FAQ & Resources

Frequently Asked Questions

Questions? We have answers.

Here, we aim to address the most common questions and concerns you may have about our services and offerings. We understand that seeking information is essential in making informed decisions, and our goal is to provide you with clear and comprehensive answers to help you feel confident and at ease. If you can’t find what you’re looking for, please don’t hesitate to reach out to our team, and we’ll be more than happy to address your questions and concerns.

Frenectomy AfterCare Instructions

Questions? We have answers.

Here, we aim to address the most common questions and concerns you may have about our services and offerings. We understand that seeking information is essential in making informed decisions, and our goal is to provide you with clear and comprehensive answers to help you feel confident and at ease. If you can’t find what you’re looking for, please don’t hesitate to reach out to our team, and we’ll be more than happy to address your questions and concerns.

Frenectomy AfterCare Instructions

Questions? We have answers.

Here, we aim to address the most common questions and concerns you may have about our services and offerings. We understand that seeking information is essential in making informed decisions, and our goal is to provide you with clear and comprehensive answers to help you feel confident and at ease. If you can’t find what you’re looking for, please don’t hesitate to reach out to our team, and we’ll be more than happy to address your questions and concerns.

Frenectomy AfterCare Instr.

Symptoms

What are symptoms a baby with a tongue tie may have?

  • difficulty achieving a good latch
  • falls asleep attempting to nurse
  • slides or pops off breast when attempting to nurse
  • clicking, swallowing air or inflated tummy
  • short sleep episodes (needing to feed frequently)
  • strongly pursed lips
  • child appears to have a small mouth
  • child will not open their mouth wide to feed
  • child appears to have a short tongue
  • heavy or noisy breathing
  • snoring (even a little)
  • witnessed events of breathing stopping (apnea)
  • unable to keep pacifier in
  • waking up congested
  • sleeping only in upright position
  • unhappy when laying on back
  • torticollis
  • arches back when put to breast
  • discomfort when upper lip is raised by adult
  • gagging once solid food introduces
  • needing to supplement after a nursing session
  • picky and messy eater once solid food is introduced
  • colic
  • milk leaking out sides of mouth or nose during feedings
  • failure to thrive, not gaining weight
  • falling off the babies growth curve for weight
  • long nursing sessions, baby not satisfied with session
  • swallowing air
  • uncoordinated suck-swallow-breathe pattern
  • excessive gas
  • gulping or just “drinking” a heavier let down
  • clicking sound while nursing
  • cannot keep nipple of a bottle in mouth
  • biting or chomping on bottle nipple instead of sucking
  • blisters on lip(s) and or tongue
  • difficulty swallowing
  • choking on milk
  • unable to move tongue side to side and lift up
  • heart shaped tongue or cleft or notch in tip of tongue
  • can extend tip of tongue over lower ridge only or not even to lower ridge
  • cannot raise tongue
  • high and narrow palate
  • retracted lower jaw
  • plagiocephephy, brachycephaly, or scaphocephaly head shape, or commonly heard is a flat spot on the head
  • a scissors “snip” at birth that did not resolve problem
  • a health professional suggesting a tie may be a problem

How do I know if my baby has a tongue-tie?

“My Facebook and Instagram people said he does!”

If a healthcare professional has diagnosed a tongue tie based on in-person anatomy and function evaluation, then it’s confirmed. However, online suggestions, even from well-meaning parents, may not be accurate due to the complexity of a thorough examination. It’s crucial to support one another, but for an accurate diagnosis, consult a qualified professional, preferably one with expertise in tongue ties!

Why have I been told by some providers there is a tongue tie and others say there isn’t a tie?

In healthcare, the knowledge gap regarding tongue-ties has been a challenge. Medical training often dismissed them as non-existent, and even dental education rarely covered their comprehensive impact. The changing tide now sees increased awareness, but embracing this transformation requires proactive learning and sometimes a complete shift in perspective.

Read more

What symptoms of a tongue tie may a nursing parent experience?

  • cracked, creased, misshapen or blanched nipples
  • painful nursing
  • painful latching
  • bleeding, abraded or cut nipples
  • poor or incomplete draining
  • feeling of baby chomping
  • infected nipples or breasts
  • plugged ducts
  • mastitis
  • lipstick shaped nipples
  • breast, areola, or nipple thrush
  • feelings of depression
  • over or under supply of milk
  • knowing “something isn’t right” compared to a previous breastfeeding experience
  • nursing for long periods of time
  • unable to breastfeed so switched to bottles

What are the long term implications of a tongue tie?

Children and Adults:

Have you ever been told to “wait and see,” only to discover that waiting doesn’t always lead to the best outcome? This advice is still commonly given by healthcare professionals, even when there are early signs of airway-related breathing issues in children. Today, we understand that addressing underdeveloped upper and lower jaws in children aged 4 to 10 can yield more predictable and successful outcomes compared to waiting until their growth potential diminishes in their teenage years.

The consequences of a compromised airway are significant. A narrow nasal airway often leads to mouth breathing and vice versa. Unfortunately, mouth breathing lacks the benefits of filtering, humidifying, warming the air, and stimulating the release of vital compounds like nitric oxide, all of which nasal breathing accomplishes effectively. In addition, mouth breathers tend to take in excessive air while expelling excessive carbon dioxide, the primary driver of our breathing. This imbalance can lead to a negative cycle of chronic hyperventilation.

 

Infants and Feeding Mothers:

See the list of possible symptoms for infants and their feeding mothers for some ideas of how you may have been or are affected. For adults, add headaches, neck and shoulder pain, speech problems, poor quality of sleep, a bad bite, TMJ pain, and swallowing issues to the list of symptoms. While these lists are not exhaustive, please know that the mouth is not separate from the rest of your body. Your body is a whole, and there are consequences to not being able to function as it’s meant to. It’s possible you have experienced many symptoms and just worked your way through them. This is what compensation is all about, making do with less than ideal. However, if you do not recognize that any of those symptoms apply to you, congratulations, you are a rare tongue-tied human! We do know through research that having a tongue tie increases your risk of pediatric sleep apnea and should be screened for by age one. It is also a risk factor for sleep-disordered breathing in school-aged children. It increases the risk of not being breastfed and having an underdeveloped upper jaw that is further back in your face, which is problematic due to restricting airflow.

 

Read more 

What are symptoms a baby with a tongue tie may have?

  • difficulty achieving a good latch
  • falls asleep attempting to nurse
  • slides or pops off breast when attempting to nurse
  • clicking, swallowing air or inflated tummy
  • short sleep episodes (needing to feed frequently)
  • strongly pursed lips
  • child appears to have a small mouth
  • child will not open their mouth wide to feed
  • child appears to have a short tongue
  • heavy or noisy breathing
  • snoring (even a little)
  • witnessed events of breathing stopping (apnea)
  • unable to keep pacifier in
  • waking up congested
  • sleeping only in upright position
  • unhappy when laying on back
  • torticollis
  • arches back when put to breast
  • discomfort when upper lip is raised by adult
  • gagging once solid food introduces
  • needing to supplement after a nursing session
  • picky and messy eater once solid food is introduced
  • colic
  • milk leaking out sides of mouth or nose during feedings
  • failure to thrive, not gaining weight
  • falling off the babies growth curve for weight
  • long nursing sessions, baby not satisfied with session
  • swallowing air
  • uncoordinated suck-swallow-breathe pattern
  • excessive gas
  • gulping or just “drinking” a heavier let down
  • clicking sound while nursing
  • cannot keep nipple of a bottle in mouth
  • biting or chomping on bottle nipple instead of sucking
  • blisters on lip(s) and or tongue
  • difficulty swallowing
  • choking on milk
  • unable to move tongue side to side and lift up
  • heart shaped tongue or cleft or notch in tip of tongue
  • can extend tip of tongue over lower ridge only or not even to lower ridge
  • cannot raise tongue
  • high and narrow palate
  • retracted lower jaw
  • plagiocephephy, brachycephaly, or scaphocephaly head shape, or commonly heard is a flat spot on the head
  • a scissors “snip” at birth that did not resolve problem
  • a health professional suggesting a tie may be a problem

How do I know if my baby has a tongue-tie?

“My Facebook and Instagram people said he does!”

If a healthcare professional has diagnosed a tongue tie based on in-person anatomy and function evaluation, then it’s confirmed. However, online suggestions, even from well-meaning parents, may not be accurate due to the complexity of a thorough examination. It’s crucial to support one another, but for an accurate diagnosis, consult a qualified professional, preferably one with expertise in tongue ties!

Why have I been told by some providers there is a tongue tie and others say there isn’t a tie?

In healthcare, the knowledge gap regarding tongue-ties has been a challenge. Medical training often dismissed them as non-existent, and even dental education rarely covered their comprehensive impact. The changing tide now sees increased awareness, but embracing this transformation requires proactive learning and sometimes a complete shift in perspective.

Read more

What symptoms of a tongue tie may a nursing parent experience?

  • cracked, creased, misshapen or blanched nipples
  • painful nursing
  • painful latching
  • bleeding, abraded or cut nipples
  • poor or incomplete draining
  • feeling of baby chomping
  • infected nipples or breasts
  • plugged ducts
  • mastitis
  • lipstick shaped nipples
  • breast, areola, or nipple thrush
  • feelings of depression
  • over or under supply of milk
  • knowing “something isn’t right” compared to a previous breastfeeding experience
  • nursing for long periods of time
  • unable to breastfeed so switched to bottles

What are the long term implications of a tongue tie?

Children and Adults:

Have you ever been told to “wait and see,” only to discover that waiting doesn’t always lead to the best outcome? This advice is still commonly given by healthcare professionals, even when there are early signs of airway-related breathing issues in children. Today, we understand that addressing underdeveloped upper and lower jaws in children aged 4 to 10 can yield more predictable and successful outcomes compared to waiting until their growth potential diminishes in their teenage years.

The consequences of a compromised airway are significant. A narrow nasal airway often leads to mouth breathing and vice versa. Unfortunately, mouth breathing lacks the benefits of filtering, humidifying, warming the air, and stimulating the release of vital compounds like nitric oxide, all of which nasal breathing accomplishes effectively. In addition, mouth breathers tend to take in excessive air while expelling excessive carbon dioxide, the primary driver of our breathing. This imbalance can lead to a negative cycle of chronic hyperventilation.

 

Infants and Feeding Mothers:

See the list of possible symptoms for infants and their feeding mothers for some ideas of how you may have been or are affected. For adults, add headaches, neck and shoulder pain, speech problems, poor quality of sleep, a bad bite, TMJ pain, and swallowing issues to the list of symptoms. While these lists are not exhaustive, please know that the mouth is not separate from the rest of your body. Your body is a whole, and there are consequences to not being able to function as it’s meant to. It’s possible you have experienced many symptoms and just worked your way through them. This is what compensation is all about, making do with less than ideal. However, if you do not recognize that any of those symptoms apply to you, congratulations, you are a rare tongue-tied human! We do know through research that having a tongue tie increases your risk of pediatric sleep apnea and should be screened for by age one. It is also a risk factor for sleep-disordered breathing in school-aged children. It increases the risk of not being breastfed and having an underdeveloped upper jaw that is further back in your face, which is problematic due to restricting airflow.

 

Read more 

Diagnosis

Are tongue ties a new thing?

The short answer is no, they are not new.  Stories of Moses point to his tongue tie and well as some other Biblical texts.  As early as 1473, it was taught to midwives to use a sharp nail to divide a tongue tie.  What is new is the attention it is getting and the number of procedures done.  The huge increase in procedures has made main-stream medicine very worried.  Studies in the past only studied ties that go to the tip of the tongue, so the incidence was found to be between 1  and 12.1%, depending on the study.  A recent study of all babies born in one hospital for one year, the incidence of ankyloglossia was 46.3% of which around 70% were symptomatic.   The difference is that this study looked for posterior tongue ties as well as ties to the tip of the tongue.

What is the best age to release a baby's lip and tongue tie?

Research has shown that as soon as the baby is ready, in the opinion of the care team, the results are higher than those who wait. 

What are the next steps after a Tongue-Tie is diagnosed?

When a tongue-tie is diagnosed, we talk about when that should be released with a frenectomy. The specific procedure that is performed at Life Smiles for adolescents and adults is coined a “functional frenuloplasty.” This procedure involves sutures.

 

On the other hand, children under 18 months old are treated with a CO2 laser and the laser site is left open. If you are fascinated with lasers, check out the website for the LightScalpel laser.

 

Dr. Geisler will release patients who are actively in treatment with a myofunctional therapist. For others who have a tongue tie, the tongue-tie release may be recommended mid-way through a series of steps. As the public knowledge of tongue-ties increases, there are many people who are convinced that a simple “snip” will resolve their health concerns and seek just the procedure, however, Dr. Geisler has seen that poor results can be expected if therapy isn’t done before and after the procedure.

What do Airway exams look like?

When individuals contact our practice for a tongue tie evaluation, if they are 4 years of age or older we conduct what we call an ‘airway exam.’ Dr. Geisler recognizes the importance of proper tongue function in optimal airway development and considers overall well-being during the assessment.

 

After an initial conversation to gather concerns and history, we perform a comprehensive assessment. This includes photographing aspects like the face, arches, tongue, throat, and body posture. We also measure factors like mouth opening, tongue-to-palate reach, and suction ability. Additionally, we assess the length of the lower face, arch widths, and examine tonsils, throat, dentition, and nasal passages. We often recommend at-home sleep screening as a healthy airway and quality sleep are closely connected.

 

People with tongue ties often exhibit various compensatory mechanisms and may have a collapsible or narrow airway. To gauge fatigue and its impact on daily life, we use the fatigue severity scale (FSS). We may also review past imaging or request new films like panorex, cephalometric films, or cone beam CT (CBCT). Dr. Geisler checks for muscle tenderness in the head and neck area and evaluates jaw range of motion. Observing eating and drinking habits aids our assessment. Our recommended steps vary depending on individual circumstances and often involve referrals to other healthcare professionals, including ENT specialists, sleep experts, chiropractors, orthodontists, physical therapists, and certified orofacial myofunctional therapists who are also speech-language pathologists (COMs). Dr. Geisler tailors her recommendations to address specific needs!

What does sleep screening involve?

In our dental practice, we have many different types of sleep screening tools that are recommended and are worn at home. They are easy to use, really! If you have never seen a photo of a person wired up for a sleep study in a lab, just do a web search, and you appreciate the simplicity of our screening.

The sleep screening device that is approved for age 6 months of age and up is made by a company named Sleep Image and is a single lead EKG called a Cardiopulonary Coupler. (left image)

 

The another device is called a high resolution pulse oximeter (HRPO) and can be used for both children and adults. (right image) The reports from our devices are not a true or medically official sleep study, but a software report is generated after a few nights of sleep, simply working as a tool to get a balanced objective measure of sleep quality to help us decide who needs to see a sleep physician.

 

Because the screening devices are easy to use while you sleep in your own bed, it is reasonable to follow-up in 6-12 months after any therapy to objectively compare data to assure we are truly improving sleep quality.

 

Dr. Geisler uses the first mentioned device for very young children and for others who are very sensitive to their sleeping environment. More commonly since 2021, we use a WatchPat which includes a reading of the report from a sleep physician, who is able to diagnosis problems. This is approved for ages 12 and older. For 3 to 11 year olds, we are working with a third party called True Sleep Diagnostics to get similar, physician interpreted reports and diagnoses.

 

Sleep Disordered Breathing (SDB) affects the health and quality of life of anyone it impacts, and nearly always the family they are a part of. SDB is a spectrum, and has numerous presentations. Some symptoms that are related to sleep disordered breathing are:
  • Fatigue
  • Snoring
  • Difficulty falling asleep
  • Difficulty staying asleep
  • Gasping or choking
  • Grinding teeth
  • Pausing breathing (apnea)
  • Recurrent tonsillitis or history of tonsils and/or adenoid removal
  • Poor school or work performance
  • Tossing and turning
  • Feeling stressed out upon wakening
  • Not feeling rested after a good amount of hours of sleep
  • Emotional instability
  • ADHD/ADD
  • High resting pulse rate
  • Hypertension
  • Falling asleep on sitting
  • Falling asleep while driving
  • Poor memory
  • Dry mouth on waking
  • TMJ pain
  • Headaches
  • Neck and shoulder pain
  • Forward head posture
  • Restless legs
  • Low thyroid hormone
  • Difficulty losing weight
  • Depression and anxiety

Are tongue ties a new thing?

The short answer is no, they are not new.  Stories of Moses point to his tongue tie and well as some other Biblical texts.  As early as 1473, it was taught to midwives to use a sharp nail to divide a tongue tie.  What is new is the attention it is getting and the number of procedures done.  The huge increase in procedures has made main-stream medicine very worried.  Studies in the past only studied ties that go to the tip of the tongue, so the incidence was found to be between 1  and 12.1%, depending on the study.  A recent study of all babies born in one hospital for one year, the incidence of ankyloglossia was 46.3% of which around 70% were symptomatic.   The difference is that this study looked for posterior tongue ties as well as ties to the tip of the tongue.

What is the best age to release a baby's lip and tongue tie?

Research has shown that as soon as the baby is ready, in the opinion of the care team, the results are higher than those who wait. 

What are the next steps after a Tongue-Tie is diagnosed?

When a tongue-tie is diagnosed, we talk about when that should be released with a frenectomy. The specific procedure that is performed at Life Smiles for adolescents and adults is coined a “functional frenuloplasty.” This procedure involves sutures.

 

On the other hand, children under 18 months old are treated with a CO2 laser and the laser site is left open. If you are fascinated with lasers, check out the website for the LightScalpel laser.

 

Dr. Geisler will release patients who are actively in treatment with a myofunctional therapist. For others who have a tongue tie, the tongue-tie release may be recommended mid-way through a series of steps. As the public knowledge of tongue-ties increases, there are many people who are convinced that a simple “snip” will resolve their health concerns and seek just the procedure, however, Dr. Geisler has seen that poor results can be expected if therapy isn’t done before and after the procedure.

What do Airway exams look like?

When individuals contact our practice for a tongue tie evaluation, if they are 4 years of age or older we conduct what we call an ‘airway exam.’ Dr. Geisler recognizes the importance of proper tongue function in optimal airway development and considers overall well-being during the assessment.

 

After an initial conversation to gather concerns and history, we perform a comprehensive assessment. This includes photographing aspects like the face, arches, tongue, throat, and body posture. We also measure factors like mouth opening, tongue-to-palate reach, and suction ability. Additionally, we assess the length of the lower face, arch widths, and examine tonsils, throat, dentition, and nasal passages. We often recommend at-home sleep screening as a healthy airway and quality sleep are closely connected.

 

People with tongue ties often exhibit various compensatory mechanisms and may have a collapsible or narrow airway. To gauge fatigue and its impact on daily life, we use the fatigue severity scale (FSS). We may also review past imaging or request new films like panorex, cephalometric films, or cone beam CT (CBCT). Dr. Geisler checks for muscle tenderness in the head and neck area and evaluates jaw range of motion. Observing eating and drinking habits aids our assessment. Our recommended steps vary depending on individual circumstances and often involve referrals to other healthcare professionals, including ENT specialists, sleep experts, chiropractors, orthodontists, physical therapists, and certified orofacial myofunctional therapists who are also speech-language pathologists (COMs). Dr. Geisler tailors her recommendations to address specific needs!

What does sleep screening involve?

In our dental practice, we have many different types of sleep screening tools that are recommended and are worn at home. They are easy to use, really! If you have never seen a photo of a person wired up for a sleep study in a lab, just do a web search, and you appreciate the simplicity of our screening.

The sleep screening device that is approved for age 6 months of age and up is made by a company named Sleep Image and is a single lead EKG called a Cardiopulonary Coupler. (left image)

 

The another device is called a high resolution pulse oximeter (HRPO) and can be used for both children and adults. (right image) The reports from our devices are not a true or medically official sleep study, but a software report is generated after a few nights of sleep, simply working as a tool to get a balanced objective measure of sleep quality to help us decide who needs to see a sleep physician.

 

Because the screening devices are easy to use while you sleep in your own bed, it is reasonable to follow-up in 6-12 months after any therapy to objectively compare data to assure we are truly improving sleep quality.

 

Dr. Geisler uses the first mentioned device for very young children and for others who are very sensitive to their sleeping environment. More commonly since 2021, we use a WatchPat which includes a reading of the report from a sleep physician, who is able to diagnosis problems. This is approved for ages 12 and older. For 3 to 11 year olds, we are working with a third party called True Sleep Diagnostics to get similar, physician interpreted reports and diagnoses.

 

Sleep Disordered Breathing (SDB) affects the health and quality of life of anyone it impacts, and nearly always the family they are a part of. SDB is a spectrum, and has numerous presentations. Some symptoms that are related to sleep disordered breathing are:
  • Fatigue
  • Snoring
  • Difficulty falling asleep
  • Difficulty staying asleep
  • Gasping or choking
  • Grinding teeth
  • Pausing breathing (apnea)
  • Recurrent tonsillitis or history of tonsils and/or adenoid removal
  • Poor school or work performance
  • Tossing and turning
  • Feeling stressed out upon wakening
  • Not feeling rested after a good amount of hours of sleep
  • Emotional instability
  • ADHD/ADD
  • High resting pulse rate
  • Hypertension
  • Falling asleep on sitting
  • Falling asleep while driving
  • Poor memory
  • Dry mouth on waking
  • TMJ pain
  • Headaches
  • Neck and shoulder pain
  • Forward head posture
  • Restless legs
  • Low thyroid hormone
  • Difficulty losing weight
  • Depression and anxiety

Are tongue ties a new thing?

The short answer is no, they are not new.  Stories of Moses point to his tongue tie and well as some other Biblical texts.  As early as 1473, it was taught to midwives to use a sharp nail to divide a tongue tie.  What is new is the attention it is getting and the number of procedures done.  The huge increase in procedures has made main-stream medicine very worried.  Studies in the past only studied ties that go to the tip of the tongue, so the incidence was found to be between 1  and 12.1%, depending on the study.  A recent study of all babies born in one hospital for one year, the incidence of ankyloglossia was 46.3% of which around 70% were symptomatic.   The difference is that this study looked for posterior tongue ties as well as ties to the tip of the tongue.

What is the best age to release a baby's lip and tongue tie?

Research has shown that as soon as the baby is ready, in the opinion of the care team, the results are higher than those who wait. 

What are the next steps after a Tongue-Tie is diagnosed?

When a tongue-tie is diagnosed, we talk about when that should be released with a frenectomy. The specific procedure that is performed at Life Smiles for adolescents and adults is coined a “functional frenuloplasty.” This procedure involves sutures.

 

On the other hand, children under 18 months old are treated with a CO2 laser and the laser site is left open. If you are fascinated with lasers, check out the website for the LightScalpel laser.

 

Dr. Geisler will release patients who are actively in treatment with a myofunctional therapist. For others who have a tongue tie, the tongue-tie release may be recommended mid-way through a series of steps. As the public knowledge of tongue-ties increases, there are many people who are convinced that a simple “snip” will resolve their health concerns and seek just the procedure, however, Dr. Geisler has seen that poor results can be expected if therapy isn’t done before and after the procedure.

What do Airway exams look like?

When individuals contact our practice for a tongue tie evaluation, if they are 4 years of age or older we conduct what we call an ‘airway exam.’ Dr. Geisler recognizes the importance of proper tongue function in optimal airway development and considers overall well-being during the assessment.

 

After an initial conversation to gather concerns and history, we perform a comprehensive assessment. This includes photographing aspects like the face, arches, tongue, throat, and body posture. We also measure factors like mouth opening, tongue-to-palate reach, and suction ability. Additionally, we assess the length of the lower face, arch widths, and examine tonsils, throat, dentition, and nasal passages. We often recommend at-home sleep screening as a healthy airway and quality sleep are closely connected.

 

People with tongue ties often exhibit various compensatory mechanisms and may have a collapsible or narrow airway. To gauge fatigue and its impact on daily life, we use the fatigue severity scale (FSS). We may also review past imaging or request new films like panorex, cephalometric films, or cone beam CT (CBCT). Dr. Geisler checks for muscle tenderness in the head and neck area and evaluates jaw range of motion. Observing eating and drinking habits aids our assessment. Our recommended steps vary depending on individual circumstances and often involve referrals to other healthcare professionals, including ENT specialists, sleep experts, chiropractors, orthodontists, physical therapists, and certified orofacial myofunctional therapists who are also speech-language pathologists (COMs). Dr. Geisler tailors her recommendations to address specific needs!

What does sleep screening involve?

In our dental practice, we have many different types of sleep screening tools that are recommended and are worn at home. They are easy to use, really! If you have never seen a photo of a person wired up for a sleep study in a lab, just do a web search, and you appreciate the simplicity of our screening.

The sleep screening device that is approved for age 6 months of age and up is made by a company named Sleep Image and is a single lead EKG called a Cardiopulonary Coupler. (left image)

 

The another device is called a high resolution pulse oximeter (HRPO) and can be used for both children and adults. (right image) The reports from our devices are not a true or medically official sleep study, but a software report is generated after a few nights of sleep, simply working as a tool to get a balanced objective measure of sleep quality to help us decide who needs to see a sleep physician.

 

Because the screening devices are easy to use while you sleep in your own bed, it is reasonable to follow-up in 6-12 months after any therapy to objectively compare data to assure we are truly improving sleep quality.

 

Dr. Geisler uses the first mentioned device for very young children and for others who are very sensitive to their sleeping environment. More commonly since 2021, we use a WatchPat which includes a reading of the report from a sleep physician, who is able to diagnosis problems. This is approved for ages 12 and older. For 3 to 11 year olds, we are working with a third party called True Sleep Diagnostics to get similar, physician interpreted reports and diagnoses.

 

Sleep Disordered Breathing (SDB) affects the health and quality of life of anyone it impacts, and nearly always the family they are a part of. SDB is a spectrum, and has numerous presentations. Some symptoms that are related to sleep disordered breathing are:
  • Fatigue
  • Snoring
  • Difficulty falling asleep
  • Difficulty staying asleep
  • Gasping or choking
  • Grinding teeth
  • Pausing breathing (apnea)
  • Recurrent tonsillitis or history of tonsils and/or adenoid removal
  • Poor school or work performance
  • Tossing and turning
  • Feeling stressed out upon wakening
  • Not feeling rested after a good amount of hours of sleep
  • Emotional instability
  • ADHD/ADD
  • High resting pulse rate
  • Hypertension
  • Falling asleep on sitting
  • Falling asleep while driving
  • Poor memory
  • Dry mouth on waking
  • TMJ pain
  • Headaches
  • Neck and shoulder pain
  • Forward head posture
  • Restless legs
  • Low thyroid hormone
  • Difficulty losing weight
  • Depression and anxiety

Definitions

What does “scope of practice” mean?

From Wikipedia:

“Scope of practice describes the procedures, actions and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license.  The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency.”

 

For instance, your massage therapist isn’t qualified legally, even if they are brilliant and have gone through a tongue tie journey with their own family.  You do not need to be referred by a healthcare professional to be seen for an evaluation.  Dentists, Speech Language Pathologists, Nurse practitioners, Physician Assistants, Chiropractors and Physicians are officially qualified.  Lactation specialists are often the first to recognize there are problems and in some countries, midwives also diagnose and release tongue ties.

What is a posterior tongue tie?

The term posterior tongue tie is confusing to so many people. The term posterior means toward the back. Many physicians  may read that and think we are referring to the very back part of the top of your tongue, the part that is down the throat. It still is under the tongue, it just doesn’t attach so closely to the tip of the tongue. Posterior tongue ties are known for restriction elevation of the middle to back third of the tongue to the roof of the mouth. This effectively causes compensating suck, swallow and breathing and speech. In addition, it leads to a low tongue posture which has a negative domino effect on facial growth. Sticking the tongue out is the very worst way to see if there is a tongue tie. Challenging elevation from the top of the patients head while they lay in front of you, is the technique used to assess anatomy under the tongue. This video is very helpful to understand what a posterior tongue tie is, and what a proper swallow looks like with ultrasounds and graphics.

 

While various methods exist for classifying tongue-ties, they mainly focus on anatomy, not function. Severity depends on symptoms, such as poor weight gain, latching issues, or difficulties in breastfeeding, revealing the tie’s impact on function. Functional assessments gauge a frenum’s impact, and current research validates the effectiveness of posterior tie releases. Here is current research showing improvements after a posterior tongue tie release.

Why are there so many words for tongue-tie and surgery?

You are right if you think the nomenclature for this subject is tricky.  Here is a list to help you:

 

  • Lingual:  pertaining to the tongue

 

  • Lingual Frenum=Frenulum=Tongue-tie=tethered oral tissue (TOTs): From Dictionary.com: a fold of membrane that checks or restrains the motion of a part, as the fold on the underside of the tongue

 

  • Maxillary: pertaining to the maxilla (think upper lip or upper jaw)
  • Buccal = pertaining to the cheek = cheek tie:
    we have four of them, 2 upper and 2 lowers

    • Frenotomy: incising a frenum
    • Frenectomy: removing a frenum
    • Frenulectomy: removing a frenulum
    • Frenulotomy: incising a frenulum
    • They four are basically indistinguishable and can be used interchangeably.  For ease, I use the term Frenectomy for babies and Frenuloplasty for adolescents and adults

 

  • Frenuloplasty: surgical repair of a frenum

 

  • Tongue tie: Ankyloglossia; An embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement

 

  • A Release: lay term for any of the above procedures

 

  • A Revision: a term when the procedure is done again due to less than ideal healing

 

  • Tethered oral tissues (TOTs): any combination of tight frenums

What does “scope of practice” mean?

From Wikipedia:

“Scope of practice describes the procedures, actions and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license.  The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency.”

 

For instance, your massage therapist isn’t qualified legally, even if they are brilliant and have gone through a tongue tie journey with their own family.  You do not need to be referred by a healthcare professional to be seen for an evaluation.  Dentists, Speech Language Pathologists, Nurse practitioners, Physician Assistants, Chiropractors and Physicians are officially qualified.  Lactation specialists are often the first to recognize there are problems and in some countries, midwives also diagnose and release tongue ties.

What is a posterior tongue tie?

The term posterior tongue tie is confusing to so many people. The term posterior means toward the back. Many physicians  may read that and think we are referring to the very back part of the top of your tongue, the part that is down the throat. It still is under the tongue, it just doesn’t attach so closely to the tip of the tongue. Posterior tongue ties are known for restriction elevation of the middle to back third of the tongue to the roof of the mouth. This effectively causes compensating suck, swallow and breathing and speech. In addition, it leads to a low tongue posture which has a negative domino effect on facial growth. Sticking the tongue out is the very worst way to see if there is a tongue tie. Challenging elevation from the top of the patients head while they lay in front of you, is the technique used to assess anatomy under the tongue. This video is very helpful to understand what a posterior tongue tie is, and what a proper swallow looks like with ultrasounds and graphics.

 

While various methods exist for classifying tongue-ties, they mainly focus on anatomy, not function. Severity depends on symptoms, such as poor weight gain, latching issues, or difficulties in breastfeeding, revealing the tie’s impact on function. Functional assessments gauge a frenum’s impact, and current research validates the effectiveness of posterior tie releases. Here is current research showing improvements after a posterior tongue tie release.

Why are there so many words for tongue-tie and surgery?

You are right if you think the nomenclature for this subject is tricky.  Here is a list to help you:

 

  • Lingual:  pertaining to the tongue

 

  • Lingual Frenum=Frenulum=Tongue-tie=tethered oral tissue (TOTs): From Dictionary.com: a fold of membrane that checks or restrains the motion of a part, as the fold on the underside of the tongue

 

  • Maxillary: pertaining to the maxilla (think upper lip or upper jaw)
  • Buccal = pertaining to the cheek = cheek tie:
    we have four of them, 2 upper and 2 lowers

    • Frenotomy: incising a frenum
    • Frenectomy: removing a frenum
    • Frenulectomy: removing a frenulum
    • Frenulotomy: incising a frenulum
    • They four are basically indistinguishable and can be used interchangeably.  For ease, I use the term Frenectomy for babies and Frenuloplasty for adolescents and adults

 

  • Frenuloplasty: surgical repair of a frenum

 

  • Tongue tie: Ankyloglossia; An embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement

 

  • A Release: lay term for any of the above procedures

 

  • A Revision: a term when the procedure is done again due to less than ideal healing

 

  • Tethered oral tissues (TOTs): any combination of tight frenums

Our Practice

What age of babies do you see?

We provide care for patients ranging from newborns to 18 months, offering examinations and performing tongue, lip, and cheek tie releases for infants using a laser.

 

From 18 months to 4 years old, we focus on dental check-ups, assessing jaw development, and addressing sleep and airway concerns in children. When performing releases for children aged 4 and above, including elementary school-age patients, we conduct the procedure known as a functional frenuloplasty. In some cases, we use laughing gas for young children to alleviate anxiety.

 

Remarkably, we’ve successfully treated patients as old as 70 years. Our approach encompasses discussions on breathing, overall health, and sleep for all patients. Additionally, for early interceptive growth orthodontics, we often begin treatment around the age of 4.

Can I be in the room for the procedure?

Our approach to treatment prioritizes the safety and comfort of your baby. Through our experience, we have determined that it is in the best interest of the child to conduct the procedure without any family members present in the room. This firm rule ensures a controlled and sterile environment, allowing our skilled professionals to focus entirely on the procedure.

 

We understand that as parents, your presence provides a sense of security to your child. That’s why we have created a dedicated feeding room where you can prepare to be the calm, nurturing presence that will soothe and reassure your child immediately after the procedure. This separation during the procedure allows us to carry out the treatment efficiently while minimizing any potential distractions or interruptions, ultimately leading to a safer and more successful outcome for your little one!

Will you guarantee I can have a release the same day as my consultation?

No, we do not  guarantee that there will be a release the same day as the consultation.  Often-times, releases do happen on that day, but please come with expectations that it may not!  Through the years of seeing patients for releases, Dr. Geisler has learned that proper timing is paramount. Wisdom comes with experience, and when releases are done before the patient is ready, poor results of not gaining improved function and less than ideal healing can be the result.

 

Those who do have releases done the day of the assessment always had tongue tie feeding experts working with them, have been doing exercises with the baby called “suck training” and have been working with a bodyworker.  That being said, you can have done those things, and release is still not guaranteed the day of assessment. 

 

Dr. Geisler knows from personal experience as a parent of a tongue-tied baby, that anxiety can be high and it’s tough to wait.  Please understand, we do not enjoy making people wait, and we don’t charge extra if treatment is provided on another day.  We have performed over 3500 releases, and our primary goal is to provide the best care and do everything possible to assure a great result.

 

Read more:

Can I have a consultation only?

Yes, we often schedule consultations only, as the initial step in our patient evaluation process. This allows us to thoroughly assess your condition and listen to your concerns. We believe in personalized care, and an examination doesn’t always lead to treatment or there are preparatory therapies or measures that can enhance treatment effectiveness. This consultative approach empowers us to make informed, tailored decisions for our patients’ health.

What age of babies do you see?

We provide care for patients ranging from newborns to 18 months, offering examinations and performing tongue, lip, and cheek tie releases for infants using a laser.

 

From 18 months to 4 years old, we focus on dental check-ups, assessing jaw development, and addressing sleep and airway concerns in children. When performing releases for children aged 4 and above, including elementary school-age patients, we conduct the procedure known as a functional frenuloplasty. In some cases, we use laughing gas for young children to alleviate anxiety.

 

Remarkably, we’ve successfully treated patients as old as 70 years. Our approach encompasses discussions on breathing, overall health, and sleep for all patients. Additionally, for early interceptive growth orthodontics, we often begin treatment around the age of 4.

Can I be in the room for the procedure?

Our approach to treatment prioritizes the safety and comfort of your baby. Through our experience, we have determined that it is in the best interest of the child to conduct the procedure without any family members present in the room. This firm rule ensures a controlled and sterile environment, allowing our skilled professionals to focus entirely on the procedure.

 

We understand that as parents, your presence provides a sense of security to your child. That’s why we have created a dedicated feeding room where you can prepare to be the calm, nurturing presence that will soothe and reassure your child immediately after the procedure. This separation during the procedure allows us to carry out the treatment efficiently while minimizing any potential distractions or interruptions, ultimately leading to a safer and more successful outcome for your little one!

Will you guarantee I can have a release the same day as my consultation?

No, we do not  guarantee that there will be a release the same day as the consultation.  Often-times, releases do happen on that day, but please come with expectations that it may not!  Through the years of seeing patients for releases, Dr. Geisler has learned that proper timing is paramount. Wisdom comes with experience, and when releases are done before the patient is ready, poor results of not gaining improved function and less than ideal healing can be the result.

 

Those who do have releases done the day of the assessment always had tongue tie feeding experts working with them, have been doing exercises with the baby called “suck training” and have been working with a bodyworker.  That being said, you can have done those things, and release is still not guaranteed the day of assessment. 

 

Dr. Geisler knows from personal experience as a parent of a tongue-tied baby, that anxiety can be high and it’s tough to wait.  Please understand, we do not enjoy making people wait, and we don’t charge extra if treatment is provided on another day.  We have performed over 3500 releases, and our primary goal is to provide the best care and do everything possible to assure a great result.

 

Read more:

Can I have a consultation only?

Yes, we often schedule consultations only, as the initial step in our patient evaluation process. This allows us to thoroughly assess your condition and listen to your concerns. We believe in personalized care, and an examination doesn’t always lead to treatment or there are preparatory therapies or measures that can enhance treatment effectiveness. This consultative approach empowers us to make informed, tailored decisions for our patients’ health.

Recovery

What is the recovery like?

Infants: When it comes to infants, you can expect a day or two of fussiness following the procedure. Lots of skin-to-skin time is helpful during this period, offering snuggles and comforting. Feedings may vary, initially improving, then becoming a bit more challenging before improving again. Some families find homeopathy or infant Tylenol helpful during the first day or possibly two. Stretching the released areas can cause some discomfort for the baby, leading to fussiness for a few minutes afterward. This tends to greatly reduce around day 6 or 7. Keep in mind that every baby is unique, so your experience may differ from others.

 

Children and Adults: For children and adults, you can anticipate some soreness for a day following the procedure. To manage discomfort, we recommend taking ibuprofen before the procedure to stay ahead of any pain. Stick to soft foods for the first few days, gradually progressing to textures you can chew and swallow without much difficulty. Some individuals may take ibuprofen or a similar medication for just that day, while others opt for 2-3 days. It’s perfectly fine to return to work or school the day after the procedure. During the follow-up at one week, many people report that each day of the first week becomes easier.

Should I feed my baby after the procedure?

Yes, you should be prepared to feed your baby immediately following the procedure! This can involve breastfeeding, bottle-feeding, or syringe feeding, a decision that rests with you, not Dr. Geisler.

 

This post-procedure feeding serves multiple valuable purposes. It provides comfort and reassurance to both the baby and the parent, promotes tongue exercise, and aids in sealing any potential residual bleeding should it occur. This nurturing and nourishing act is an essential part of the post-procedure care, ensuring the well-being and recovery of your little one.

What is the recovery like?

Infants: When it comes to infants, you can expect a day or two of fussiness following the procedure. Lots of skin-to-skin time is helpful during this period, offering snuggles and comforting. Feedings may vary, initially improving, then becoming a bit more challenging before improving again. Some families find homeopathy or infant Tylenol helpful during the first day or possibly two. Stretching the released areas can cause some discomfort for the baby, leading to fussiness for a few minutes afterward. This tends to greatly reduce around day 6 or 7. Keep in mind that every baby is unique, so your experience may differ from others.

 

Children and Adults: For children and adults, you can anticipate some soreness for a day following the procedure. To manage discomfort, we recommend taking ibuprofen before the procedure to stay ahead of any pain. Stick to soft foods for the first few days, gradually progressing to textures you can chew and swallow without much difficulty. Some individuals may take ibuprofen or a similar medication for just that day, while others opt for 2-3 days. It’s perfectly fine to return to work or school the day after the procedure. During the follow-up at one week, many people report that each day of the first week becomes easier.

Should I feed my baby after the procedure?

Yes, you should be prepared to feed your baby immediately following the procedure! This can involve breastfeeding, bottle-feeding, or syringe feeding, a decision that rests with you, not Dr. Geisler.

 

This post-procedure feeding serves multiple valuable purposes. It provides comfort and reassurance to both the baby and the parent, promotes tongue exercise, and aids in sealing any potential residual bleeding should it occur. This nurturing and nourishing act is an essential part of the post-procedure care, ensuring the well-being and recovery of your little one.

General Questions

What is the difference between an ENT snipping a tongue tie and a dentist using a laser?

The success of a release is not in the instrument used to release nor is it determined by the release provider being either a dentist or an ENT doctor.  Success starts with well thought out diagnosis and plan, pre-release therapy, and experienced and thorough release, proper stretching by the parent(s) and regaining of function. It never should be “just a snip.” 

 

Dr. Geisler does use a laser to release babies, but if that was taken away, and all the other factors above stood, a scissors would work very well in her hands. The advantage of a laser is that a relatively dry field is maintained, so that a thorough release is done. We can see well when we use a laser, but with scissors, compression is needed to aid in clotting before a reassessment is done and any further release during the procedure itself.  When lasers are used during surgery, it is very quick and research has shown less swelling than other methods. A laser is a precision instrument, and only releases tissues up to a millimeter from the tip.

 

Our laser is a Co2, non contact laser, named Lightscalpel.  As opposed to less expensive lasers which operate like cautery (intense heat,) it is truly laser energy that releases tissue. The benefits of scissors are that they are inexpensive tools, are easy to travel with and require no additional laser training.

Why do I have to see a Myofunctional Therapist?

Beyond finding a skilled provider for tongue tie release, the path to success involves comprehensive therapy both before and after the procedure. Often, the rush to have a consultation and release on the same day or the desire to skip therapy due to time and cost constraints can overshadow the ultimate goal – improved function. Myofunctional therapy, commonly referred to as orofacial myofunctional therapy, plays a pivotal role in achieving this goal. This therapy aims to establish nasal breathing, proper lip and tongue posture, and correct swallowing. With no one-size-fits-all approach, therapists with diverse backgrounds, from speech-language therapy to dental hygiene, guide patients through this essential process.

 

While virtual therapy visits are becoming more common, they may not suit everyone due to the shortage of skilled therapists. Through extensive experience and collaboration with experts, we’ve learned that optimal results typically require several months of therapy before and after the release. The therapist’s expertise determines the ideal timing for the release. Furthermore, patient education about post-release expectations and stretching exercises is crucial. To delve deeper into orofacial myofunctional therapy, we recommend visiting this resource. Dr. Geisler encourages new patients considering a tongue tie release to work with a therapist beforehand, enabling a more informed and effective treatment plan. Collaboration between the therapist and Dr. Geisler ensures the best possible outcome for each individual.

What is the difference between an ENT snipping a tongue tie and a dentist using a laser?

The success of a release is not in the instrument used to release nor is it determined by the release provider being either a dentist or an ENT doctor.  Success starts with well thought out diagnosis and plan, pre-release therapy, and experienced and thorough release, proper stretching by the parent(s) and regaining of function. It never should be “just a snip.” 

 

Dr. Geisler does use a laser to release babies, but if that was taken away, and all the other factors above stood, a scissors would work very well in her hands. The advantage of a laser is that a relatively dry field is maintained, so that a thorough release is done. We can see well when we use a laser, but with scissors, compression is needed to aid in clotting before a reassessment is done and any further release during the procedure itself.  When lasers are used during surgery, it is very quick and research has shown less swelling than other methods. A laser is a precision instrument, and only releases tissues up to a millimeter from the tip.

 

Our laser is a Co2, non contact laser, named Lightscalpel.  As opposed to less expensive lasers which operate like cautery (intense heat,) it is truly laser energy that releases tissue. The benefits of scissors are that they are inexpensive tools, are easy to travel with and require no additional laser training.

Why do I have to see a Myofunctional Therapist?

Beyond finding a skilled provider for tongue tie release, the path to success involves comprehensive therapy both before and after the procedure. Often, the rush to have a consultation and release on the same day or the desire to skip therapy due to time and cost constraints can overshadow the ultimate goal – improved function. Myofunctional therapy, commonly referred to as orofacial myofunctional therapy, plays a pivotal role in achieving this goal. This therapy aims to establish nasal breathing, proper lip and tongue posture, and correct swallowing. With no one-size-fits-all approach, therapists with diverse backgrounds, from speech-language therapy to dental hygiene, guide patients through this essential process.

 

While virtual therapy visits are becoming more common, they may not suit everyone due to the shortage of skilled therapists. Through extensive experience and collaboration with experts, we’ve learned that optimal results typically require several months of therapy before and after the release. The therapist’s expertise determines the ideal timing for the release. Furthermore, patient education about post-release expectations and stretching exercises is crucial. To delve deeper into orofacial myofunctional therapy, we recommend visiting this resource. Dr. Geisler encourages new patients considering a tongue tie release to work with a therapist beforehand, enabling a more informed and effective treatment plan. Collaboration between the therapist and Dr. Geisler ensures the best possible outcome for each individual.

Resources

Videos to Watch

Explore these insightful videos to provide you with a comprehensive understanding of the long-term effects associated with tongue ties. These resources will help you to grasp the long-lasting effects that tongue ties can have on various aspects of health and well-being.

Resources

Videos to Watch

Explore these insightful videos to provide you with a comprehensive understanding of the long-term effects associated with tongue ties. These resources will help you to grasp the long-lasting effects that tongue ties can have on various aspects of health and well-being.

Books to Read

Explore the complexities of tongue ties and their impact with our recommended books. These resources provide insights into the subject, covering their effects on health and well-being. Whether you’re a parent, healthcare professional, or simply curious, these books offer a comprehensive guide to understanding tongue ties.

Books to Read

Explore the complexities of tongue ties and their impact with our recommended books. These resources provide insights into the subject, covering their effects on health and well-being. Whether you’re a parent, healthcare professional, or simply curious, these books offer a comprehensive guide to understanding tongue ties.

More Questions?

If you have any additional questions that were not addressed in our FAQ section, please feel free to contact our team. We are here to provide you with all the information you need to make informed decisions and ensure your experience with us is as smooth as possible!

CONTACT US

More Questions?

If you have any additional questions that were not addressed in our FAQ section, please feel free to contact our team. We are here to provide you with all the information you need to make informed decisions and ensure your experience with us is as smooth as possible!

CONTACT US