clinician spotlight

Laser Infant Frenuloplasty for Latch Enhancement

By Dr. John R. Blaich, D.M.D.

Historically, treating nursing baby latch issues did not include a trip to the dentist.

Proper dental training and the development of working relationships with the medical community can take time to develop. For centuries scissors, scalpels, and even fingernails had been used!

Now, with the introduction of lasers in dentistry, there is a new pathway to viable and effective treatment.

Lasers provide an efficient, safe, and predictable means for treatment. The following article describes how case diagnosis, treatment settings, post- operative results, and insight on how this dentist treats these issues. 

There are photos available of ideal anatomical frenum positions and recommendations from multiple resources. However, the most important diagnostic tool is perhaps to listen closely to Mom.

If she describes any of the following common symptoms you may need to perform a frenulum revision.

  • Clicking sounds
  • Babies latch fails to hold while nursing
  • Pain during nursing
  • Frustratingly long sessions
  • Inadequate weight gain, low milk production, and excess gas.
  • Clinical observations such as a tongue tie that restricts adequate movement up and forward or an upper lip that inhibits a protrusive movement restricting the ability for an adequate flange around the nipple creating a seal and thus providing for a solid vacuum.

The most common complaint in our clinic seems to be pain during nursing. This is commonly due to a tongue tie or due to an upper lip tie that inhibits an adequate flange around the nipple, resulting in a chewing motion rather than a smooth sucking motion.  Imagine trying to create a vacuum for a plugged commode with a plunger that is bent on one edge!

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You will find various medical studies and reports questioning the need for a maxillary frenectomy. The increased vascularity and limited ability for hemostasis control are inhibiting factors for most physicians making these releases rarely performed in my region of care.

With a laser, vascularity is of little concern. Lingual frenectomies have a slightly different technique, due to location and anatomical concerns, but with proper equipment and training, they are managed easily. Find several BIOLASE on-demand webinars on lingual frenectomies.

The following case was presented via an urgent call from the patient’s pediatrician:

  • The child was five days old, underweight, and currently below his birth weight. According to the mother, if her baby fails to gain weight immediately, a trip to a Pediatric Care Facility is warranted.
  • Upon examination, the upper lip is severely tied along with a partial tie of the tongue. A decision was made to free the upper lip and allow mom to try nursing prior to a tongue release.
  • Post lip release the mother could feel significant latch improvement. Mom wanted to nurse for a few sessions before we proceeded with a tongue revision. Within five days, an increase in weight gain of 12 ounces was recorded.

This simple procedure at their local family dentist eliminated a 150-mile one-way trip to a hospital, medical expenses for the family, time off work for both parents, and most importantly- a feeling of calm and removal of stress on the family was achieved. 

A complete and thorough understanding of the child’s anatomy and laser performance is paramount to these procedures. Each case needs to be evaluated regarding the amount of tissue to reduce, the ability to provide adequate control of the patient, and a means to provide for adequate control of the surgical site.

Laser settings and tip sizes can be adjusted to each case. Factory settings were designed for most soft tissue cases. My personal go to setting is an mz6 2.75 watts, 50-75 Hz, 20A/1-5W. Enough release should be provided to stretch the upper lip adequately forward to create a seal.

The tongue should be able to raise without a cupping at the tip and freely extend forward.   Always be careful to avoid charring of the tissue – add only enough water to control this.   Retraction is provided with a frenum director that has had the edges polished prior to usage.

Utilizing a high-volume suction with slotted sides helps tremendously. Have an assistant cover the child’s eyes with glasses or taped with gauze while holding the head as calm as possible. Mom laying down on the chair, holds the swaddled baby on her chest firmly. Your second assistant provides evacuation. Infant wraps and restraints are fantastic as well.

Post-op provide Mom with gloves and instructions to massage the wound site 4-5 times per day in order to inhibit reattachment. I prefer not to massage prior to feeding.  We provide additional information on the benefits of breastfeeding along with my office, cell and home phone numbers. A courtesy call is given the next morning as well as a follow-up recall visit in ten days.

Pre- and post-op photographs,  a report from mom on latch improvement and progress,  a brief summary of the pre-op findings,  a brief description of the laser utilized for this procedure are mailed to the attending pediatrician. If a lactation consultant is utilized, a report is given to them as well.

I have not found a more profound way to provide care in a dental setting. It is rewarding, simple, and provides incredible relief and joy to an entire family.

Dr. John R. Blaich

About Dr. John R. Blaich, D.M.D.

Dr. John has held various Scouting positions in Southeast Missouri at the council level culminating in his receipt of the Silver Beaver Award. Dr. John has also been active in his community serving as chairman of Ducks Unlimited, Past President of Poplar Buff Rotary Club where he received a Paul Harris Fellowship, and has served on the board of trustees at the First Methodist Church where he is a member. He has served on the Poplar Bluff High School academic foundation and the board of directors at Union Planters Bank. Dr. John is currently serving on the Board of Poplar Bluff Regional Medical Center. Dr. John currently holds an associate fellowship from the World Clinical Laser Institute. Dr. John performs all aspects of general dentistry including endodontics (root canals), oral surgery (wisdom teeth as well), minimally invasive periodontal surgery (gum surgery), orthodontics including Invisalign and laser dentistry for minimally invasive surgeries and restorative fillings.

Dr. John’s Hobbies and interests include farming, sporting clays, reloading, hunting, golf, woodworking, camping, scuba diving, and photography. Dr. John lives on the family farm with his wife, Grace, an attorney in Poplar Bluff. He has two children, Katie who lives in Springfield, Mo. and Rachael, who is a hygienist at Dental Arts.

He practices with his brother, Rick Blaich, and two nephews, Eric Blaich and Travis Blaich, as Dental Arts Group in Poplar Bluff, MO.

Dental Arts is raising funds to support St. Jude’s lifesaving mission of finding cures for children battling cancer and other life-threatening diseases, and we need your help to reach our fundraising goal. Nursing babies who cannot latch their mothers properly receive laser treatments from Dr. John Blaich to develop a proper latch profile at no cost. Donations for St. Jude Hospital are requested for these services but not required. Please join us in helping Dental Art reach their goal for the children of St. Jude. To learn more or to donate, visit St. Jude