Breastfeeding is often described as a natural bonding experience between mother and baby, but for many, it comes with challenges. One common issue that can make breastfeeding difficult is a tongue tie, a condition where the tongue's range of motion is restricted due to a tight or short frenulum. In this Q&A, we sit down with Dr. Quinn from Milk Tooth, a pediatric dentist with extensive experience in diagnosing and treating tongue ties, to discuss how this condition can affect breastfeeding. Dr. Quinn shares valuable insights into the importance of early diagnosis, treatment options, and how parents can support their baby’s breastfeeding journey if a tongue tie is present.
Maria: Hi my name is Maria! I'm a lactation specialist with Rumble Tuff, and I'm here interviewing Dr. Quinn today from Milktooth.
Dr. Quinn: Yeah, I'm Dr. Quinn. Nice to meet you all. I'm a board-certified pediatric dentist, and I'm really excited to get to talk to Maria today about tongue and lip ties.
Maria: Awesome. Alrighty, so we’re going to jump right into it. First, if you want to just talk about the inspiration behind Milktooth—what made you start it, what’s your philosophy, things like that?
Dr. Quinn: Yeah, sure. I have three kids of my own, and I’ve been in dentistry for a while. What made me want to start Milktooth was... well, our slogan is, “We’re reimagining dentistry” or doing things differently. I’m really into health in my personal life with my kids and family, so I wanted to create a practice that makes people healthier. Everything we do at Milktooth follows that guiding principle: Does this make the patient healthier?
Our patients here get a lot of educational content—text messages and emails—and most of our appointments are focused on preventing cavities. We treat far fewer cavities than other providers because we try to reverse them. So, my main goal at Milktooth is to focus on health.
Maria: That’s good to hear, especially because it’s preventative and not just straight to treatment, which can be stressful for parents.
Maria: Okay, so I really want to focus on tongue and lip ties today, since we are a lactation blog. How do you diagnose a lip or tongue tie, and how do you notice that it affects a child's trajectory?
Dr. Quinn: Yeah, so diagnosing tongue and lip ties really has two parts: physical or anatomical restriction—can we see a tie?—and then symptoms. For example, my own children have lip ties and tongue ties, but they nursed great, so I didn’t treat their lip ties and tongue ties. One of them might have some speech challenges later, and one of them has a lip tie that’s caused some aesthetics, like a big gap between their teeth, so I might treat that one. It’s about balancing what we see clinically, or what it looks like, with the symptoms—how it’s affecting their life.
I just saw a brother and sister yesterday who are older kids. The brother has a classic tongue tie that he’s had for a long time. He mouth-breathes, his palate is really high, his mouth is open all the time, and his teeth are flared out. He has what’s called a tongue thrust, so he has large tonsils and all these symptoms of a patient who’s lived a long time with a tongue tie. It’s affected the way he’s used his tongue. He’s a really picky eater, he chokes a lot, gags, all these classic signs.
His sister has a tongue tie just like him, but she has a big wide palate, she sleeps with her mouth closed, and she breathes through her nose. So, just because you have a tie doesn’t mean it needs treatment. It’s more about how it’s affecting your life, and that’s what guides treatment.
Maria: Got it. Okay, awesome. That’s really good to hear. Okay, so, I guess I wanted to ask you: Do you work closely with other professionals, like speech therapists, when treating ties? It kind of sounds like you look at it from a big-picture perspective, rather than just seeing the tie and immediately wanting to laser it or clip it.
Dr. Quinn: Yeah, that’s a great question. I always tell families, if I just treat the tongue tie and send you off with no other care, no other providers, and no other treatment, then maybe when I send you home, the tongue will be 100% released, but it’s going to go back by 50%. So, I work really closely with lactation consultants like yourself, chiropractors, myofunctional therapists, speech pathologists, cranial sacral workers, and occupational therapists. It really depends on the child’s age and what they need.
You’re focused on babies, so with babies, the standard is we’re going to do an IBCLC, like you, and then we’re going to do a chiropractor. I used to think, “Why would you use a chiropractor with babies?” But, oh my gosh, the results I get from the chiropractors are amazing. They do bodywork, releasing tension in the neck, and the tongue is connected to the neck. A lot of these babies prefer one side and have a lot of tension in their neck. So, I can actually get a better release after the baby has done some pre-chiropractic work because the tongue is looser, and everything is looser. My families get a better outcome with the post-op work because we’ve released the tongue, but then we work on how to move this tongue, right? How do you work with a tongue that’s now looser, as opposed to just returning to the old tension? The body wants to go back to where it was, right?
So, I think for babies, we do chiropractor and lactation consultant. For older kids, it depends on what the needs are. If it’s a child with speech issues, we work with a speech pathologist. We do some pre-work, and when they’re ready, we do pre- and post-work with speech. I also like to incorporate chiropractic care or some form of bodywork because I see my patients get much better results when someone is there manipulating the tissue and releasing the tension.
Maria: Wow, that’s awesome! That’s really good to hear. So, what’s typically the age range where you’re reluctant to treat? There’s a myth right now that if your baby is over three months old, a release could cause oral aversions, or it’s already too late. Do you feel that older babies are just as important to treat?
Dr. Quinn: Yes, because I’m a pediatric dentist, I see the whole spectrum. I get to meet kids who are 14 years old, and their moms tell me they couldn’t nurse because they had low milk supply. Then I check, and it turns out their child has a severe tongue tie that was never diagnosed. Their eyes open up when they hear that. So, I treat the whole spectrum if it’s necessary.
With babies, you can see early on how it’s affecting their life because they can’t nurse or latch well. But when you get into that 1- to 3-year-old age range, it’s harder to say how the tongue tie is affecting their life. At that age, they’re developing speech and getting used to eating, and they’re not nursing as much. So, it can be difficult to diagnose how it’s affecting their life, and the treatment can be more challenging. It’s hard to do post-op care for a 2-year-old with all their teeth in. If I ask you to do stretches and tongue manipulations that are uncomfortable, they’re going to resist. It’s much harder.
There’s no strict age limit on when it’s beneficial, but it can be more difficult to diagnose and treat in that toddler age range. I typically only do really severe cases in that age group, where we have a speech pathologist, an OT, and a feeding therapist all on board, and they feel it’s really necessary. In those cases, I’ll work with an anesthesiologist, and we’ll do it under sedation, which reduces post-op care. But that’s the most challenging age range.
Maria: Wow, that’s really interesting. So, basically, last week, the AAP came out with new guidelines saying that tongue ties are being diagnosed way too often. There was a lot of pushback from providers, especially pediatricians, saying it’s becoming trendy and that it’s not always necessary. How do you feel about that, especially since you’re a specialist in the mouth, and you work closely with a team? Sometimes pediatricians might be on an island, and they’ll say, “It’s okay, they’ll grow out of it,” or something like that. The guidelines were upsetting to hear because there’s so much confusion for parents. It’s scary for a mom to make the decision, but they also want to breastfeed successfully. What’s your take on that?
Dr. Quinn: I understand that perspective. I’m friends and colleagues with a lot of pediatricians, and I get where they’re coming from. There can be overdiagnosis. I get referrals where the baby’s problem is said to be a tongue tie, but sometimes it’s actually a high palate, and the tongue might only be mildly tied. It has to be a whole-body approach and a team approach, where you’re working with other professionals.
I don’t like to have a baby come in, and I’m the only one who has laid eyes on them, and then I just do the tongue tie release. That’s not how I operate. We work with a team and make sure it’s necessary. My favorite thing is to see a baby who has a tongue tie, but after seeing a chiropractor, they’re feeding great, and they don’t need the release anymore. If it’s a mild tie, I might say, “Let’s try this first,” and if it’s only a few weeks old, let’s see how they’re doing before jumping into surgery. So, there’s a balance. Some patients really need it and benefit from it, but for those in between, we always try the non-surgical approach first.
Maria: That makes sense. What are the risks or complications that can arise from a frenectomy, from a scared parent’s perspective?
Dr. Quinn: That’s a good question. The risks are that we’re doing a surgical procedure, even though it’s minor, fast, and relatively painless. The main risks are that you could cut something that’s not supposed to be cut, like a blood vessel or a nerve, or there could be excessive bleeding. But those complications are very rare because the procedure doesn’t go deep. Most tongue ties are just releasing that easy part of the tissue that you can see.
A lot of providers now, including myself, use a laser, which makes it easy to visualize everything. You can see the muscle, the nerve, the blood vessel if you go that deep, and there’s not much bleeding. Before, people used to use scissors or scalpels, which made it harder to see. So, while complications are real and possible, they’re very rare with the technology we have today.
Maria: Got it. Is there a method you prefer, like using a laser over scissors?
Dr. Quinn: I prefer the laser because it works best for me. I can see better, be more conservative, and there’s no bleeding, which is great. The pain or discomfort is incredibly low with the laser. But I have a colleague in the community who uses scissors, and I’ve seen her post-op results, and they look good. So, it doesn’t mean that the laser is the only way; it’s just what works for me. It’s about how you cut the tissue—whether with scissors or a laser.
Maria: That’s helpful to know. I have a couple of last questions. I’m really curious to hear your response. What are the potential benefits of a tongue tie release? Have you noticed improvements in things like colic or reflux? Do you track any of that?
Dr. Quinn: Yes, we track that. Everyone fills out what we call our “Discovery Form” which is an infant assessment form. It covers how the tongue tie is affecting feeding, latch, reflux, and the mother’s discomfort. There are probably 50 to 100 questions, and parents fill it out both before and after the release. It’s quick to fill out, but it helps us track improvements.
My favorite cases are the anterior tongue ties—where the tie is right at the tip—and the baby can’t nurse. They’re very colicky, have lots of reflux, are always nursing, always hungry, and always fussy. After we do the release, they come back, and everything is so much better, sometimes almost instantly. You see the whole spectrum, from completely changing a baby’s life and making them feel so much better, to only minimal improvement because the tie was just one piece of the puzzle. In some cases, there might also be a dairy intolerance, or other things going on, and the tongue tie is only part of the issue, not the whole story.
It’s the same with the mother’s discomfort or milk supply. It’s really empowering for a mom to feel better, to feel more comfortable nursing, and to see that their baby is latching better.
Maria: That makes sense. Are there any myths or misconceptions about tongue ties that you frequently encounter with parents? I imagine you have situations where one parent wants to do the release, and the other doesn’t.
Dr. Quinn: Yes, I see that most often with older kids, where the only concern about the tie is speech. I’ll tell the parents that their child has a mild tongue tie, and ask if it’s affected their life. The first response is usually, “Oh, well, their speech is good.” And while a tongue tie can affect speech, and it does for a lot of kids, you can also learn to say most sounds pretty well by using different tongue positions and movements. The Speech Pathology community didn’t believe for a long time that tongue ties affected speech, but that’s starting to change now.
But speech isn’t the only concern. Maybe the tongue tie affects how they breathe, or how they eat. That’s what I see a lot—parents focusing only on speech, but it can be more than that.
Maria: That’s a great point. Research now shows that tongue ties are related to issues like colic, reflux, picky eating, and more. Even though there’s still limited research, it’s interesting how much more is coming to light.
Dr. Quinn: As a pediatric dentist, I think a lot about airway and how tongue ties affect breathing. Kids with tongue ties generally can’t put their tongue to the roof of their mouth, which is part of the problem with nursing—they can’t make a good seal. If you can’t put your tongue to the roof of your mouth, your palate ends up narrower because the tongue acts as a natural expander, making the palate bigger and wider.
These kids often end up with a host of dental problems, like a narrow arch, crowded teeth, and crossbites. They have more congestion and trouble breathing through their nose, so they mouth-breathe more. If the tongue is tied too tightly, it can’t fit up in the roof of the mouth, so it stays low, leading to more mouth-breathing.
Patients with severe tongue ties often mouth-breathe, which increases the risk of cavities and gum disease, and changes the way the face grows. You end up with a longer face, a more narrow palate, and it all feeds on itself—more mouth-breathing, more inflammation in the tonsils, and airway issues. So, when I think about tongue ties, I’m not just thinking about speech and nursing. I’m thinking about how it’s going to affect the way the child grows and breathes because that’s something a lot of people don’t recognize.
Maria: That’s really interesting. I’ve noticed a lot of people are using mouth tape now—even my brother. He’s in his 40s, and he says it helps him not to mouth-breathe at night.
Dr. Quinn: Yes, I don’t know if we want to go deep down this road, but I snore at night, and I have a bit of a narrow palate, so I tape my mouth at night. My four-year-old son also had his mouth open at night. He would wake up every morning and say, “Dad, I swallowed my spit,” and he’d be upset and grumpy because his throat hurt. I told him I tape my mouth at night, and asked if he wanted to try it too. He said yes, but he couldn’t fall asleep with it on. So, I asked if he wanted me to put the tape on after he fell asleep, and he agreed.
I’ve been doing this for six months, and he’s a different kid. He sleeps longer, wakes up happy, is less dysregulated, and is calmer when he wakes up. He’s just happier overall. I still have more work to do with him because if I didn’t tape him, he’d still mouth-breathe, but it’s made a big difference.
Maria: Wow, that’s so interesting. In infancy, they pay a lot of attention to mouth-breathing, but once the baby is six or twelve months old, it seems like it’s not a big deal anymore. I remember mentioning my twins’ mouth-breathing to my pediatrician, and they said, “Oh, it’s fine, they’re growing.” Everything was based on their growth trajectory, so it didn’t seem like a concern. But now, they snore and wake up several times at night, and they’re four and a half.
Dr. Quinn: With kids like yours, we need to check whether they have a tongue tie, or if they just keep their tongue low like a child with a tongue tie. They might need to strengthen their tongue through myofunctional therapy, learn how to put their tongue up, so at night, it rests on the roof of their mouth and they breathe through their nose. If the tongue isn’t up, whether because it’s tied or just habitually low, it can’t suction-cup out of the throat, so when they lay down, the tongue falls back into the throat, making the airway smaller. That leads to snoring, and they might grind their teeth to move the jaw forward, which opens up the airway a bit.
Maria: That sounds so uncomfortable, but we just do it automatically.
Dr. Quinn: Yes, and we say, “Oh, it’s normal.” When I was in residency and other pediatric dentists would say, “My child is grinding their teeth,” the canned answer was, “Oh, that’s normal. A lot of kids grind their teeth.” We’d say it’s because they’re uncomfortable, maybe stressed, or have growing pains. But a lot of times, it’s worth evaluating how they’re breathing.
Maria: Wow, that’s really interesting.
Maria: Alright. Well, that was it for today! Thanks so much to Dr. Quinn at Milktooth for taking the time to interview with us today.
Dr. Quinn: Yeah, that was so fun. I really appreciate it. Thanks so much for having me!
Maria: Awesome, thank you!
Breastfeeding challenges, such as those caused by tongue ties, can feel overwhelming for new parents, but with expert guidance and the right information, many of these obstacles can be overcome. Dr. Quinn from Milk Tooth has provided valuable insights into how tongue ties can affect breastfeeding and how timely intervention can make a significant difference for both mother and baby. If you suspect a tongue tie may be affecting your client's nursling and their ability to breastfeed, referring the dyad to an experienced professional is a crucial first step.
For more information on Dr. Quinn and Milk Tooth, please visit MilkTooth.co.
The Rumble Tuff website does not contain medical advice. The contents of this website, such as text, graphics, images and other material are intended for informational and educational purposes only and not for the purpose of rendering medical advice. The contents of this website are not intended to substitute for professional medical advice, diagnosis or treatment. Although we take efforts to keep the medical information on our website updated, we cannot guarantee that the information on our website reflects the most up-to-date research.
Please consult your physician for personalized medical advice. Always seek the advice of a physician or other qualified healthcare provider with any questions regarding a medical condition. Never disregard or delay seeking professional medical advice or treatment because of something you have read on the Rumble Tuff website.
Before taking any medications, over-the-counter drugs, supplements or herbs, consult a physician for a thorough evaluation. Rumble Tuff does not endorse any medications, vitamins or herbs. A qualified physician should make a decision based on each person's medical history and current prescriptions. The medication summaries provided do not include all of the information important for patient use and should not be used as a substitute for professional medical advice. The prescribing physician should be consulted concerning any questions that you have.
In a medical emergency call 911 immediately. Rumble Tuff does not recommend or endorse any specific test, physician, product, procedure, opinion or any other information provided on its website. Reliance on any information provided by Rumble Tuff, Rumble Tuff employees, others represented on the website by Rumble Tuff's' invitation or other visitors to the website, is solely at your own risk.
0 comments