Has your pediatrician or lactation consultant told you that your child’s nursing difficulties may be related to a lip or tongue tie? If so, a pediatric dentist experienced in laser treatment for frenectomies (surgical removal of lip and tongue tie) can be your resource to correct this issue.

Here at Charlottesville Pediatric Dentistry, we are dedicated to giving you and your child compassionate care and treatment.  We strive to help you achieve your feeding goals through proper diagnosis and treatment of restrictive lip and tongue ties.

What is a Frenum?

A frenum is a connective tissue under the lip and the tongue. Most people have a frenum attachment. However, some frenums are too restrictive and can interfere with proper lip and tongue movement. The labial frenum (under the lip) and the lingual frenum (under the tongue) can restrict movement of the lip or tongue. This can cause feeding issues for the newborn and other problems as the child grows. A frenectomy is a quick, minor surgical procedure that releases this connective tissue and increases the range of motion for the lip and tongue. This, in turn, improves oral muscular function and can reduce complications later in life.

What symptoms can mother and baby experience from a lip or tongue tie?

Mother’s Symptoms

  • Painful nursing
  • Poor latch
  • Cracked, bleeding, creased, flattened, lipstick-shaped nipples
  • Poor breast drainage
  • Plugged ducts, engorgement, mastitis
  • Nipple thrush
  • Unwanted feeding modalities (e.g. nipple shield, bottles)
  • Feeling like feeding is full-time job (12+ feedings per day)

Baby’s Symptoms

  • Poor Latch and sliding off the breast
  • Struggle to stay awake while feeding
  • Fussy at breast
  • Colic
  • Reflux symptoms
  • Frequent spitting up
  • Gagging/choking while feeding
  • Gassy/burping/hiccoughs
  • Swallowing air - “clicking” noise when feeding
  • Milk leaking from corners of the mouth
  • Biting/chewing/chopping nipple
  • Pacifier regularly falls out
  • Mouth breathing, snoring
  • Congested nose
  • “Thrush” / milk residue on the tongue
  • Feeding sessions longer than 20 minutes
  • Eating more frequently than 2-3 hrs.

How can an untreated tongue and lip tie impact your child’s future?

  • May increase risk for speech and social issues
  • May impact airway and breathing
  • May impact sleeping
  • May influence tooth and jaw development (orthodontic issues)
  • May create difficulties maintaining proper oral hygiene
  • May increase risk for tooth decay
  • May influence postural problems that can lead to head, shoulder and neck pain

How we correct lip and tongue ties.

At Charlottesville Pediatric Dentistry we use a state-of-the-art Carbon Dioxide Laser to perform the frenectomy procedure.

The benefits of a Carbon Dioxde Laser are:

  • Very precise (the laser cuts less than the width of a human hair)
  • Laser energy is sterile; essentially no chance of infection
  • General Anesthesia not required
  • Local Anesthetic not indicated in infants
  • Quick – about 20 seconds per frenum
  • Minimal/No Bleeding
  • No sutures required
  • Improved healing
  • Minimal Pain – 2-3 days of soreness

Before Your Visit

*Infants under the age of 6 months MUST have received a Vitamin K shot prior to procedure.*

We are here to collaborate with your child’s healthcare and feeding team. *We require referrals from your Lactation Consultant, Speech Language Pathologist, and/or Primary Medical Provider (e.g. Pediatrician or Nurse Practitioner).* Results are greatly improved if you have the proper team in place to help with your concerns. Furthermore, best practices include body work sessions with a skilled body worker (e.g. Chiropractor, Craniosacral Therapist, Massage Therapist, or Physical Therapist) familiar with infants before and after the frenecomy procedure.

Prior to your visit, we need to gather some information. Please fill these forms out before your visit to expedite your appointment or please arrive 15 minutes early to complete the paperwork in the office.

Please do not feed your baby for 2 hours before the procedure. That way your baby is hungry and is more likely to eat following the frenectomy procedure.

What to bring:

Please bring anything you feel your child may need to be comfortable. Please also bring a swaddle for your baby. We will use the swaddle during the procedure to help keep your child safe. We have nursing pillows and a stool for you to immediately try to breastfeed after the procedure. Please bring any other breastfeeding aids you find helpful.

Please pre-medicate your child 30 minutes prior to the procedure. Please use the dosage table below to determine the amount to give.

Children under the age of 6 months should NOT take Ibuprofen

Arnica Montana 30C: Homeopathic remedy that may be used pre and postoperatively to minimize inflammation.

Dissolve 10 pellets in a 2-3 oz. of water or breast milk.  Give ~2 ml every 1-2 hours.  Most effective if given 1-2 days prior to treatment.  Ok to give more frequent (10-15 min) during an acute episode.  Store chilled.

During your Visit

Our goal is to make sure we provide a comfortable atmosphere for you and your child. Your child’s health and safety are our top priorities. Feel free to bring a friend or relative with you for additional support. Please try to leave other young children at home so we can focus on you and your child and you can focus on our consultation.

When you arrive, you will be asked to fill out some forms (please see above for forms to expedite this process). We will bring you back to our consultation room where we will listen to your concerns and perform a thorough examination on your child.  We will discuss treatment options and answer any questions that you may have. We will review post-operative care and what to expect during your child’s healing period. For your reference, we give you a handout that explains, in depth, post-operative care and what to expect.

For your convenience, treatment may be done on the same day as the consultation.  We provide this service only our Hollymead location north of Charlottesville.

We do not allow parents to be present for the procedure on infants. This is a stressful situation and we do not want the stress to negatively affect mom. For example, stress hormones can decrease milk production and let-down and we want the baby to have the best opportunity to feed immediately after the procedure.

If you decide to pursue treatment, we carefully swaddle your baby and take pictures for proper documentation of the lip and/or tongue tie. We carefully place eye protectors over your baby’s eyes to protect them from the laser. After that, we use the laser to carefully remove the frenum attachment on the lip and/or tongue.

We use a Carbon Dioxide Laser called Light Scalpel for the procedure. Treatment only takes a couple of minutes. It is normal for your infant to cry during the procedure. We place a high strength topical anesthetic that is safe to use on infants at the frenectomy site. We wait a few minutes for it to start working before we do the procedure in order to ensure maximum comfort for your baby.

After the procedure, you will have a private area to feed and soothe your child. The best thing to calm your baby after this procedure (and at home) is skin-to-skin time and feeding. In some cases, the baby may just fall asleep. You will be given as much time as you need to be with your baby.

Before you go, we want to review the necessary stretches and exercises that will be needed to optimize results. Although your baby may not like these so soon after the procedure, they are absolutely necessary to review. Proper stretches are essential to giving the best outcome. **If stretches are not done adequately then undesired scaring will occur which can inhibit the function of the tongue/lip which will decrease success.

Below is a video of a frenectomy procedure using a Light Scalpel Carbon Dioxide Laser:

After your visit

Below is the Home Care Post-Operative handout

You will be instructed to do stretches and exercises to prevent the surgical wound from healing back on itself. Below are videos to help guide you through the stretching exercises.


Please follow up with your Lactation Consultant, Pediatrician, and/or Body Worker as recommended by them.

We would like to see your infant back at Charlottesville Pediatric Dentistry in 1 week to assess healing and answer any follow up questions or concerns you may have.

Please call us if you have any concerns or questions. We want to provide the best possible care in the least stressful environment for you and your baby.