I thought this might be a good follow up to Alison's last post.  I just
recently read her thesis and think it is excellent.  It covers the topic of
ankyloglossia better than anything I have read. She and I have very similar
views.

There is a lot of ignorance out there about what problems tongue tie can
cause - in the medical, dental, and speech therapy fields.  Problems include
difficulty in bf, speech problems, automatic dental malformation and related
problems, digestive problems, and it can also be a contributing cause to
obstructive sleep apnea.

My recommendations to lactation specialists (this would be especially good if
local society members worked this as a project) on how to standardize the
documentation and treatment for tight frena, as well as find a professional
to perform the procedure, is as follows:

1)  Consider purchasing Alison's 1993 thesis "The assessment tool for lingual
frenulum function: Use in a lactation consultant private practice".  I feel
it is an excellent thesis and will help lactation specialist get a better
understanding and history of ankyloglossia.  She also has an "Assessment
Tool" that I recommend lactation specialists consider using to develop a
beginning standard to start documenting cases of tongue tie.  She could
modify the "Tool" as needed from suggestions of other specialists.  It could
 be a good unifying start to resolving the problems I am reading about on
LACTNET.

2)  Get a copy of the article written by Dr. Notestine in one of the 1990
issues of JHL (I have not read it yet - but a copy is coming).  I talked with
him on 3-13 and he will be joining LACTNET shortly.

3)  Also include Diane Wiessinger's article (JHL Vol 11, No 4, Dec. '95)
"Breastfeeding Difficulties as a Result of Tight Lingual and Labial Frena: A
Case report".  It is also important to incise labial frena as well.  If not,
the infant can have problems latching on and then grow up having a diastema
(gap between the teeth - like Ernest Borgnine - great for him - but not for
most people).

4)  Consider purchasing a video on frenotomies (I will be ordering the video
that Leslie  discussed on LACTNET a few days ago)  I have already talked to
someone who knows about the video, and it sounds like a good video.  It is
the only one I know about that is available at present.  If there are others
out there, please let me know about them.

5)  My recommendation would then be to bypass any disinterested MDs, find a
good oral surgeon, show him the above data, and more than likely he will be
interest in helping you out.  I am planning on doing that for KC consultants
- the oral surgeon is already interested in doing - he just needs more
information on the importance of doing the procedure, and how best to do it.
 Most oral surgeons are quite approachable and are doing surgery in the mouth
all the time.  I feel they will be more at ease doing the procedure than most
MDs.  In fact, many OSs have to resect or fracture both jaws and reset them
as a result of the tongue thrust that tight frena cause!  Dentists are very
preventive oriented!

To get insurance to understand the necessity for the procedure, and to pay
for it, documentation is needed!  The above is just my recommendation as to
how you might consider collecting that data.  Good Luck!

"We only see what we know, therefore we must know to serve"!

Brian Palmer D.D.S.