Updated: Nov 4, 2020
There is no doubt that in the last few years there has been an explosion in awareness about tongue ties. ✋ Even I didn't know much about them 3 years ago. The problem is that there has also been an explosion in providers offering frenectomies, and the vast majority of them have Very. Little. Training.
You know how I know this? FB groups. Every single day I see posts from people asking their peers for advice and instructions about frenectomies. My question is, where are their providers!? I understand that you may want different perspectives from others who have gone through it, and that's the beauty of FB 👍, but they should not be your primary source of education. Not to mention that half of the advice given in these groups is, though well-intentioned, just plain wrong, because they also got their information from their peers whose providers did not properly educate them. It's a vicious cycle.
So here is my list of questions for you to ask when searching for a frenectomy provider:
1. What education have you had specifically relating to oral tethers❓
2. What recent conferences or classes have you attended❓
3. Is it a posterior tongue tie❓
4. Do you check for buccal ties❓
5. What is your protocol for pre-frenectomy❓
6. What is your protocol for post-frenectomy❓
7. What do you recommend for pain management❓
8. What additional resources and referrals will my child need for best results or if we continue to struggle post-frenectomy❓
9. If using a laser, what type of laser do you use❓
1. So I'll toot my own horn here for a second- I've had over 350 hours of continuing education specific to oral tethers and oral dysfunction in the last 2 years. That's a lot. If your provider is not limited to frenectomies, it is unlikely they've had that much specific education. But if the answer is less than a hundred, then I'll go out on a limb and say they need more. It wasn't until about halfway through those 350 hours where everything started to click for me. Because as I say all the time, the procedure is the easy part - any competent provider can do an excellent release with a very small amount of training. It is EVERYTHING ELSE that is so complicated and important when working with a tongue tied patient. Your frenectomy provider should be your quarterback, not just the surgeon.
2. Medical knowledge is constantly changing. It is not ok to go years without refreshing and updating that knowledge 📖. Medical licenses require some number of continuing education credits every single year. When I did kids' dentistry, I took continuing education classes in kids' dentistry - in order to be great at what you do, you have to stay up to date and knowledgeable.
3. Why yes, yes it is. Dr. Ghaheri's sailboat ⛵ analogy is my fav. All ties have a mast (aka a posterior portion of the restriction). Many ties also have a sail (aka the part of the tie that you can easily see). If your provider can not explain and demonstrate NORMAL tongue function and how the posterior portion of the tongue tie affects that function, then they don't understand tongue function! (Also, the chances that your baby just has a lip tie are slim to none.)
4. Going off clinical experience and results here - releasing buccal ties in infants has amazing outcomes. You can instantly see the face relax and the mouth open wider 😌. It took doing it for the first time to convince me.
5./6. This is the most common thing I hear locally about pediatricians, ENTs, and dentists doing frenectomies - no pre-therapy or aftercare needed 🙅♂️. This is not ok! It either means they are not doing a complete release, and/or they have no idea about proper post-frenectomy healing and function.
7. Again, a very, very common question seen in the FB groups. It is ok to compare or search for alternatives, but if you can't have a thorough discussion with your provider about this topic that answers your questions and makes you feel comfortable, then they are doing you a disservice 🤕.
8. Your provider should have a list of resources for you: lactation specialists and support groups, bodyworkers, speech and feeding therapists, ENTs, orthodontists, OTs, PTs, etc. - all of which should be knowledgeable in ties, tongue function, and airway. Not all locations have access to all of these educated professionals, but a good provider should be able to guide you 📝.
9. Ah, lasers 🔫. Are they the best tool for the job? Jury is out. But let's be clear about one thing - a surgical laser is a beam of light that cuts, and a diode laser is not a surgical laser. Unfortunately, corporate salespeople have been selling low cost diodes as surgical lasers - which has completely mucked up what we know and understand lasers to be. A diode laser has a glass tip that, when blacked out, traps the laser light and heats up to over 2000 degrees Fahrenheit. It becomes a hot scalpel that must be physically applied to the tissue in order to cut. If your provider is using a diode, they are not doing a laser frenectomy, period. Are they still doing an excellent frenectomy? It's possible! Are they cutting with a laser? Nope!
As a dentist, I have never placed an implant, delivered a denture, or placed a bridge. Am I allowed? Yup. Was I taught how in school? Yup. Am I currently qualified to do so based on those answers? Absolutely not. Would I need boatloads of re-education and training to do so well? Yup.
Hold your providers 👨⚕️👩⚕️ to a higher standard. Just because the procedure itself is easy doesn't mean anyone should do it. Don't pay for your providers' tool, pay for their knowledge and expertise. You would expect excellence with any other medical procedure - don't let frenectomies be any different.