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Tarun Agarwal, DDS

8304 Creedmoor Road
Raleigh, NC 27613
Telephone: (919) 870-7645

Frenectomies Are Changing Lives

Dr. Nate Leedy has joined Dr. Tarun Agarwal at Raleigh Dental Arts, and he brings with him interest and expertise in performing frenectomies— especially in newborns and infant children. The life-enhancing procedure is often completed in several minutes.

On the computer screen: a close up of the laser repairing a lip-tie.

Dr. Leedy and his wife, Mai, have two small sons, Harrison and Beckett, sparking his interest in infant care. Dr. Leedy com-pleted a five-year tour with the U.S. Navy in 2013, emerging from the experience as a lieutenant and practicing dentist in private practice.

Recently, he explains, an oral procedure has been introduced to dentists called a frenectomy—which is the surgical removal of a small fold of tissue that prevents the tongue from moving too far.

“About four percent of infants are born with some sort of lip or tongue tie,” he explains. “The connective tissues between either the lip and the gums on the top, or the tongue down on the jaw, are tightly connected to the point where tongue movement is so restricted that the baby can’t properly latch onto the mother’s breast for essential nutrition. There’s a percentage of infants that have both tongue and lip ties, but more commonly, it is the tongue tie that’s more inhibitive to breast-feeding.”

Symptoms of tongue ties include uncomfortable breast-feeding, damaged nipples, diminished milk supply, mastitis or thrush infection, shallow or weak latch, frequent reflex or spit up, and more. When infants can’t latch, they’re rubbing tissue.

 “To diagnose ties you have to check whether the tongue is able to move vertically and has enough mobility left and right. That’s really important when breast-feeding, as it allows the baby to latch on to the mother’s nipple. Tongue-tied babies have a very short tongue lift. They can’t quite get vertical enough, so the tongue only moves a little bit off of their lower jaw.”

There are two types of tongue ties, notes Dr. Leedy, anterior and posterior. “The anterior tie is very noticeable because the tip of the tongue is attached to the lower jaw. Posterior tongue ties are somewhat more complex because the mouth looks normal—the tie is back in the flesh of the tongue and you can’t see the connective tissue. The condition is determined by how the baby’s tongue moves when you take a look at it.”

The consequences of not attending to a tie immediately, explains Dr. Leedy, can be significant. “It impedes nursing, creates failure to thrive, and later can cause speech issues. If you can’t articulate the tongue to the roof of your mouth properly, it can cause a lisp or other speech problem.

“If adolescent children or adults have a lip tie that’s down in between the two front teeth it can cause spacing between them. If you look carefully, there’s usually a piece of tissue in between the teeth that goes the whole way up and attaches to the lip. If the lip doesn’t move properly when you chew food, you can actually get cavities in that area, creating a higher risk of tooth decay. Many things can be avoided later in life by doing a release of these ties in infancy.”

Failure to Thrive

Patients requiring treatment for tongue- or lip-ties are often referred by lactation consultants, notes Dr. Leedy. “Lactation consultants are great at communicating with mothers, and understand how serious a latching problem can be. Latching creates the ability to develop your mouth, your tongue—all the muscle activity that goes along with getting milk from the mother’s breast. Tongue ties disrupt this and have long-lasting effects on the baby. In a very severe case, you absolutely have to do something because the baby is unable to nurse.” 

The Benefits of Laser Technology

“Doctors may screen for this condition and refer this issue to a specialist. If they have training, they will do it themselves, typically with scissors—which opens those vessels causing more blood. The wound doesn’t look as good as it does with laser treatment. This is where the benefits of dentistry come into the play, because we have excellent soft tissue equipment and experience in managing soft tissue, just by doing what we do every day.

Dr. Leedy points out that the advanced cold laser technology is used increasingly in the practice for a wide variety of purposes, in addition to frenectomies. “It is a simple, efficient way to remove fibromas—little callouses that you can get on  the inside of the cheeks—and is effective in killing the bacteria there.

“We’re also using it for fillings. With the cold laser, there’s no need to give any local anesthetic and there’s no drilling required. The tip of the instrument never touches the tooth. You simply focus the laser onto the area where there’s decay just a few millimeters above the surface. The laser closes the tubules off that cause sensitivity, and the tooth doesn’t feel any sensation afterwards.”

“We have two lasers available for this procedure—either a hot- or cold-tip laser. The hot-tip laser is much like a cauterizer, charring the tissue. This is the most commonly used dental laser. At Raleigh Dental Arts we use the latest in soft tissue laser technology—a cold laser—with which we focus a beam on the tissue, not touching the tip of the laser to it, so there is no heated instrument at all. This cold laser vaporizes, rather than cuts, the tongue tie, producing little blood. The tissue just opens up leaving just a little diamond-shaped white patch.

“Often we don’t even administer topical local anesthesia for this procedure, because it is so quick and anesthesia can at times be toxic to infants. Typically we complete the procedure in about two minutes—with healing time of seven to fourteen days. Following the procedure, the baby is immediately able to latch and the mother-child bond is enhanced in a critically important way.”

Procedure for Adults

Notes Dr. Leedy: “In this practice we also work with adults and adolescents who are functioning with tongue ties, but could benefit from freeing up the tongue connective tissue. Post-surgery, they are able to speak more clearly. And, by eliminating the connective tissue on the lip, we get better orthodontic outcomes because we can close the space in between those teeth better. I’ve had adults report that they’ve had this condition all their lives and never knew that they could do something about it.

“The youngest tongue-tie patient I’ve seen was six weeks old; the oldest was in his mid-forties. We have some patients who want orthodontics in their forties and fifties, and they’ve had that diastema—the unwelcome space—between their two front teeth, all their lives. We will recommend, in some cases, to take that tissue away before we put them in something like Invisalign or braces. At that age the issues are mostly cosmetic.”