Dr. Justin Warcup of North Texas Smiles want to help you be as informed as possible about your child’s tongue- or lip-tie condition. By understanding more about the condition and the possible side effects and treatments, we believe that you can make a more informed decision about whether a frenectomy is right for your child. We welcome you to read through our questions and answers below, or call our practice at 817-732-9341 with any additional questions you may have about frenectomy in Fort Worth, Texas. Our dentist will be happy to meet with you and discuss your questions or concerns.

What is a tongue tie?

The tongue plays several important roles when it comes to your oral and overall health. Not only does it assist in feeding and the gastrointestinal system but it also helps with proper speech, good oral heath, and proper craniofacial growth. On the underside of the tongue, there is a small piece of tissue, called a frenulum, that attaches to the bottom of the mouth. When the frenulum is too short or attaches to the front of the tongue, it is often referred to as tongue-tie. This condition can limit the tongue’s mobility and affect its many roles.

What is a functional frenulum?

A functional frenulum does not restrict the tongue’s up-and-down or side-to-side movement. It also does not negatively affect the surrounding muscles and areas of the mouth. If you can see your frenulum, that does not necessarily classify it as being “tied”. On the other hand, being able to stick out your tongue also does not mean that your frenulum is fully functional.

What is a dysfunctional frenulum, or “ties”?

In many cases, the feel of a frenulum and the symptoms that the parent and/or child experience can help identify whether a frenulum is dysfunctional. It can be easy to diagnose anterior tongue-ties (where the frenulum attaches close to the tongue’s tip) than a posterior tongue-tie (where the frenulum attaches farther back). While some may exhibit noticeable symptoms, not all cases of tongue-tie are as prominent. By getting a thorough examination by our dentist, you can help your child get any necessary treatment early on.

Do I need a referral from another doctor?

In short, no. Our practice is a primary care provider, so patients are welcome to visit us without a referral from another specialist or doctor. Although a referral is not required, it is often beneficial to visit a lactation specialist to ensure that your child does have tongue-tie and require treatment. Any additional information from other healthcare providers can also help our dentist make a more accurate diagnosis and treatment plan.

At what age do I need to have my child evaluated for tongue-tie or lip-tie?

You baby can be evaluated for tongue-tie or lip-tie as early as one day old; it is never too early! Our dentist recommends that you bring your child in for an evaluation as early as possible, as it is better to provide early treatment and avoid possible long-lasting side effects.

Will the first visit be considered a consultation or an exam visit?

It will be an exam visit, since it does include a physical examination of the oral cavity, which is needed for full diagnosis and treatment plan recommendations. However, your One Year Exam with Dr. Warcup will be complementary.

Do you have a referral network for other therapists?

Yes. When Dr. Warcup began treating newborns, children, and teenagers with tongue-tie and lip-tie, he also created a support group that included several specialists in the area. Removing the frenulum does not always cure all the problems that infants or children may experience from a tongue-tie or lip-tie. In many cases, it may require a team of specialists to provide complete therapy. Our referral network includes lactation consultants, speech language pathologists, midwives, cranio-sacral therapists, pediatric chiropractors, and myofunctional therapists.

Will just having surgery correct my baby’s breastfeeding issues?

Caring for you and your baby is something that our entire team is proud to work with, and we recommend that you work with a lactation consultant if you and your baby are experiencing issues with breastfeeding. In some cases, correcting a tongue-tie or lip-tie can improve nursing and require little to no additional therapy. However, there are some cases where there are more issues that the tongue-tie or lip-tie that interfere with breastfeeding. Depending on your child’s condition, he or she may require craniosacral therapy to relieve pain or correct any misalignment.

Will any pain medication be given to my baby after conducting the procedure?

For most procedures, Dr. Warcup will use a safe, specially-compounded topical anesthetic during the procedure; if needed, he may also use local anesthetic. After examining your child’s unique condition, Dr. Warcup can provide more specific answers about what your child may need during and after the procedure. For older patients, we will use local and topical anesthetic during the procedure.

Can I breastfeed my baby prior to the procedure?

Yes; however, if you are having the surgery performed in the same visit, we suggest waiting until after the procedure before breastfeeding. This will help prevent regurgitation and possible aspiration of the milk your baby just ingested.

I have a toddler who I think needs to have the procedure conducted. What options do I have as far as sedation or IV anesthesia with the use of a laser?

If your toddler is 16 months old or younger, we may be able to treat him or her without oral or general anesthesia; whether we use anesthesia depends on your level of comfort in regards to having your child physically restricted during the procedure. Because infants at this age are more mobile, there can be some difficulty in performing the procedure without anesthesia. After your child’s examination, Dr. Warcup can recommend which sedation and anesthesia options are best.
For children age 16 to 23 months, we may need to wait until the child is two years old before doing IV sedation, based on the child’s weight. Dr. Warcup does not typically recommend anesthesia when treating a tongue-tie or lip-tie unless it is absolutely necessary and the benefits outweigh the risks.

How long does the appointment usually last?

The examination typically takes 20-30 minutes. This includes taking time to show you stretching exercise, providing necessary information, and answering questions. The procedure itself takes only a few minutes, and we will take your baby to you immediately once we are finished.

Am I allowed to stay in the room with my baby while the procedure is being conducted?

During the examination, Dr. Warcup wants you to be present with your baby; however, due to laser guidelines and regulations, you must remain in the waiting room during the procedure. By doing so, Dr. Warcup can focus fully on your baby and complete the procedure quickly. We invite you to trust us and know that we will take the utmost care of your baby. If the procedure takes a little longer than anticipated, it is because we are being careful and removing the tie(s) as efficiently as possible.

Will my baby bleed extensively on the area being revised?

Typically, no. Lasers cauterize the arteries and veins in the treatment area during the treatment. Because there are no major arteries or veins in the frenulum, there is usually no or minimal bleeding.

What will happen if I do not conduct the post-procedure exercises?

Disregarding the post-procedure exercises can increase the chance of re-attachment. Some individuals claim exercises don’t play a major role in re-attachment; however, well-respected doctors such as Dr. Kotlow, Dr. Margolis, and Dr. Ghaheri recommend them to increase the success of the revision. We have seen how proper exercises have produced better results. During the follow-up visit, if Dr. Warcup suspects re-attachment, he may mechanically separate or recommend additional revision treatments, which may set you back a week or more in recovery.

Is my baby going to be in pain after the procedure? What can I use for pain management?

On the day of the procedure, most babies do not experience discomfort; however, the discomfort typically sets in after a day or two and can last up to five days. Every baby is unique; therefore, every baby will experience the healing process differently. We recommend skin-to-skin contact, allowing your baby to latch on you as much as possible, whether that is for feeding or comfort. You can freeze some breast milk and place small shavings of it in your baby’s mouth, allowing it to melt. You may also use natural coconut oil during the stretching exercises.

What else can I expect post-revision?

Some babies may sleep more and breastfeed less in the days following the procedure; we suspect that this is their way of healing. Some babies may have shorter feeding episodes, and some may have a greater latch on the day of the revision but less during the following days. In many cases, the tongue needs time to readjust, and it may require re-training if it has been compensating for a while. Remember, sucking begins in-utero, so even though your baby may be a newborn, he or she may still need time to adjust or require therapy to strengthen the oral musculature.

In addition, your baby may cray during the stretching exercises. This is normal, considering you are stretching tissue in an open wound. There may be minimal bleeding during the exercises, but this is only a cause of concern if it does not stop quickly. Increased drooling may also be a side effect, but it returns to normal as the wound heals.

Does my insurance cover the procedure?

In most cases, we do not find out whether your insurance covers the procedure until after your claim is processed. Over time, we have learned that each plan is unique with different stipulations, deductibles, and coverage. We highly recommend that you contact your insurance plan and ask about coverage prior to the procedure. Keep in mind, we are a non-contracted dental office, and therefore, we only bill claims to Dental PPO plans. Therefore, when contacting your insurance, have them look at the dental codes coverage. We are NOT contacted with any medical plans, including any HMOs, and we do not file any medical claims.

Please understand that we file dental claims as a courtesy. Our practice does not have a contract with your insurance company; only you do. We are not responsible for how your insurance decides to handle its claim or what benefits they will cover. We can only assist you in estimating your treatment costs; we cannot guarantee that your insurance will cover your claim. We are not responsible for any errors while filing your insurance.

We highly recommend that you contact your insurance company and check the status of your claim. Keep in mind that any estimates are just that, an estimate. We are not aware of how much your reimbursement will be until your insurance processes your claim.

Does my baby need to be ACTIVE on dental insurance for the procedure to be covered?

Yes. Most insurance companies will not consider a claim for reimbursement unless your child is active on the insurance plan on the date of service. We are not contacted with specific Dental PPO plans. Please see previous question.

Does medical insurance cover the procedure, and will you bill my medical insurance?

We cannot say whether your medical insurance will cover the procedure. We do not have contracts with any medical insurance plans, including HMOs. We recommend that you call your medical insurance plan and learn whether the procedure will be covered in your benefits. If they approve and reimburse for part or all of the procedure, they should reimburse you directly. We do not have a contact or negotiated fees with any medical insurances, and we do not receive reimbursements from them.