Dr. Green’s Family

Meet Dr. Green

Dr. Joanna Green brings her experience as a mother to her work and the health and comfort of her patients, from infants to adults, is always a priority. As a mother of a lip and tongue tied baby, having gone through the frenectomy procedure, she has a special interest in tongue and lip tied infants. Dr. Green has persued specialty courses and advanced training in laser frenectomy treatment. Working alongside other infant healthcare specialists, she has developed a comprehensive, compassionate and conservative approach to treating our littlest of patients.


What is tongue tie?

Tongue tie or ankyloglossia is a condition that may be present at birth that restricts the tongue’s range of motion. Most recent research estimates that between 4-11% of infants present with a frenum that is restricted. With tongue tie, an unusually short, thick or tight band of tissue tethers the tongue to the floor of the mouth. This infamous band of tissue is known as the lingual frenum or frenulum, and can effect nursing, bottle feeding, as well as have serious overall growth and development implications from childhood to adulthood. This is a physical barrier that restricts normal function and is not a fad!

What is lip tie?

A labial or lip frenum is a normal part of anatomy that can be readily found on infants, children and adults. However, when the frenum tissue is thick, tight, or inelastic and impedes the normal range of motion of the upper lip, it can cause issues with nursing, bottle feeding, and feeding solids.  During nursing, the ability to flare the upper lip out and create a seal on the breast is an integral part of a good latch and can in turn decrease excess air intake and gassiness. During your baby’s exam, Dr. Green will demonstrate range of motion, creasing, blanching, that may or may not be noted on your child.

There are many ways that a tongue tie can affect breastfeeding in an infant, with each situation being unique. In general, a poor latch starts a cascade of events caused by compensatory actions. For example, a tongue tied baby will attempt to nurse using their tongue that only has limited movement and thus chomping, gumming, popping on and off, and clicking occur. It is common for nipple pain and trauma to cause poor transfer of milk which in turn can ultimately cause decreased milk intake, decline in milk supply, and premature weaning.

An adult who has a tongue tie may have a history of speech therapy, mouth breathing, small narrow jaws (or had teeth removed for orthodontics), crowded or misaligned teeth, acid reflux, and sleep apnea.

How is tongue tie or lip tie treated in an Infant?

A frenectomy or “release” is a procedure that consists of releasing the band of tissue under the tongue or upper lip to allow for better range of motion. After careful evaluation,  this procedure is performed to allow for the tongue and/or the lip to function properly during swallowing and/or latching at the breast or bottle.

As certified by the Academy of Laser Dentistry, Dr. Green is safely and proudly using the latest and most innovative technology, the Light Scalpel CO2 Laser. Using laser technology, we can achieve controlled and precise removal of tissue with paramount safety, minimal bleeding, less post-operative pain. For more information on light scalpel technology and how it works, click here.

Frequently Asked Questions

Will my baby or child need sedation or general anesthesia for a frenectomy?

Infants typically do not require any type of sedation for a frenectomy. Your baby will be swaddled, protective eyewear placed, and either one or two assistants will keep your baby safe and still. Keep in mind that the laser is very precise and controlled, and is very safe even on a crying infant.
For older babies and children, each situation is evaluated on a case by case depending on symptoms, urgency, physical and emotional well being of your child. For older children we may use a combination of laughing gas, a movie, and numbing.

Will you use numbing for my baby?

As a general rule, for newborns less than 2 weeks old no anesthetic is used.  We find that the procedure can be performed so quickly that the risks outweigh the benefits of numbing. For infants 2 weeks and older, we use a topical numbing cream that is custom formulated and safe for babies. We only use this for lip ties as placing numbing under the tongue causes difficulty nursing afterwards.  For older babies and children we may use a combination of topical local anesthetic along with an injection, if needed.

After the procedure, is there anything we need to do?

The short answer is Yes! During your appointment we will thoroughly discuss, demonstrate, and give written instructions on home care as we have found it is critical for the success of the frenectomy.

How will my baby feel afterward?

First and foremost, it is important to understand that every baby is different. On average, the younger the baby is, the less we see fussiness. For the average baby one can expect a couple days of fussiness or soreness. At first, feeding can be disorganized because of the tongue’s new range of motion. Until the soreness goes away and the tongue strengthens, this is normal and part of the rehabilitation process. Dr. Green works closely with lactation consultants, speech therapists, and myofunctional therapists to make sure we have all hands on deck in the care and rehabiliation of your baby.

Can I nurse or bottle feed right after?

There are no restrictions, and in fact, we recommend nursing/feeding right after! Nursing and skin to skin will help relax and soothe your baby. We have private rooms so you can take your time.

Is this procedure only for the benefit of breastfeeding or will it help later in life?

When there is a restriction in the normal range of motion of the tongue, it is often first identified in infancy during breastfeeding. Red flags ( link to signs and symptoms) are raised that something isn’t right. Sometimes babies are able to compensate extremely well or the mother may have an oversupply that masks inefficient nursing. Bottle feeding does not require the same mechanics and is generally easier for the baby, which may contribute to undiagnosed tongue ties at cause feeding or speech issues in older children. There are so many factors surrounding proper diagnosis ( link to team approach) which is why it is so very important to have a team approach and a comprehensive evaluation by a specialist such as an International Board Certified Lactation Consultant (IBCLC) or Speech language pathologist (SLP) prior to meeting with Dr. Green.