whether it’s suggestive of a tie that should probably should be released..

Step 3: Evalutate Treatment Options

Mama’s often ask: I’m not having nursing problems, should I have the procedure done anyway?

According to Dr. Kotlow, a diagnosis involves looking at the structure of the mouth and discussing symptoms. If your baby is tongue-tied but you’re not experiencing any problems a revision may not be necessary. However, in some cases a revision might be recommended anyway due to the potential for  other problems: speech difficulties, trouble swallowing, orthodontic problems, etc.

Laser Revision

An erbium laser is able to effectively “vaporize” the extra tissue without any instruments actually coming in contact with the mouth. Babies usually feel little or no discomfort throughout the process (though they may protest at being swaddled – a safety measure to keep them still), and there is very little bleeding. Babies are encouraged to nurse immediately following the procedure and healing is very quick.

The photo on the right was taken 30 minutes after my son had the laser revision done by Dr. Kotlow (the quickie update I posted that morning is here). The rest of the day was spent strolling through Essex Village in Connecticut with my snuggly boy in the Boba. A great experience overall.

Unfortunately, few doctors/dentists currently use laser instruments so travel is often required. Here is the list of tongue-tie specialists currently using lasers (if you know of someone I’ve missed please let me know!)

Note: So you don’t miss it I am adding this comment from Mellanie Sheppard (who discovered Micah’s tie): “Recovery is not easy for every baby. For many babies, they first 24 hours can be pretty rough – very fussy and not wanting to nurse. This probably hinges on how thick/fibrous/deep the tie runs. Also, it is not a miracle cure. Some babies will need suck training afterwards (sometimes with an occupational therapist or speech therapist). Most babies will benefit from CST (cranio-sacral therapy) or chiropractic support afterwards. A tongue that is restricted is creating the wrong “pull” on the muscles in the floor of the mouth, which can in turn lead to subtle misalignment in the jaw, neck, etc.”

Scissor Method

Scissors cannot penetrate as deeply as lasers and do not remove the extra tissue, but if travel is out of the question seek out a highly qualified professional in your area – usually an ear/nose/throat doc or a pediatric dentist – to do the scissor method.  Then follow through with the stretching exercises described in the post-op section of this article. Most likely you will not receive instructions to do this but it is absolutely critical to the success of the procedure.

Micah first procedure was a frenectomy using scissors at 5 months. We were not given any instruction for post-op care and the tie grew back together with scar tissue on top, which is why we took him to Dr. Kotlow at 8 months.

Note: Mellanie’s statement about the above procedure applies here, too.

Other Beneficial Therapies

Cranio-sacral therapy and chiropractic care are both excellent complementary treatments to tongue/lip tie revision.

Breastfeeding a Tongue-Tied Baby

If, for whatever reason, neither procedures are available here are some tips on breastfeeding a tongue-tied baby

Well, that’s it.

If you have questions, insights or doctor recommendations please share them in the comments!

More breastfeeding support:

 

Photo credit: Lamour Michelle Photogray
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450 Responses to How To Spot Tongue/Lip Ties & Get FREE Expert Advice

  1. Amber says:

    Out of curiosity, what happens to a severe LT if nothing is done? My 9 month old has one but we are way down south in GA, and there are no doctors in the area that I trust. She is very wakeful (still every 2 hours at night to nurse) and has quite a large gap in her top teeth, but weighs 19 pounds and doesn’t seem to have any other issues.

    • Melissa says:

      http://www.kiddsteeth.com/articles/ttfactssheet.pdf‎ Will give you some ideas on what happens. Keep searching, or consider taking a trip to see Dr Kotlow in New York or someone else closer. We had my daughter’s Grade IV lip tie revised when she was 18 months old; it was a 13 hour one-way drive to get to somewhere that would do it with laser, and on a child less than 5 years old. It was worth every second of the drive and the cost of the trip. Good luck.

  2. A Step-By-Step Guide To Diagnosing Tongue/Lip Ties | The Mommypotamus | says:

    […] this post I share how to get a FREE expert opinion from Dr. Kotlow, who is the leading expert on tongue/lip […]

  3. Kathryn nordyke says:

    So I have an almost two year old that has buck teeth. When he was first born, we had him checked for a lip tie, and there wasn’t one present. We never had breast feeding issues. He gained weight very well and still has a very hardy appetite. He has just never slept well. So I looked on his mouth as I was trying to make sure he didn’t have food left in it before his nap. It now looks like he hasa. Major lip tie and also he has ties to his eye teeth. Is that normal? Is it worth looking in to? Even though he hasn’t had eating issues?

  4. Melissa says:

    My daughter was born in 2010, Calgary, AB, CanaDa. A city of over 1 million people, and not a single dentist in this city will touch a lip-tie until age 3, most not before 5. After emailing Dr Kotlow, we came to the conclusion that her lip-tie was significant enough to need repair sooner rather than later. Eventually, we found Dr Glenn Van As in Vancouver, BC. A 13 hour drive later, our daughter had her tie repaired by laser, the day before she turned 18 months. We had an immediate and dramatic change, and though she had some reattachment that may need to be dealt with in another couple years, things are great now. No speech problems, she’s still nursing (we were lucky that she was able, though only on one breast), and no cavities or other tooth problems. For other Canadians, finding someone can be very hard. I highly recommend Dr Van As for those out west. Here’s his website: http://www.drvanas.com/home/

    • Dr. Glenn van As says:

      Hi Melissa..thanks so much for mentioning my name here for lip tie and tongue tie releases. Yes I am doing these procedures for new borns on a regular basis with a laser and am willing to take photos from your smartphone if you are concerned enough prior to making a long journey to our office. I appreciate your kind words very much and as a good friend of Dr. Kotlow and someone who has lectured with him in the past and who lectures all over the world on lasers in dentistry, the ability to quickly release lip and tongue ties to help with nursing is something that many moms are aware of but not a lot of dentists are. If anyone is concerned about your son or daughter, feel free to either contact our office info@drvanas.com or my personal email at glennvanas@me.com. Thanks again Melissa that was very kind of you to mention us. Warmest regards- Glenn

  5. Ashley Campbell says:

    You say Dr. Kotlow will look at high quality picture and give a consultation. Any thoughts on how to capture a good image of a squirmy almost one year old’s mouth? She for sure has a lip tie, and I think possibly a posterior tongue tie, but I’m not sure on the tongue. Thoughts would be appreciated!

  6. Rene' Moore says:

    Actually, Dr Kotlow no longer has been able to keep up with email correspondence. It might be easier for you to feel under her tongue for any bump your finger may go over. If there is resistance and inelasticity when you start at one side and move your finger across to the other and there is a rather obvious ‘speed bump’ to go over then you will know there is something there to be evaluated by an expert. Hope this helps, and you can always email a picture to me, for an IBCLC eval. :)Rene’ Moore

  7. GMOs: 10 Surprising Places You'll Find Them - Mama Natural says:

    […] mom, friend and blogger who creates compelling and credible content on everything from vaccines to tongue-tied babies to awesome recipes. She also created the fantastic Nourished Baby book, something I rely on and […]

  8. SD says:

    I know moms who’ve gone to Dr Leonard Kundel DMD (holistic dentist) in Stamford, CT and have had very good results with their babies. He diagnosed our non-breastfeeding, pumped-breastmilk-drinking 9 mo with a lip tie and partial posterior tongue tie and, given we were well beyond learning how to breastfeed, suggested NOT correcting anything and keeping an eye on how things progress which I really respect.

  9. Heather Stein says:

    My three daughters had their lip tie revisions all done with Dr. Amy Grawey in St. Louis, MO (one of my daughters also had a lip tie). She has a laser and I am almost positive she was trained by Dr. Kutlow. She is excellent! I recommend her very highly. She has patients come back several days after a tongue tie revision to check and make sure it is not healing up. When we did this, she said that the tie was healing up paritally (we had been doing the post-op procedures) and she “popped” it back open (just with a forceful maneuver with a tongue depressor). I’m so grateful for this follow-up. My daughter began to nurse much better after the procedure and is still going at two years old.

    A very knowledgeable LC in my area (who regularly evaluates for tongue tie and then refers to other doctors) recommends Dr. Grawey and also a Dr. Kohler. I don’t know anything about him, or whether he has a laser.

  10. Christine says:

    I had my 2 month old sons lip tie lasered today by Dr. Korenman at Loveable Smiles in Richardson TX.

  11. Dafna Y. says:

    Adding to the list: Annette Skowronski, DDS, FAGD, in Shelby twsp, Michigan.

    My son was just now diagnosed with a posterior tongue tie & a lip tie. We have not yet went to see her, but I understand she is the only doctor in Michigan who does laser revisions.

  12. Ashley says:

    Great info! Dr. Myers is a Pediatric Dentist in Middleberg, FL (near Jacksonville) who uses laser. http://www.tooth2tooth.com.

  13. Sara Barnson says:

    Holy cow, I’m tongue tied. This explains almost all of my mom’s breastfeeding problems she had when I was a baby. 😀

    It also explains my jaw issues, grinding, shoulder & neck tension, and alignment issues that bring me to the chiropractor regularly. With that bit of tissue pulling on everything up there, little misalignments lead to bigger ones…

    Wow. I’ll have to be on the lookout with my kids one day.

  14. Michelle says:

    I am a midwife and many of my clients have gone to Dr Matt Rasche in Bloomington, Indiana for laser revision. He is the only doctor in the area that I know of who does this procedure on babies regularly and women have been traveling to him from as far away as Kentucky and very southern Indiana. http://www.sipediatricdentistry.com/tongue-tie-lip-tie.html

  15. Stephanie says:

    Dr. Ghaheri http://drghaheri.squarespace.com/ Portland, Oregon does laser revisions and was trained by Dr. Kotlow

  16. Elizabeth Thomas says:

    Just discovered my little 7week old has a lip tie. No major nursing issues- other than he pulls off often and has trouble maintaining a deep latch for long. Do you know of anyone near Nashville that does the laser procedure. Traveling is out of the question for us until Sept, I would like to see someone sooner than later. Thank so much!

    • Heather says:

      Elizabeth, I am just outside of Nashville, so hello! I’ve heard some folks say Vanderbilt does the procedure, but I have not confirmed whether they do the laser or scissors method. There is also a doc in Chicago that Mama Natural went to. It’s a short flight, so if you can’t get it handled immediately you might consider asking her for a reference later on.

  17. Debbie says:

    I wanted to let you know of another doctor using a laser to correct tongue and lip ties. Dr. Bobak (Bobby) Ghaheri is an ENT working in Portland and Gresham, OR. He treated my 4-week old daughter last week. I can’t recommend him enough! It’s been less than a week and my girl is nursing so much better! He literally saved our breastfeeding relationship! He entered this arena after his wife had breastfeeding issues due to ties with both of their daughters. More info can be found on his website, drghaheri.com. I will be blogging about my experience soon on my site, thepaleohygienist.com.

  18. Grace says:

    You can add Dr. Robert Marcus, DDS, in MD

  19. HeatherHH says:

    You can add Andrew Goldstone at Ear, Nose, and Throat Associates at the Greater Baltimore Medical Center. He used a laser to correct one of my children’s tongue-tie. We were very happy with him and would travel to him again if we had another child that needed a tongue tie corrected.

  20. Sunday Surf – January 15, 2012 Edition Hybrid Rasta Mama says:

    […] establish a breastfeeding relationship. Then check out part 2 if you are concerned about your baby possibly having a tongue tie. The tongue tie post was by far the most informative one I have ever read and really wish it was […]

  21. sherri says:

    Hi, there is a doctor in Portland, OR who does laser tongue/lip tie revisions. Found out about him on the Facebook tongue tie page. Dr. Bobby Ghaheri – http://www.drghaheri.com/

  22. Lauren Ferrin says:

    Mommypotomus, Dr. Ghahari in Portland, OR uses a laser. I’m considering going to see him for my boys. I’ve had many friends travel from Washington to go see him after unsuccessful scissor attempts.

    http://www.oregonclinic.com/our-team/bobak-ghaheri

  23. Megan says:

    I saw that someone posted about the pediatric dentists in Utah already, but I just wanted to add about Dr. Matthew Swan. He’s at http://www.kaysvillepediatricdental.com. We went several months ago to get our daughter looked at and then got her tongue tie revised with him. He was very nice to work with.

  24. Brianne says:

    Can you please provide links to medical studies that back up the claims being made here?

    Most everything about this “condition” that I can find on Google are poorly sourced blog entries that don’t really cite to any medical studies that can confirm that lip ties are abnormal, cause long term problems, or that procedures to snip them are safe for children long-term. Linking these studies on your blog would be helpful as many people may not know where to find the medical journal resources to locate the scientific information about this condition and the effects of the procedure.

  25. Cynthia says:

    Hi! Just wanted to let you know that Dr. Gina Tanios-Rafla in E. Brunswick, NJ also does a laser revision. Actually, it’s a water laser. She did my son’s type III PTT.

  26. Bev in Texas says:

    Julie Martinez in The Woodlands Texas uses a laser and I have heard excellent things about her
    http://childrensdentistwoodlands.com/

  27. Alissa says:

    We live in Perth, Western Australia. Our little boy had his tongue and lip tie reversed by Dr Mody at Woodvale Park Dental. He is one of only two dentists in Perth that use laser. Highly recommended. He very quickly identified a lip tie and posterior tongue tie after we were told by midwives, lactation consultants, doctors and nurses that he was fine, and that lip tie wouldn’t affect breastfeeding. I’m glad we had it reversed, breastfeeding is much more pleasant now, though we are still working through issues with low milk supply. Trying not to think on the “if only…” !

  28. Jen says:

    In Anchorage, AK Dr. Coplin (Alaska Dentistry for Kids: http://www.alaskadentistryforkids.com) revised our infant son’s lip with a laser.

  29. Kelsey says:

    Hi Heather! My daughter had laser surgery done to correct her tongue and lip tie by Dr. Leonard Kundel, a holistic dentist in Stamford, CT. He is wonderful! I hope that you add him to your list.

  30. Margaret says:

    Heather, your information on ties has been invaluable to me and I can’t thank you enough for it. We took our little one to Dr. Rajeev Agarwal in Phoenix, AZ. He uses the laser method for revisions. I would have recommended him to anyone and everyone just on the basis of our consult. After having our revisions done (tongue and upper lip) I would recommend him even more highly! We even decided to switch to his practice for our regular pediatric care.
    Do you have any information on buccal ties? Not only did our little one have PTT and ULT but Dr Agarwal also diagnosed buccal ties. PTT and ULT were revised, but since he didn’t know if buccal ties need to be revised he hasn’t scheduled a revision.

  31. Rene Moore says:

    I couldn’t agree more that Dr. Agarwal be highly recommended! (have recommended him here before) It may be important to know that his tool is actually electro-cautery, and he is fantastic with it! Parents are often surprised at how quick his procedures are. His vast experience makes him a top choice in Arizona. :)

    • Chelsea says:

      I have a daughter with a lip tie. We live in AZ. Where is Dr. Agarwal located? Do you know the name of his practice?

      • Margaret says:

        His practice is Agave Pediatrics in Scottsdale.

      • Rene' Moore says:

        Hi Chelsea,

        Dr. Rajeev Agarwal, MD of Agave Pediatrics
        North Office Location:
        7010 E Chauncey Ln
        Phoenix AZ 85054
        South Office Location:
        7333 E Thomas Rd
        Scottsdale AZ 85251
        Phone to reach both locations is 480-585-5200

  32. neha says:

    Can anyone pls tell me wat is the approximate cost of tongue tie surgery by scissor or by laser?

  33. neha says:

    Also pls suggest me any good doctor in st louis missouri us. For tongue tie treatment.

  34. Laura says:

    NEHA–Dr. Amy Grawey is wonderful. She is in St. Louis, MO. https://www.littleflowermd.com

  35. Misty TB says:

    I have never even heard of this until I clicked my way over from your placenta encapsulation post! I’m about to have my 3rd baby and am determined to successfully nurse this time. I checked my 3yo’s mouth and it seems like she has a very tight connection on her lip. Is it something I should have looked at even at 3?

  36. Pamela says:

    My son is 2 weeks old today. I have had problems with nursing the last 3 of my 5 babies. This little guy doesn’t latch well and doesn’t get much when he nurses (I have a breastfeeding scale). When he nurses he gets that upper lip callus and also needs to burp frequently. He didn’t receive the vitamin k shot at birth but got the oral at birth and at one week. Is there a risk for bleeding in a situation such as mine following the laser? Thank you

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