In 2010, at the IATP Summit in Toronto, we face the dilemma of language variability between dentists, doctors and IBCLCs in describing the anatomy around ties. Larry and I pretty much formed the committee at that conference to see what we could do to address the varying issues related to education, language and uniformity on the issue of lip tie (which at the time were referred to as labial or maxillary frena or frenula depending on who you asked). 

As to lip ties causing caries, Larry has published to that effect in JHL. It is one of the reasons we all took a closer look at lip ties, bc clearly there is more involved than the mechanics of latch.

Larry and I began working together frequently and discussing the issue globally, especially as I was in Paris and in discussion with a lot more folks in EU. Basically, Larry simply realized that referring to the restriction as a lip tie solved the language problem completely and really simplified things for parents who had often had no idea what "maxillary" or "labial" meant. At that time the Tongue-tie Baby Support group on FB was co-Admined (along with mothers and a few other HCPs) by myself and several other IBCLCs, most of whom have become active in IATP . We decided to change the language and it was very simple to do as we had a huge audience. One of the positives of social media in that case. 

Another thing we did was actively seek out dentists to revise babies, although we made every effort to educate them about babies, breastfeeding and ties. Most were flying to Albany to observe Larry and learn about integration of care, including from EU, so outcomes were generally quite good. 

The flip side is that lip ties are very easy to spot and mothers started figuring them out for themselves and calling local dentists, who of course are very familiar with lip ties, which are often revised when kids have a diastema or have braces. This meant that dentists who had no idea how to recognize or even revise a TT were beginning to do lip ties, and that meant a whole new education effort. I feel like a broken record when I tell mothers "It is very, very rare to see a LT w/o a TT". And it becomes a red flag as to a provider's assessment skill when the mother says her baby only has a LT as well. 

Do LT's need revision? IMO, a restriction needs revision, while a frenum may or may not. I have personally trained this past year as an oral facial myologist so that I could better understand the function associated with ties and develop interventions to help babies normalize function. I have been collaborating with folks involved in sleep medicine as the long-term consequence of oral restrictions are impaired airway function and sleep issues leading often to gut issues and behavior issues (the gut-brain axis). I will be giving a guest lecture at a dental school this Spring on breastfeeding for a post-grad program on airway function. The dentists I am collaborating with are very much interested in prevention. 

I was in the UK in October to lecture on Epigenetics and Breastfeeding and met with two dentists in London who are exploring dealing with various sequela from untreated ties and oral dysfunction. From posture to airway function/sleep to digestion and behavior, oral restrictions are a very big deal. 

On the other end, I began referring all my TTd babies for testing about 2 years ago for MTHFR and when over 90% were coming back positive, I contacted one of the world's leading researchers in MTHFR and asked him why. My clients were eager to know as well, so they each paid a $35 fee to attend a webinar he produced after spending scores of hours delving into the research to find some answers. He also presented that material at IATP last year. Since then, he has found more evidence suggesting the use of synthetic folic acid as a key factor in midline defects and tongue-tie. Folic acid does not ever occur in Nature and seriously impairs methylation in all humans, but especially in the 40%+ of the population with a SNP (mutation) at the MTHFR gene. Various forms of methylated folate are now being added to high quality supplements as a safe form of folate. The entire biochemistry is far more complex and is an issue of maternal nutrition and toxin exposure, not simply of taking a supplement. 

So, I do not think that ties should be revised only if they obviously interfere with breastfeeding. If breastfeeding is managed in a compensatory way, then oral function is compromised. If oral function is compromised, then human health is compromised. Nose breathing is the single most important function of the face. If we do not preserve nose breathing, we suffer long-term consequences as I mentioned above. 

IATP is working to define policies and protocols for assessment and treatment, recognizing these other implications. We are working to develop clinical competencies for IBCLCs, revisers and bodyworkers. We are concerned that mothers are getting incomplete information from other mothers, but in all fairness many..perhaps most..are getting more accurate assessment from strangers on FB than their providers, including IBCLCs who have been slow to learn about TT/LT. as my interest is broader, I am in frequent conversation with the folks involved in OMT and sleep/airway and am working to change our access to knowledge on these subjects. 







Date:    Tue, 7 Jan 2014 20:23:54 -0800
From:    Melinda <[log in to unmask]>
Subject: Re: Lip Ties

Good point, Jane, about the relationship between lip ties and dental caries. 
I wonder about if/when a pediatric dentist or other provider would revise a tie 
that is not inhibiting feeding --do they wait until caries occur, or do they 
clip ties preventatively?
 My experience is in observing Dr O'Hara in Seattle, who mentioned that many lip 
ties (that are not causing problems with breast-feeding) will "revise" 
themselves in the course of typical childhood injuries. She did not (that I know 
of) perform any 'preventative' lip tie revisions. 
Melinda Harris Moulton FNP, IBCLC 
Olympia, WA

Sent from my iPad

> On Jan 6, 2014, at 8:03 AM, [log in to unmask] wrote:
> 
> When it comes to lip and tongue ties, we need to have input from dentists who 
are into preventative care.  I have seen babies who successfully nursed despite 
lip and tongue-ties turn into babies with "bottle-mouth caries"!  I am wondering 
in cases where dentists are blaming nighttime breastfeeding for caries, if what 
is really the problem is lip ties.  This causes excessive pressure on soft tooth 
enamel of erupting teeth, especially the top ones - and voila! - cavities in the 
top teeth!
> 
> -----Original Message-----
> From: Lactation Information and Discussion [mailto:[log in to unmask]] 
On Behalf Of Melinda
> Sent: Saturday, January 04, 2014 9:51 PM
> Subject: Re: Lip Ties
> 
> I am eager to get others opinions. I am on the tongue tie support site on 
Facebook, and have noted lots of talk about both tongue and lip ties--but I 
guess that's what one would expect on a site devoted to this issue. 
> I believe the interest in 'ties' over the past decade is that many women with 
very sore nipples, who would've just switched to bottle feeding in previous 
years, are now seeking out the causes for such pain and ways to correct it. 
> I am an advocate of revising lip and tongue ties, but only when they prevent a 
successful breastfeeding relationship. IBCLC's need to be able to perform an 
oral exam/ assessment in addition to a feeding evaluation to determine the 
effect a tie is having. 
> Melinda Harris -Moulton FNP IBCLC
> 
> 
> 
> 
> 
> 
> Sent from my iPad
> 
>> On Jan 4, 2014, at 6:57 PM, Kathleen Huggins <[log in to unmask]> wrote:
>> 
>> Hello to everyone from warm, sunny Central California!  Being from Buffalo, I 
feel your pain if you are suffering with the extreme cold!  I have recently 
started responding to nursing mothers on a popular breastfeeding website.  I 
have been quite surprised at the number of mothers responding to mothers 
experiencing breastfeeding issues and their advice.  Everyday, nursing mothers 
post to those having problems to check for "lip ties" and to ask physicians to 
get them clipped so that their particular problem will be solved.  I see this 
with any moms experiencing  latch issues, painful nursing, fussing at the 
breast, making sounds while nursing, etc, etc.  It reminds me of the 1980's when 
we all thought anyone with sore nipples must have yeast!
>> 
>> So, what am I missing here? Where is this coming from?  I have missed ONE 
ILCA conference in  25+ years.  Was that the conference that was all about lip 
ties? 
>> 
>> Anxiously awaiting to hear where this is coming from!
>> 
>> Thanks to all!
>> 
>> Kathleen



Jennifer Tow, IBCLC, USA & France
Intuitive Parenting Network, LLC





 

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