Successful breastfeeding is dependent upon an infant's ability to correctly latch onto a mother's breast. If an infant is born with oral soft tissue abnormalities such as tongue-tie or lip-tie, breastfeeding may become challenging or impossible. During the oral evaluation of an infant presenting with breastfeeding problems, one area that is often overlooked and undiagnosed and, thus, untreated is the attachment of the upper lip to the maxillary gingival tissue. Historically, this tissue has been described as the superior labial frenum, median labial frenum, or maxillary labial frenum. These terms all refer to a segment of the mucous membrane in the midline of the upper lip containing loose connective tissue that inserts into the maxillary arch's loose, unattached gingival or tight, attached gingival tissue. There is no muscle contained within this tissue. In severe instances, this tissue may extend into the area behind the upper central incisors and incisive papilla. The author has defined and identified the restrictions of mobility of this tissue as a lip-tie, which reflects the clinical attachment of the upper lip to the maxillary arch. This article discusses the diagnosis and classifications of the lip-tie, as it affects an infant's latch onto the mother's breast. As more and more women choose to breastfeed, lip-ties must be considered as an impediment to breastfeeding, recognizing that they can affect a successful, painless latch and milk transfer.
Successful breastfeeding depends on an infant’s latching onto the mother’s breast correctly. If an excessive amount of air reaches the stomach due to a poor latch, abdominal distension, belching, and flatulence often develop. This may be the result of pathologic aerophagia. Aerophagia
(from the Greek word aerophagein: “to eat air”) is excessive swallowing of air during feeding. A poor or incorrect latch may be the result of both a maxillary lip-tie and ankyloglossia. The author presents two cases where infants were being treated for reflux by their medical
doctors. After revision of both the lip- and tongue-ties, the symptoms were significantly reduced, eliminating the need for medications.
In breastfeeding infants, an abnormal attachment of maxillary frenum has the potential to become a significant factor in contributing to facial caries formation on the maxillary anterior teeth. This is in part due to the inability of infants to remove residual milk from the area between the lip and facial surfaces of the maxillary central and lateral incisors at the completion of nursing. Early diagnosis and treatment of an abnormal frenum attachment with the simple and quick revision technique using the Erbium: YAG or Diode laser can prevent these from occurring and does not present any significant risks to the infant.
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