September 5, 2018
by Dr. María del Pilar Martín Santiago, DDs. MSc Lasers in Dentistry, Expert in Dentistry for Newborns
Breastfeeding has an important role in the development of the orofacial structures in babies. For this reason, we need to review our knowledge and the importance of the mouth in the success of breastfeeding and in the growth of the infants and, on the other hand, the role of laser systems in a minimally invasive management of oral disorders and pathologies.
In the first world countries of the 20th century, we observed a significant decrease in breastfeeding, which contributed to an increase in orofacial imbalances. Fortunately, from the end of the 20th century and continuing now, we are experiencing the resurgence of breastfeeding. In many cases, breastfeeding problems for mothers and babies are attributed to abnormal attachments of the tongue or the upper lip (such as tongue tie and lip-ties). Other problems like epulis, tumors, angiomas or natal teeth can be considered to be primary factors in creating breastfeeding difficulties, they alter the correct function of the mouth of the baby.
This means that pediatricians and breastfeeding experts, together with expert dentists in neonatology, must create multidisciplinary teams to study cases in which the mouth becomes an impediment to the proper development of breastfeeding.
We must carefully study each case and check for a restrictive pattern that is the cause of the difficulty in breastfeeding, as this is vital for the integral development of the newborn.
There is a strong belief or axiom that we must wait until the child has grown to perform a frenectomy, but sometimes when we do not do it, it may affect the future growth process itself and limit the infant’s own development.
Complete sealing during breastfeeding, shape of the lips in C.
Disturbances caused by not being breastfed
We have to take into account that oral health is an important part of the breastfeeding experience 1,2,3,4,5,6,7 and breastfeeding is not only a lifestyle choice, but rather a basic health need. When we do not have proper type of nutrition, we can observe some problems in the development of babies. We associate the following problems with babies who were not breastfed: dental malocclusions, high palates, narrow dental arches, anterior & posterior dental crossbites, inadequate nasal respiration, alterations in the deglutition and in the management of the tongue, inadequate facial development, incorrect mastication pattern, parafunctions, thumb sucking or problems in the emotional sphere. 4,5,8 Newborns often present with ankyloglossia (tongue tie) or lip-tie which cause problems in breastfeeding. Ankyloglossia is associated with 25-60% of the incidence of difficulties during breastfeeding for mothers and babies. 9,10
Breastfeeding and mandibular advancement
The importance of breastfeeding. The nipples as expanders of the palate.
Alterations in oral structures allow us to understand the importance of the breastfeeding experience, because the “Nipples are considered like Mother Nature’s palate-expanders”. As babies push the nipple behind the front teeth and push on the palate, they develop a wide and forward palate and enough room for the permanent teeth. On the other hand, peristaltic movements (in bottle feeding, piston movements) 11 produce the first physiological advance of the mandible, connecting the jaw, hyoid bone and cervical spine in a harmonic three-dimensional position.
The benefits of breastfeeding in the development of orofacial structures, allow infants to naturally breathe and swallow at the same time without learning a complicated protective mechanism.
Breastfeeding benefits to infants:
In the future, adults with ankyloglossia will have more problems with snoring and nocturnal apneas, because the tongue goes backwards during sleep, closing more airway space.
Symptoms in babies
We can observe:
There are many other symptoms and signs in the neonatal period and during childhood.
Diagnosis of frenulum disorders
For the diagnosis of frenulum and oral disorders in babies, we need to study the clinical history of baby and mother, type of delivery, maturity…etc. and a clinical exploration of all the structures of the child and mother which are involved in Breastfeeding. For example, checking the condition of the baby’s mouth by assessing: tongue, gums, jaws, lips, epiglottis and soft/hard palate. It is also important to take a look at the oral-nasal respiratory circuit and pattern.
We need the important information provided by the pediatrician about the baby. In addition, we need to carefully examine oral frenula, breathing and the neurological reflexes correlated with breastfeeding and with the maturity of babies. A child with neurological immaturity cannot perform adequate suction, even if we control his frenulum. 6
Nasal respiratory pattern and movement of mandibular advancement when the baby is sucking
How to determine if your newborn infant is tongue-tied
Ankyloglossia or lip tie can be defined in different ways:
There is no universally agreed upon way to classify tongue or lip-ties, therefore, there are different frenula classifications. However, in our experience, we believe it is more appropriate to simplify everything and classify the presence of ankyloglossia in:
Double upper Labial frenulum in a baby
Treatment options for lip and tongue-ties
Frenotomy and Frenectomy Techniques with laser systems
It is very important for the infant’s safety and for a good visualization of the surgical area to have a well-trained staff to properly hold the infant and assist in maintaining a good airway. It is imperative to locate the mamelons where the holes of the outflow of the Wharton ducts are located, as they are excretors of the submaxillary salivary glands. We can use the fingers or the Lorenz tongue holder or groove director (Tongue lifter) to help position the tongue.
Differents laser systems, like the diodes or erbium lasers, can be used to perform this surgical procedure, as reported by several authors in recent publications on this subject. 12,13,14,15,16,17
In my opinion, Erbium laser is more comfortable for the babies. We don’t need anesthetic or sutures, we don’t have bleeding, we have precise control over the important surrounding structures, like the glands, and there is no recurrence.
In most cases, 2-8 mm of freedom is adequate to allow an improved and comfortable nursing.
Surgery for tongue tie release with Er,Cr:YSGG laser
Post-operative care instructions
Our mouths are very important for our lives! Dentists are in the unique position to help our youngest patients to start their lives on the right foot (or with the right mouth). Are we as a profession ready for this challenge?
A note from the editor
Performing baby frenectomies to help release tongue tie and lip tie is a very important service we can provide to young mothers and to give babies the right start in life. Many other laser systems, including Fotona or LiteTouch Er:YAG 2940nm, LightScalpel 10,600nm CO2, Solea 9300nm CO2, 1064nm Nd:YAG, 810nm diode Picasso, 980nm diode Zolar, Sirolase and Gemini, can safely and effectively perform this procedure. It is important to be properly trained by a certified and manufacturer approved trainer, as the machine settings and laser parameters vary among different laser systems and the parameters listed in this article cannot be applied to other laser systems. OH
Oral Health welcomes this original article.
About the Author
Dr. Pilar Martín graduated in 1987 from the Universities of La Laguna (Spain) and Universidad Odontológica Dominicana (Santo Domingo) with degrees in Medicine, Surgery and Dentistry. In 1996, Dr. Pilar completed her Post Graduate Course in Cosmetic Dentistry at the Baylor Collage of Dentistry in Texas. She has also been trained in the field of surgery with the Master in Implantology, Surgery, Periodontics and Prosthodontics in the University of Bern (Switzerland) in 2002.
In 2010 she finished the European Master Degree in Oral Laser Applications in the University of Barcelona and EMDOLA. After that, she received her Master of Laser in Dermo-aesthetic Pathology in the University of Barcelona. She holds Master of Science degree in Laser Dentistry from RWHT University in Aachen, Germany, and is the Official Representative for AALZ (Aachen Dental Laser Center) in Latinamerica and Spain. Dr. Pilar is a member of WCLI (World Clinical Laser Institute) and recently, she has been named the Official Representative of WFLD (World Federation for Laser Dentistry) in Spain.
RELATED ARTICLE: The Importance of Breastfeeding
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