ISSN 0974-3618 (Print) www.rjptonline.org
0974-360X (Online)
REVIEW ARTICLE
Breast feeding Difficulties in Tongue-Tie
G.S.V. Nivashini1, Thenmozhi M.S2
11st year BDS, Saveetha
Dental College and Hospitals, Chennai, India.
2Head of the Department,
Anatomy, Saveetha Dental College and Hospitals, Chennai, India.
*Corresponding Author E-mail: nivashinisridhar@gmail.com
ABSTRACT:
Aim : To identify the Breast feeding
difficulties in tongue tie
Objective: To find out the breast feeding
difficulties in tongue tie
Background: The tongue is a muscular hydrostatic on
the floors of the mouths of most vertebrates which manipulates food for
mastication. Ankyloglossia is a congenital disorder in which the tongue is
attached to the floor of the mouth called frenulum. This decreases the mobility
of the tongue leading to the open deformity and results in mandibular
prognathism. The frenulum fails to move back to the tongue during development
or heart shaped tongue. The difficulties in Breast feeding will be the baby can
open its mouth fully so it can't latch it in correct position which leads to
the aspiration of the milk as the baby can't open widely, it will open till the
nipple bleeding from the nipple there will be a noisy suck.
Reason: The reason is to find out the problem in
the beginning level and can explore the possible ways of treatment and to gain
knowledge about it.
KEY WORDS: Tongue-tie,
frenulum, breastfeeding, nipples, ankyloglossia, frenectomy
INTRODUCTION:
1The medical terminology of tongue tie is
ankyloglossia. It is a congenital and hereditary disorder. It is formed when
the lingual frenulum is short or thick and attaches to the tongue to the floor
of the mouth1. It may also cause speech problems (I.e)
they may find difficulty in pronouncing (s, I, th, d, t) and breast feeding
difficulty is a common problem which will be helpful in identifying the problem
in an earlier stage. In some children the frenulum may recede on its own in the
first year of life.2 In order to extract milk from the breast
the baby needs to move his/ her tongue to a full extent to cup nipple then it
compresses the roof of the mouth. If the child fails to do it, the tongue may
lead to the nipple soreness or damage2.
It all depends on the degree of tongue tie.3 It
is very difficult if it points on the very tip or top ridge of the gum in the
floor of the mouth then at the backside.4
The mouth may be affected with simple
trauma, mastitis and plugged ducts. If the mother have a small or medium
nipples, the child can manage even though with tongue tie than large or flat
nipples4.
History:
Scientists
like Galen, Hippocrates and others consider tongue as a health barometer and
they also stressed on the prognostic and diagnostic importance of the tongue.
In medical examinations tongue assessment will5 have a historical importance. The
difference in the colour, texture, and oral mucosa6 of the tongue will be used for the
diagnosis of several other problems of the body. For.eg : the oral mucosa is
compared to the skin of the body and certain diseases like cyanosis will be
apparent in the mouth often. That's why the tongue is considered to be the
" mirror of physical health".
Development of tongue:
The tongue
begins to develop at about 4th week of gestation. Local proliferation of the
mesenchyme that gives rise to a number of swellings in the floor of the mouth.
First swelling is called the tuberculum impar (a large midline swelling of the
of mandibular process) which is flanked by two other bulges called lingual
swellings. They rapidly enlarge and merge with each other and tuberculum impar
to form a large mass from which the mucous membrane of anterior 2/3 rd of
tongue so formed. The root of the tongue arises from the hypobranchial eminence
(a large midline swelling developed from the mesenchyme of the third arch). It
serves as a primordium of the epiglottis7. This will give rise to mucous covering of the root
or the posterior 1/3rd of the tongue. The tongue separates from the
floor of the tongue by a down growth of the ectoderm around its periphery which
subsequently degenerates to form the lingual sulcus and gives the tongue
mobility. The muscles of the tongue have different origin. They arise from the
occipital Somites, they carry with them their nerve supply the 12 th cranial
-the hypoglossal nerve. The mucosa of the anterior two- third of the tongue
form the first arch and supplied by the fifth cranial nerve and posterior one
third from the third arch and supplied by the ninth cranial nerve.8
Anomaly- tongue- tie:
9Tongue -tie is
know as ankyloglossia which is a congenital disorder the May arrest the
mobility of the tongue. It is caused by the short and thick lingual frenulum
which connects the tongue from the floor of the mouth. Ankyloglossia can affect
feeding, speech like letters like (s, I, th, d, t) and pronunciations that needs
tip of the tongue movement9.
Normal breastfeedingmethods:
Breast
feeding is natural but it won't be efficient for all the mothers it is a
acquired skill. There are four simple steps for efficient feeding a10 normal child.
Step:1
Take a
simple and relaxed position while breastfeeding and for comfort you can use
pillow and position it whichever side you want. Hold the aerola with your thumb
and other fingers.
Step:2
Position
your baby in such a way that his/ her head should be placed in your elbow and
back in your palm then tilt your head backwards so that the baby can touch your
nipple to his /her mouth wider. Bring your baby close to you so that his/ her
belly should touch yours.
Step:3
Help the
baby to scoop your nipple by placing baby's lower jaw below your nipple.
Step:4
Tilt his/
her head forward and help to place the upper jaw and see to that at least 11/2
inches of the areola should be inside his / her mouth.
Normal movement of the
tongue in normal babies:11 As soon as you position your baby the tongue will go
to the lowermost position and draws milk from the nipple and the it rises to
the roof of the mouth and swallows the milk.12 The principle behind it is when the tongue is in the
lowermost position the intra oral vacuum will be increased and milk ejection
starts intern rises the tongue and vacuum will be decreased and milk ejection
will be ceased.12
Movement of tongue in tongue tied babies:
Here the
babies cannot move their tongue so as to compensate that baby will use his /her
jaws to increase the pressure excreted on the13 nipple will be beveled. The other most
common compensation is that they use their lips to draw milk from the breast.
In normal the lips will act act as a seal around the breast and14 so they have to use the lip for both the purpose
so baby may fall of during feeding. This leads baby to a fatigue stage, if
there is extreme compression it will lead to jaw tremors and interrupts
feeding.15
Difficulties of mother in breast feeding
tongue tied babies:16
When the
baby uses jaw to draw the milk, the nipple will be beveled or damages with the
compression in the nipple, this may lead to a blister or burst or a crack in
the nipple. 17
The mother will
experience maximum pain when there is large tissue damage and vice versa. There
will be excessive compression which will be felt more prominent with shallow
latch. When a baby has a shallow latch baby's tongue will become less stable.
This will lead to extreme pain. The pain will slow down the milk ejection
reflex and so the pressure exerted by the baby will still increase and will get
milk.18 When the milk flows, the pressure will be
reduces and lubricates the nipple and will reduce pain temporarily
CONCLUSION:
Treatment
for tongue tie will be prescribed only when the symptoms are seen. If the child
is less than twelve months of age surgery can be done with local anaesthesia in
physician's office, as the baby will be fully cooperative. If the child is
about 1-12 years old general anesthesia will be given19. Usually surgery will be done with
clamp and scissor technique and now -a- days they are using laser as well. In
some clinics, they are using 1064nm diode laser. This procedure will hardly
take a few minutes.20
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