PAEDIATRIC DENTAL.

TONGUE-TIE

What is tongue-tie?

Tongue-tie occurs when the thin piece of skin under the baby’s tongue (the lingual frenulum) restricts the movement of the tongue. In some cases the tongue is not free or mobile enough for the baby to attach properly to the breast. Tongue-tie occurs in about 5% of people. It is three times more common in males than females and can run in families.

Some babies with tongue-tie are able to attach to the breast and suck well. However, many have breastfeeding problems, such as nipple damage, poor milk transfer and low weight gains in the baby, and recurrent blocked ducts or mastitis due to ineffective milk removal.

Why is a tongue-tie a problem for breastfeeding?

A baby needs to be able to cup the breast with his tongue to be able to remove milk from the breast well. If the tongue is anchored to the floor of the mouth, the baby cannot do this as well. The baby may not be able to open his mouth wide enough to take in a full mouthful of breast tissue. This can result in ‘nipple-feeding’ because the nipple is not drawn far enough back in the baby’s mouth and constantly rubs against the baby’s hard palate as he feeds. As a result, the mother is likely to suffer nipple trauma.

There are many signs that a baby’s tongue-tie may be causing problems with breastfeeding, but you don’t have to have all of them:

  • nipple pain and damage
  • the nipple looks flattened after breastfeeding
  • you can see a compression/stripe mark on the nipple at the end of a breastfeed
  • the baby keeps losing suction while feeding and sucks in air
  • the baby makes a clicking sound when feeding
  • the baby fails to gain weight well
  • he may readily gag

It is important to note that all of the above signs can be related to other breastfeeding problems and are not necessarily related to tongue-tie. If you experience any of the signs above, you may wish to call the breastfeeding helpline to speak with a breastfeeding counsellor.

Diangosis of tongue-tie

Australian Breastfeeding Association counsellors are not medically trained and cannot assess whether or not a baby has a tongue-tie.

If you suspect your baby has a tongue-tie that is causing breastfeeding problems, you may wish to contact a lactation consultant or other experienced health professional. They will be able to assess your breastfeeding and check your baby’s mouth to see whether the tight frenulum may need to be released.

Treatment for tongue-tie

If it is deemed that a tongue-tie is interfering with breastfeeding, then release (snipping) of the tight frenulum can improve the baby’s ability to breastfeed.

Snipping a tight frenulum in young babies is a simple procedure that takes only a second or two. No anaesthetic is needed. The baby usually breastfeeds straight after the procedure.

CHILDREN WITH ANXIETY / BEHAVIOURAL MANAGEMENT

Dental anxiety in children is being increasingly recognized as a major public health concern, as it can lead to underuse of dental care, as well as poor oral health. It is common to have a child afraid of the dentist. Research has shown that people with dental phobia (for this article, I’m using dental anxiety and phobia interchangeably) experience clinically significant panic symptoms including: cardiac sensations, sweating, trembling/shaking, dizziness/fainting and paraesthesia (tingling, ‘pins and needles’ or numbness type sensations). Panic symptoms may be associated with various anxiety-producing treatments and look differently based upon the specific dental procedure. For example, individuals who primarily fear oral X-rays may experience panic attacks with choking sensations, whereas people who fear other types of dental procedures may display a different set of panic symptoms. Dental phobia is a very real thing, and can sometimes prevent children and adolescents from receiving the best oral or medical care they need. As parents, what can you do to ensure your child gets the healthcare they need when it seems they are paralysed by fear of the dentist? This post will give you some research and information regarding dental anxiety and then share some tips to help you and your child better manage it.

As part of the first comprehensive population-based investigation of the origins of dental fear in childhood (1995), researchers discovered that children’s significant fear and avoidance of the dentist is highly prevalent and can be attributed primarily to direct conditioning associated with previous negative treatment experiences. Or, children acquired fears through modelling by parents or siblings. In fact, children who had a guardian with moderate to high dental fear were twice as likely to be afraid of the dentist than children who had a guardian with low dental fear. Strangers, injections and choking were the most common sources of fear among the group of child participants.

While it is true that one of the underlying causes of anxiety is the result of direct negative dental experiences, the nature of dental anxiety is more complicated than what is commonly presumed. For example, evidence suggests that how a person perceives the dental environment is a considerably more important determinant of dental fear and avoidance than having had a previous distressing experience at a dental visit. Avoidance of dental care might also be an aspect of some other condition, such as fear or social evaluation (social phobia), fear of germs, or fear of being away from the safety of home.

Children with generalized dental anxiety experience significant anxiety in anticipation of dental treatment and are not typically able to identify one aspect of dental treatment that is difficult for them, just that it’s all terrible. Furthermore, children with generalized dental anxiety will often report difficulty sleeping the night before an appointment and feeling physically and/or emotionally exhausted after treatment. These children will worry about the procedure itself; their own behaviour during the treatment and whether they will be able to manage their own anxiety; what future dental treatment they may or may not need; and whether the dentist and dental staff are perceiving them in a negative light because of their fear and oral health.

The body’s physical reaction to the fear of dental procedures can result in a variety of panic symptoms as previously mentioned. As part of the Turnaround Anxiety program, children learn there are three parts of their anxiety: their thoughts, feelings and reactions. ‘Krank’ is their body’s intense reaction to fear and stress, often times producing panic attacks to stressors. ‘Chill’ slows down the heart rate, and relaxes the body’s systems when faced with a potential stressor or what the child thinks might be a stressor. So, along these lines, what can you do to help your child turn down his body’s ‘Krank’ reaction and begin to increase his relaxation ‘Chill’ response enough to make a dental visit possible?

Tell – Show – Do

Individuals with ASD diagnoses often respond well to advanced preparation or pre-teaching. Helping an individual with an ASD know what to expect during a dental visit and being clear about the sequence of events which will occur can be very helpful. For individuals with limited language, use pictures or objects to help explain what will occur. Use simple language. Some individuals will benefit from practicing certain aspects of a procedure before experiencing them in a dental office. Desensitization techniques may also be helpful. We discuss the use of visual schedules later in this tool kit, and this may also help an individual learn what to expect during a dental visit

DENTAL HOME

The concept of a ‘Dental Home,’ is the ongoing relationship between a dentist, a child patient and their family. It means your child has a familiar place to visit for comprehensive, continuously accessible, coordinated and family-oriented dentistry.

In a Dental Home, there is an emphasis on starting preventive oral health care during infancy, with a first dental visit by the age of one year. An infant oral health examination is simple, easy and effective. It ensures that parents and dentists can team up to help prevent early childhood caries and lay the foundations for optimal oral health throughout life.

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