The upper lip ideally fans out over the breast in order to help the baby grasp and latch deeply. Have you thought about that before? Babies hold the breast with only their mouths, although they often place their cute little hands on either side while nursing -- but those hands aren't holding the breast, their mouths are. Lip ties frequently come with tongue ties, and if you have been told your baby has one, make sure your provider knows how to check for the other. The baby pictured here was not able to nurse despite his mama's best efforts (she extended pumped for him), and at almost 2 years of age, his lip tie was noticed.

For more information on upper lip ties:

Advocates for Tongue-Tie Education's Fast Facts

Tell Me About Tongue Ties! Breastfeeding USA

Diagnosing and Understanding the Maxillary Lip-tie as it Relates to Breastfeeding, Dr. Lawrence Kotlow

Back in June when we took Ezra to see Dr. Jesse, it was just my husband, Ezra, and I. I had this picture on my phone, and on a whim, I shared it with Dr. Jesse to show the array of palates and tongues we had left at home:

"You see this here?" he pointed to my (then) 13 year old's picture, "His tongue-tie is pulling his bottom two teeth in." 

Now after my discovery of Ezra's mouth, and then our science project of comparing the other kids via pictures, I was amazed to see Jacob had a tongue-tie. He nursed with ease until the day he quit on his 4th birthday; well, I should say, after his stint in the NICU for 2 weeks, plus a couple of days figuring things out in our own time and space out of the hospital, he nursed with ease. I thought that was it, end of story -- nursing went well, so we didn't need to worry about it now. But I had before noticed in his otherwise lovely mouth of mostly-straight teeth, those two troublesome bottom guys...

In hindsight, a tongue like that could have caused a few issues we noticed earlier but were clueless about. Jacob was late to start solids. I offered him rice cereal at four months (it is important to know rice cereal isn't the best first food for babies, I was following mainstream guidelines and assuming since it was marketed for babies, it was best for babies; for more info about that, read here). He gagged so I figured he wasn't ready (again, I was uninformed and looking at the calendar and not the baby when determining if he was ready for food). I would wait a couple weeks and try again; same response with additional behaviors such as coughing, tongue thrust, clamping his mouth shut, and turning his head away. After a few more attempts, I lost interest and let my little sister (then 12 years old) eat it all. When Jacob was 9 months old (and still had no real solids experience) we were eating at our favourite Mexican restaurant. Jacob was large -- 9 pounds, 8 ounces at birth, 20 pounds at 4 months, 30 pounds by a year -- and because of that, we often placed him in the high chair while we dined to keep him at our level and engaged. He never acted interested in food, though. This particular night, he was madly waving his arms and shouting at us, so I offered him a bite of refried beans. Surprisingly, he took the food into his mouth, kept it in, swallowed, and wanted more! We were excited, but it still wasn't full-speed ahead with food -- he didn't really start eating food until about 14 months. 

Tongue-tied babies can often be slow to eat solids or have other food issues, but I just assumed he wasn't ready and I didn't worry due to his size. I do believe Jacob limited himself to foods he could easily eat and swallow and this shaped his preferences -- he is still a picky eater, and I fully attribute that to his anatomical make-up and how he compensated to ensure he didn't choke or suffer other discomforts while eating.

The second sign of how he was being affected by his tongue was the fact that he had extensive decay on his top teeth, necessitating caps at 18 months old. Having a tongue that doesn't move in a full range can cause decay, as the tongue isn't able to move between the teeth and the lips up at the gumline to sweep food out. Coupled with an upper lip tie (restricted upper lip), pockets can form and food and bacteria can become trapped, thereby causing decay despite the best oral hygiene practices. Again, at the time we thought it was a fluke, genetic thing, especially since he hadn't started solids until later. Now I see it makes sense. In light of his history, I recently scoured all the pictures I have of him to try and find evidence of his tongue-tie as a baby -- this is all I have come up with:

Ties, like black holes, continue to exert that force on the mouth and the teeth if they aren't resolved or released; case-in-point: my husband's parents spent thousands of dollars on orthodontics for him, to only have his bottom teeth move once the braces came off and stopped holding the teeth in proper alignment. I could further prove this with a picture, but my husband doesn't readily allow me to share the inner workings of his body on the internet :). 

We decided to take yet another trip to see Dr. Jesse and have Jacob's tie revised. We made an overnight trip out of it, with an adventure to the La Brea Tar Pits attached.

Dr. Jesse welcomed our whole entourage into the treatment room. While we waited, he ran in to get the laser and said, wheeling it away, "Someone has a canker sore that's needs zapping!" and left, happy to remove this thorn in a patient's mouth.

Dr. Jesse came back in to greet us, look in the other boys' mouths, and then get Jacob seated in the chair. He visually and digitally assessed Jacob's tongue function, saw there was no upper lip tie, and explained what he felt we should do for optimal restriction release. Jacob received a numbing shot that needed a few minutes to take effect, and we waited and chatted. 

Since I held Ezra during the last procedure, it was Brad's turn to hold Jacob (just kidding -- Jacob is 6" tall and wears a 13 shoe). I did say that, though, and it got a good chuckle. What I intended to state was, since I held Ezra and wasn't able to watch the procedure in real time, I stood close to Dr. Jesse's shoulder to get full view of the lasering. It makes sense, but I wasn't quite prepared, that it took about 5 soild minutes to keep swiping the laser over, and over, and over the frenulum. Dr. Jesse would then readjust, regrip, and reapply the laser; soon I realized I didn't need to watch the whole thing. The other children were curious, and Dr. Jesse's assistant invited them over to both have a turn.    

After the procedure, Dr. Jesse made sure all the boys (minus Ezra) received popsicles. We took care of the billing ($80), and bid Dr. Jesse farewell. We went in search of lunch and ended up at BJ's Brewhouse. Jacob ordered pizza and ate like a champ, mostly...but as he neared the end of his pizza, his eating got slower. Finally he pushed the last bit away and said he was done. I looked at him an realized he was white as a sheet! That's when it hit me:  I should have given him ibuprofen before walking out of Dr. Jesse's office! I let the pain come at full-force as the numbing shot and laser affects wore off. I quickly offered him some analgesics and we hit the road toward LA.

We stayed in a hotel, and Jacob and I found a Target to get some provisions (popcorn, hot chocolate, snacks). I threw some Anbesol into the cart, hoping it might help. Jacob threw some popsicles in for good measure. Back at the room, we tried the Anbesol (it stung mightily -- he went and washed it out!), and he decided to keep up with the ibuprofen and popsicles. He had a hard time sleeping that night, but we were away from home, and the distractions were minimal.

The next morning his mouth really hurt, but he was able to drink some hot chocolate with his brothers: 

We headed off for the day and had a great time at the tar pits. Jacob did experience pain intermittently, and we kept up with the ibuprofen (see a theme here?). For lunch we went to the Cheesecake Kitchen. Jacob ate a hamburger okay, and then the five of us shared three pieces of cheesecake (he had no trouble with that!).

For the next few days, his mouth hurt. Looking back now and reading other adults' accounts of their revisions, I wonder if we could have dissected a bit more what the pain felt like to get to the root of what might have been causing that sensation. As in childbirth, when you throw all the "pain" together in bucket, it is read as PAIN, but when you break down where the sensation is coming from it not only makes it easier to cope with, it helps us to know why it's there. I am sure he was feeling soreness at the site, but was he also feeling tenderness as his tongue moved in ways it never before was able? Was any of that the after-effects of tensing during the procedure, which caused lactic acid build up he was feeling now? Referred pain signals to areas that weren't even affected? All we knew was, he called it pain, and we treated it as such. There is science behind controlling pain for speedier healing, so I am not opposed to doing what works for him. Being that he is the size of a grown man, his frenulum was thicker and required more time to release.

I am trying to get him to write up his experience in his own words, but that may take some bribery on my part, or extra credit on his English teacher's part. But who knows, maybe it'll turn up and you can read how he felt about being tongue-tied and then released?

Did you know a parent or caregiver can pass the bacteria that causes cavities to their babies?  As I feed Ezra more of what I am eating, I realize we end up sharing the spoon. If I have untreated caries in my mouth, I can pass the Strep mutans (believed to be the primary bacteria that causes cavities) to Ezra and colonize his mouth and teeth so he could potentially "catch" cavities from me.  

We know Strep mutans are not present in babies' mouths at birth. "Research shows that caries can be infectious.  When an infant is born, its mouth is basically sterile.  It does not
have decay-causing bacteria in its mouth.  The decay-causing bacteria is 'acquired' or 'inoculated' at some point in its life.  It may be the timing and amount of the inoculation that determines the risk of decay. The infant could be inoculated by Strep mutans in many different ways -i.e.- kissing, using same spoon, etc.  Once exposed to Strep mutans, the critical issue then becomes how often the infant is exposed to sugar.  Frequency of exposure to sugar is more important than the amount of sugar.  A low bacteria count with many sugar exposures can be just as cariogenic as a high bacteria count and less sugar exposure." The late Dr. Brian Palmer was a leading researcher on breastfeeding and oral development and health, and that quote was his, taken from a presentation on his website. 

Dr. Palmer also showed us breastmilk is anticariogenic in nature -- meaning breastmilk alone will never cause decay.  Now as soon as you add a Goldfish cracker or a slip of dried seaweed -- anything that has carbs in it -- you have the makings for caries.  But his research showed teeth soaked in breastmilk did not decay. This is important in light of night-nursing.  When babies start to get active and busy, they often shift the majority of their eating from the daytime to the nighttime (we call this reverse-cycling), yet night-nursing is often blamed for infant caries.  Wiping the teeth with a clean cloth at night is something some parents do, but admittedly not every parent is awake or aware enough to see this through.  Others choose to brush their babies' teeth after dinner and only allow breastmilk or water until morning.  Whatever you choose, it is important to be mindful that as soon as your baby's teeth erupt, it is time to start taking care of them.

As parents there are things we can do to help improve our babies' dental health: 

• Ensure your own mouth is in tip-top shape and role-model good oral hygiene habits.  I did last visit the dentist in March, a month before Ezra was born, and my mouth was deemed cavity-free -- I am overdue to go back, but with a baby in my care during common office hours, I keep delaying my visit!
• If you have active caries or current mouth pain, think twice before exchanging slobbery kisses, sharing spoons, or "degerming" the fallen pacifier with a pop into your own mouth before offering it to your baby...same holds true for anyone in close contact with your baby. You can pass those Strep mutans right to your baby and that begins the infection, essentially.
• Practice good eating habits.  What the research tells us is, it isn't the amount of sugar we eat, it is the frequency of sugar.  My husband shared with pride how he could make his Halloween candy last a year when he was a kid.  In my family we were allowed to gobble all of our candy up in the matter of a few days. Everything equal as far as daily brushing routines, who has the increase risk of cavities?
• Know your family history.  Did you have an aunt who had an enamel deficiency? Be suspicious for any kind of enamel anomaly or peculiar periodontal paradox plaguing your predecessors (oh my, I had to!).  
• Along those lines, if you already know someone in your family dealt with tongue or lip ties, be aware there is a possibility your baby may be affected. Some terms you may hear at family gatherings that can hint to tie issues include: "small upper palate" (palate expander needed), "large lower jaw," "high palate;" perhaps someone had to have a frenectomy to remove  a space between the upper two front teeth (a diastema).  Any of these could allude to a tie issue. If your baby has an upper-lip-tie or a tongue-tie, consider revision.  I learned this the hard way 13 years ago with my oldest son.  He had his four top teeth capped at 18 months due to restrictions in his mouth -- at the time my husband and I had no idea why that decay occurred.  Since then we learned upper-lip-ties can hold bacteria and food in pockets close to the teeth, and a tongue-tie can limit the tongue's ability to sweep out that debris.  Often with a tight upper-lip-tie, it is hard to brush the area because of the thickness of the frenulum and the pain it can bring the chid. Dr. Palmer's website also has information on frenulums.  

There is other very interesting information at Dr. Palmer's site on additional reasons decay can occur in children, including major maternal illness or stress during pregnancy -- certainly worth a read if you feel that might fit your situation. 

There is much joy in feeding that little baby of yours "real food" once they can really go for it.  With a little bit of knowledge, and a tiny toothbrush, you have the tools to help protect those teethies while also building lifelong habits of proper dental hygiene.