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My baby has a gap between the front teeth. Does that mean there is a lip tie?

A common questions about babies teeth is about the gap between the two front teeth. If your baby has a gap, that is normal and healthy. There is supposed to be a gap between baby teeth the width of a nickel. Sometimes there is a tight upper lip tie that can affect the function of the lip, but a space alone is not a reason to release tissue. The maxillary labial frenum is the term used for the tissue that goes from the upper lip to the gums. Maxillary pertains to the upper jaw and labial refers to the lip. The other term used is frenulum, but the public knows it as a lip tie.

How wide of a gap between teeth is too wide?

When a gap between the two front baby teeth is 3 mm wide or greater, that tissue is often very fibrous and very short. In that case, a lip tie release with a laser may be recommended. It’s up to the dentist, the family, and a feeding specialist (if involved), to decide the necessity of an upper lip tie release. As I’ve been doing releases of tight oral tissues for many years for young children, I’ve learned when it is appropriate to release a toddler or young child. Maybe more importantly, is to know when to wait and see. Around the age of three years, the position of the upper frenum in the midline can appear different. It isn’t from the frenum itself changing but the upper jaw itself getting taller, so the insertion isn’t as low into the gums.

What does no gap between baby teeth mean?

When we see baby teeth that are touching each other, like the photo below, we consider it crowding. The concern we have is multifold when crowding is seen in children’s teeth. First of all, permanent teeth are larger than baby teeth, so without spaces between the baby teeth, there will not be sufficient space for the permanent ones to come in to. The tightness between teeth points to what holds them, namely, the jaws. When there is crowding of teeth, that means the jaws are too small. When the jaw is too small, there is less space for the tongue to live in the mouth, and a crowded tongue can go back into the throat, making it more challenging to breathe quietly.

Why does crowding matter?

Anatomically, the upper teeth are in an arch with an expanse between that people call the roof of the mouth. Your tongue should rest there. It’s the hard palate, made of two bones named palatine bones. Those two bones are the same bone as the floor of the nose. Think of the nose as a triangular space and then think back to geometry. If you narrow the bottom of a triangle, the area inside it is smaller. If the triangle, which represents the nasal airway, has less area, it’s harder to breathe. A narrow nasal passage can get congested much easier. Just behind the hard palate is the soft palate. That’s where when tickled it can make a person gag. The soft palate, with all the tissues connected to it, is narrow if the hard palate is narrow. This is a risk predictor for sleep apnea.

If that is too much anatomy for you, think what you breathe through, as a tube. A tube like a garden hose is much easier to breathe through than a small straw. Let’s now circle back to where this blog began. First, we want space between baby teeth. The babies jaws are too small if there isn’t space between every baby tooth the width of a nickel. Underdeveloped or small jaws equals a small tube to breathe through. No one wants to have a small tube to breathe through.

Does a lip tie make cavities more likely?

It makes intuitive sense, that if it’s hard to brush because a tight frenum, there is a greater chance for cavities to develop. As a professional, I told parents this routinely when talking about the risk of not releasing a tight lip tie. However, I now know there is no research to prove that. New research, that is about to be published, looked at cavity rates in children with, and without lip ties. No greater problems where seen with cavities or missing teeth with those with ties under their upper lip. However, it is commonly said that having a lip tie increases the risk of dental decay. A link will be inserted once that is published.

What about lip ties infants?

Over 90% of babies upper lip frenums insert right into the edge of the ridge or even past that over the edge and into the bump of tissue behind. For the infants we are checking if the tissue is flexible enough to along a proper flange or seal when feeding. A release may be indicated if the gums turn white where the frenum inserts into the gums. The white area of gums where the frenum inserts show capillaries being pressed, indicating tension. Another indicator for release is if the baby pulls off a latch because it’s uncomfortable to be that deeply latched.

What about lip ties in adults?

With adult teeth, if the frenum is low enough to insert into the triangle of gums between two teeth, it could contribute to recession locally. A lower tight labial frenum can cause recession more commonly than an upper lip frenum in adults. However, there can be a gap between the upper teeth in teens and adults. If orthodontics or veneers is desired to close that gap, a laser release of the tissue can resolve the problem. A lip tie release in teens and adults is very simple and effective. A very small amount of numbing is done, and 10 second laser treatment is all that is needed. Afterwards, we tell people the area will feel like a canker sore for a few days.