What Parents Should Know About Releasing Braces

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It's an increasingly common scenario facing new mothers across the country: A lactation consultant examines her newborn and suggests that cutting a “lingual frenulum” may ease her breastfeeding difficulties.

The quick procedure, known as a frenulum release, involves a dentist or doctor cutting a tight band of tissue that connects the tongue to the bottom of the mouth. In recent years, lactation consultants and dentists have aggressively promoted these procedures, even for babies with no signs of actual braces and despite a modest risk of complications, a New York Times investigation recently found.

Many anxious and exhausted parents wonder whether they should perform the procedure, which is often performed with a dental laser. Dentists, lactation consultants, and pediatricians often disagree about whether it will be helpful.

The Times spent months investigating the evidence behind the frenzy releases and speaking to dozens of experts. Here's what parents considering the procedure should know.

The first few days of breastfeeding can be difficult. A recent survey of more than 1,400 women found that nearly 40 percent struggled with at least one complication, such as painful latch-on, cracked nipples or breast pain.

Those first hurdles can be daunting, especially for new mothers surviving on little sleep. The good news: Many mothers report that breastfeeding tends to get easier over time as both they and their babies become more experienced.

Lactation consultants can provide support in those early days of breastfeeding by suggesting ways to place the baby in a position that will decrease the mother's pain. Consultants have become more accessible since Obamacare mandated that health insurers cover their services. Hospitals and nonprofit organizations like La Leche League also offer support groups for nursing mothers.

Pediatricians say a true tongue tie is easy to identify. When the baby tries to lift the tongue, it forms a heart shape as she pulls down on the center. Other babies with a tongue tie cannot extend their tongue past their bottom teeth.

Various studies have estimated that between 4 and 11 percent of babies have tongue ties. If you suspect a tie and are having trouble breastfeeding, a pediatrician or ear, nose, and throat specialist can evaluate you after physically examining your baby. (Certified lactation consultants are not supposed to diagnose braces without a medical degree, but they can refer babies to specialists.)

Doctors emphasized to the Times that many braces are harmless. The procedure is only justified, they said, when the frenulum is pronounced and the mother has difficulty breastfeeding.

Some providers tout frenulum release as a panacea for everything from sleep apnea and speech delays to cavities and constipation.

Little evidence supports those claims.

In 2017, after searching the medical literature for the best studies on frenulum release, researchers found five high-quality studies that included a total of 302 babies.

Studies showed that releasing your tongue could reduce nipple pain. But the data showed no effects on the baby's ability to eat.

A 2015 study by researchers at Vanderbilt University came to a similar conclusion: Frenulum release led to “mother-reported improvements in breastfeeding and, potentially, nipple pain.”

No rigorous studies have shown that the procedures affect the baby's sleep or future problems such as speech.

A major challenge for those studying the procedures is that breastfeeding often becomes easier over time. While many mothers report a better breastfeeding experience after the procedure, it can be difficult to know if that is a result of the frenulum being released.

Over the past decade, some dentists and lactation consultants have begun to recommend cutting the “oral ties” in other parts of the mouth. These include the labial tie, when tissue joins the lip to the gum, and the buccal tie, named for the membrane that connects the cheeks to the upper gum.

Some also recommend an elaborate aftercare regimen, telling parents to periodically run their fingers under the baby's tongue and around the mouth to prevent the tissue from reattaching.

Pediatric ear, nose and throat specialists said they rarely, if ever, cut babies' lips or cheeks because there is no strong evidence that ties impede breastfeeding.

These doctors strongly recommend seeking a second opinion if a medical provider has recommended this type of care. The American Academy of Otolaryngology issued a consensus statement in 2020 stating that “surgery should not be performed to release a 'buccal tie'” and that “there is no evidence” to support stretching or massaging the wound after the Liberation.

The vast majority of dentists and doctors interviewed by The Times agreed that the frenulum release, which lasts only a minute or two, has a low risk of damage.

But complications do happen and they can be serious. It's difficult to estimate an accurate rate of problems because no one systematically tracks them. Some pediatric ear, nose and throat specialists who work in children's hospitals said they see two or three frenulum complications each year.

Doctors said the most common problem was oral aversion, in which pain causes babies to become extremely sensitive to anything that enters their mouth. In severe cases, babies will refuse to eat and require hospitalization.

While some dentists and doctors often highlight the benefits of frenulum release, Dr. Soham Roy, chair of the pediatric ear, nose and throat practice at Children's Hospital Colorado, says he encourages parents to ask questions about the benefits. risks too.

“There is no risk-free surgical procedure, and parents deserve that information before signing up,” he said.



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