Transcription:
Lip & Tongue Tie

Katie Salwei:  Riverside Healthcare puts the health and wellness information you need well within reach. Thank you for tuning in to the Well Within reach podcast. I'm your host, Katie Salwei and joining me today is ear, nose and throat specialist, Dr. Kristal Brown. Thank you so much for joining me today.

Dr. Kristal Brown: Thank you for having me.

Katie Salwei: So let's start by telling our audience a little bit about yourself. How'd you get into the medical field? Where did you go to school?

Dr. Kristal Brown: Sure. I was drawn to medicine early on in life through a series of sort of personal experiences. I had a brother with some medical problems, so I was in the doctor's office a lot with him and my parents. And so just sort of seeing the difference that a physician could make on your experience, no matter the medicine that comes with it, but the personality and the bedside manner that really made a difference, I think really drew me into doing something that you could help people.

So that was sort of how I started out being interested in it. I studied undergraduate at University of Southern California. And then, I went home to Hawaii for my medical school, to the University of Hawaii. And then I did my residency training at the University of Chicago, which is how I ended up here in the Midwest.

Katie Salwei: Okay. And ENT, so ear, nose and throat, what drew you into that specialty?

Dr. Kristal Brown: I had a really great mentor back home on Maui who actually was my physician. And I loved the surgery aspect of it. I liked feeling like I could intervene and make a difference in someone. I suppose I'm not a very patient person, so surgery was sort of enticing to me, that you could just actually fix something. But it also liked ENT because you have a longitudinal relationship with your patients as well. It's not so much that you just operate on them and never see them again. You get to do a lot of medical management and sort of long-term relationships with your patients also.

Katie Salwei: Okay. Well, it's so great to have you here. And today, specifically, we're going to be talking about a common issue in infants and babies that you don't hear a lot about, which is tongue and lip-tie. And so when a baby is tongue or lip-tied, what does that mean?

Dr. Kristal Brown: Yeah, that's a good question. So, our technical term for those things are frenulums. And a frenulum is really a bridge of tissue that secures a semi-mobile body part to an anchor, basically. So, you know, our lips and our tongue are both mobile parts of our face. So each of them have what we call a frenulum or a tie. For the upper lip, it's to the maxilla and, for the tongue, it's to the floor of mouth.

So when that bridge of tissue is tighter than average or tighter than normal and it's causing a limitation in the mobility of that structure, that's when we call it a lip or a tongue-tie.

Katie Salwei: Okay. And so how can something like this affect the baby?

Dr. Kristal Brown: So, tongue-tie can cause a lot of issues. Feeding, especially breastfeeding, it can cause a big impact on their ability to latch appropriately, which can then lead to the baby not getting enough milk because they don't have an ideal sort of way to move the milk out of the breast to their mouth. And it also can cause a lot of pain for the mom, because if they're not latching appropriately, then obviously that's a painful thing. And so a lot of times we'll have moms come in because they're having prolonged pain with nursing. And that's sort of how they end up in my office.

Katie Salwei: Okay. Aside from, I mean, the pain and things like that, is there anything else that you would be able to tell or know if your baby's experiencing any of these symptoms or is it just kind of "This isn't feeling right," kind of ask or is there other symptoms that they might experience?

Dr. Kristal Brown: So in the newborn phase, usually feeding is going to be the biggest one that you'll notice. And a lot of times lactation consultants are the ones that actually first notice this or a pediatrician. And so usually, it does come up because of feeding issues or even, you know, if they're bottle feeding, sometimes babies will have kind of allowed suck or they'll lose suction frequently or sometimes they won't be able to keep a pacifier in their mouth just because they can't really maintain that suction.

If you really pay attention to kiddos with tongue-ties, sometimes they can't get their tongue out past their gums. So if you ever see that, you know, that might be something that would point you to have it evaluated. And sometimes if they're really trying to stick their tongue out, it'll cause what we call a heart-shaped deformity of their tongue, because it's sort of pulling in at the center. So that's something else that, you know, you might see if your baby has a tongue-tie.

Katie Salwei: Okay. So is this correctable?

Dr. Kristal Brown: Yes. Tongue-tie is definitely correctable. For an infant, it's done in the office under a little bit of local anesthesia. Personally, I use a little bit of lidocaine jelly to the area. And then it's very quick procedure in the office. Now, if this persists past infancy, obviously, we wouldn't do that in the office. That will be in the operating room. And usually that comes up for different reasons. You know, if a parent is seeking their child to have their tongue-tie repaired, usually it's been causing other issues past sort of the breastfeeding issues as an infant.

Katie Salwei: Okay. So there is a choice. It doesn't have to be corrected, but it could potentially solve a lot of issues that might be happening, feeding, things like that.

Dr. Kristal Brown: Yeah, for sure. It does not have to be corrected. There are many adults walking around today with tongue-ties and it probably doesn't cause them any problems. But it can cause problems even later in life with speech and sometimes with even dental hygiene, because it can limit your tongue's mobility, sometimes you’re not cleaning the backs of your teeth well while you're eating, so you can have food get stuck and things like that. So it can be a dental issue as well. Lip-ties, there's a lot of discussion about whether it can cause a gap in a child's central incisors, basically your two front teeth if it's not corrected. That's pretty controversial, but there is some sort of talk about that.

So there are things that can pop up later in life. And of course, there are sort of social concerns for teens. Sometimes a teen will come in because they've had a tongue-tie their whole life and they've been doing okay with it, but now it just sort of bothers them because they're more aware of it. And even sometimes, they'll come in and say, you know, "I can't really lick an ice cream cone" or something.

And so there are, like I said, some social concerns that can pop up later in life that might prompt someone to get that repaired later. But it's not a must. You don't have to do it. But like you said, it can sometimes solve some problems with breastfeeding, obviously. If there are other issues as well, then it's not always a magic bullet to fixing every problem that you have with breastfeeding, but it can definitely be a big part of that.

Katie Salwei: And it's a pretty simple piece to even just see if that is the cause. I mean, simply being able to fix that and, if it helps, that's great. There's some more exploration that might need to be done.

Dr. Kristal Brown: Yes, exactly.

Katie Salwei: Okay. So if surgery or a fix of this is needed, you can do this. Do they ever catch this like after birth when they're still in the family birthing center and all? Or is it something that they just need to refer to an ENT or is there other physicians that do this as well?  

Dr. Kristal Brown: Yeah. So do think that sometimes this is caught right at birth. I've seen some very young infants, like within a week of age that have been diagnosed by either their pediatrician, like I said, right after birth or by the lactation consultant that sees patients in the hospital. Pediatric dentists also have a big part in treating this. They will also do this in their office and things like that. But for the most part, I would say it's either an ENT or pediatric dentist that should be treating this.

Katie Salwei: And so to schedule that appointment, they can call your office and your office number is (815) 928-5098. You can also go online at RiversideHealthcare.org, or you can visit MyRiverside MyChart, and you can schedule online through that as well. Is there anything else that we may have missed that you wanted to share about this?

Dr. Kristal Brown: No, definitely. If you have questions, you're always welcome to come in. I know I have some parents come in that just aren't sure. You know, they might be having trouble with breastfeeding. They've seen their lactation consultant. They have good support. But like you said, it's sort of one of those things that they're at the point where they say, "You know what? Maybe let's try this and see if it helps." I'm always open to just have the conversation with parents. I think it needs to be a joint decision that happens between the physician and the parents, because this is one of those things like we said earlier is not a must. You don't have to fix this. It's not necessarily something that's dangerous. But it can have an impact.

The other thing is really the importance of the lactation consultant in all of this. I think that that's a huge part of being able to breastfeed successfully for young moms. And so if someone is out there listening that's having trouble with their latch or with breastfeeding, I would really encourage them to get a hold of our lactation consultant here at Riverside. She's great. And I'm sure she would be happy to schedule an appointment or help out with something.

Katie Salwei: Most definitely, yeah. If you're looking for contact with a lactation consultant, you can visit RiversideHealthcare.org and we have all the information on the website for you. Well, thank you so much for joining me today, Dr. Brown, and for helping us understand what this really means. Me, especially, I didn't know a lot about this until a couple of friends I know have had this happen and it corrected some stuff for them. And just being able to share this information is great to help any parents out.

And thank you for tuning into the Well Within Reach podcast with ear, nose and throat specialist, Dr. Kristal Brown and your host, Katie Salwei. To learn more about Riverside's ENT specialist, visit RiversideHealthcare.org.