Tongue-ties and lip-ties

If feeding is a struggle and someone has mentioned a tongue-tie, two things are worth knowing before anything else. A tie can genuinely be part of the problem. And not every tie needs to be treated. An assessment tells the difference, and that is where we start.

Dr Lezaan Steyn assesses tongue-ties and lip-ties and, where a release is genuinely needed, performs it with a dental laser. This is work she does often, including for very young infants. Appointments for newborns are arranged by phone, so call us rather than book online. We usually see referred newborns within a few days.

Many of our smallest patients come to us on referral from paediatricians and clinic sisters. Whether you arrive on a referral or on your own worry at two in the morning, you do not need a diagnosis before you phone. Working out what is going on is our job, not yours.

Could a tie be behind our feeding trouble?

Some signs make a tie worth assessing: a baby who struggles to latch or keeps slipping off, feeding that is painful for the mother, feeds that run very long and leave the baby exhausted but still hungry, clicking sounds while feeding, and slow weight gain.

None of these proves a tie. Each one has several possible causes, and feeding trouble is common in the early weeks for reasons that have nothing to do with the tongue. A list on a website cannot diagnose your baby. It can only tell you that an assessment is a reasonable next step, and if you recognised your nights in that list, it is.

One more thing, because exhaustion whispers otherwise: feeding trouble is not something you caused, and asking for an assessment is not overreacting.

Assessment first: not every tie needs a release

Plenty of babies have a visible band of tissue under the tongue or upper lip that does no harm at all. That band (a frenulum) is normal anatomy. It only becomes a problem when it truly restricts movement in a way that interferes with feeding. So the useful question is never "is there a tie?" but "is the tie causing this?". Assessment decides, not the label.

At the assessment Dr Steyn looks at how the tongue and lip actually move, and at how feeding is going, then tells you plainly which answer applies: the tie is interfering and a release is worth doing; the tie is there but is not the problem, so we leave it alone; or the trouble most likely lies elsewhere, and we point you to the right kind of help for it. If your baby does not need the procedure, you will hear that from us as clearly as if they did.

Dr Steyn has treated babies just days old, including in hospital where needed.

What happens during a laser release

A release (the formal name is a frenectomy) is a quick procedure. Dr Steyn uses a Biolase Epic X dental laser, which works precisely on the small band of tissue, and because the laser seals as it works, bleeding is typically minimal.

We will not call it painless, because nothing involving a baby's mouth honestly is. Most babies cry, and settling your baby afterwards is part of the appointment, not an afterthought.

To keep your baby comfortable, a topical numbing gel is applied to the area before the release.

You stay with your baby during the procedure, and we advise feeding straight afterwards.

After the release

You go home with aftercare guidance explained at the visit and matched to your baby. That guidance matters, which is exactly why we explain and demonstrate it in person instead of publishing a generic version here.

Feeding improves at different speeds for different babies. For some the change is noticeable soon; for others it is gradual, because a baby who has been feeding one way sometimes needs time, and help, to learn another. That help can involve the wider feeding team, such as a lactation consultant or your clinic sister, and bringing them in is normal, not a sign that anything failed. What we will not do is promise a breastfeeding outcome, because no honest practitioner can.

Older children and adults

Ties do not always announce themselves in infancy. In older children and adults, a tight frenulum sometimes comes up alongside speech concerns, a persistent gap between the front teeth, or difficulty keeping the area clean. The same rule applies as with babies: the label alone means nothing, and assessment decides whether doing anything would actually help.

We do assess and release ties in older children and adults. We also release lip-ties as part of correcting a diastema (a gap between the front teeth), when the assessment shows that a tight band under the upper lip is part of the cause.

If you are reading this for yourself or a school-age child, phone us and ask. And for everything else about how we work with young children, our children's dentistry page is the place to start.

For referrers

For paediatricians, clinic sisters and midwives: we assess function before we treat, and we tell parents plainly when a release is not indicated. Please ask parents to phone the practice directly on 017 631 1136 and mention that the baby is coming for a tie assessment; a short feeding history helps. For anything written, admin@vitaldent.co.za reaches us directly.

Frequently asked questions

Does every tongue-tie need to be released?

No. Many ties cause no trouble at all and are left alone. A release is only worth doing when the tie is genuinely restricting movement and interfering with feeding, and an assessment, not the label, is what decides that.

Will a release fix our breastfeeding?

Sometimes it helps quickly, sometimes gradually, and sometimes feeding needs further support from a lactation consultant or clinic sister as well. A release removes a restriction; it does not guarantee an outcome, and we will be straight with you about that before anything is done.

Does the laser release hurt my baby?

We will not pretend it is nothing. It is quick, the laser seals as it works so bleeding is typically minimal, and most babies cry briefly and are comforted as part of the appointment. A topical numbing gel is applied first, and we will talk you through the whole appointment at the assessment, before you decide anything.

How quickly can a newborn be seen?

Phone us and tell us your baby's age and what is happening with feeding. Newborn appointments are arranged by phone, and we usually see referred newborns within a few days.

What does it cost?

Your baby is assessed first, and you get the options and a written quote before any treatment happens. Medical-aid cover for tie releases varies between schemes and plans, so we check yours with you first. No surprises is the rule.