Myofunctional Therapy and Lip Ties: Advice for Every Age

Tongues usually get all the publicity but don’t be fooled, tethered lips matter. Though hotly debated in the professional circles lips ties do exist and need to be treated in very specific instances.

Here’s my professional advice on when, why and how to know if your lip tie needs release.

Infants

Babies that are nursing, or breastfeeding, need to establish a deep latch with the upper lip flanged, or protruded, as a seal over the areola. A lip tie can be restrictive and make it nearly impossible for baby to stretch its lip upward for proper reach and seal. However it is important not to mistake the presence of a labial frenulum with restrictive tissue. Function always trumps appearance. If the baby has been evaluated by a lactation consultant or specially trained myofunctional specialist they could determine the function of the lip tie.

Skipping a functional evaluation in an infant and going straight to a release provider can be risky. While some may refer you back to get a functional assessment, some may simply release and send you on your way. Breastfeeding troubles are complex and could involve a myriad of causes. Team approaches offer the best outcomes as what you self-diagnose on the internet and what you really need are two completely different things.

Prioritize a functional assessment at this age if you are unable to take two fingers and flare baby’s lip upward to the nose or get a deep latch. The latter requiring assessment and treatment from a lactation consultant.

Toddlers

Feeding and dental problems can be seen in this age group resulting from lip ties. Some problems are less the lip tie and more the history of improper oral motor skills. Prolonged sucking on bottles, sippy cups, and pacifiers can distort the oral cavity shape and size and impact function.

Seek out help from an speech-language pathologist or occupational therapist who specializes in oral motor and feeding. They will asses the function present and provide treatment before and after release when needed.

A myofunctional therapist is often not able to provide direct care for the function, but can supply you with useful tips on proper active wound management needed post-release. Bonus points for finding a feeding therapist that is also a myofunctional therapist.

Begin your search at a release provider to evaluate for the presence of a tie, but don’t end it there with an immediate release.

Children

There’s some unproven statements that exist about the lip frenulum growing until age 7. What is certain is that children commonly fall and hit their face. Sometimes this splits the frenulum whether restrictive or not. So it is possible to have a child that presented with a lip tie in the toddler age to no longer have one as a young child.

If function was impacted, however, it is still important to treat. Residual lip ties at this age can impact the ability to create a lip seal and maintain closed lips for proper resting posture. This results in a flared upper lip and is often accompanied by a space between the two front teeth due to the tension of the frenulum.

Adolescents and Adults

There is a possibility that a strong tie can impact sounds that require the lips to be articulated. If that is not the case for you then a lip tie is only a concern at this age if it impacts lip closure for proper seal or if you find the gap between your two front teeth to be aesthetically unappealing. An inability to maintain lip closure can promote mouth breathing, affect orthodontic retention (or cause shift of teeth after braces are removed unless permanent retainers are placed), and cause flaring of teeth forward.

Consult with a myofunctional therapist prior to release to see if your open mouth posture is due to a tie or is habitual and can be changed with treatment. The myofunctional therapist will help you with active wound managements stretches and exercises prior to the release and work with you to develop proper oral resting posture after the release.

Regardless of age, if you have a tie and feel that it needs to be addressed, it is always best to get a functional evaluation prior to getting a release. In some cases it may save you from undergoing an unnecessary procedure.

Karese Laguerre is a Registered Dental Hygienist and Orofacial Myologist. In her years of working with various patient populations in the dental field, she encountered similar trends and limitations in dental malocclusion and mouth-breathing. The correlation between the two became even more relevant as her own children grew in age and with the pursuit of extensive hours in continuing education she achieved training in treating the primary cause, improper oral resting posture. She is passionate about the education of airway matters to the general public.

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