Your lip is attached to your gums by tissue. Sometimes if this tissue is too short and tight, it results in a lip tie.
Lip Frenulum vs. Lip Tie
The piece of tissue inside your upper lip that attaches to your gums is called a maxillary labial frenulum, or lip frenulum. If that tissue is too short, it can limit movement in your lip. This is called a lip tie.
This piece of tissue is made of mucous membrane and connective tissue. You naturally have this tissue in your mouth to keep your lip stable as the face bones grow and change. It also helps keep your lip stable so you can suck.
This tissue is present in babies at birth and might be quite obvious. As your baby grows and teeth come in, the lip frenulum will change and move.
There are 4 general types of lip attachments.
Mucosal. This type is when the tissue is attached where the tissue meets at the top of your gums. This is called the mucogingival junction.
Gingival. This type of frenulum happens when the tissue is attached farther down into your gums.
Papillary. A papillary lip frenulum is when the tissue is attached at the gums between your front teeth. This area is called interdental papilla.
Papilla penetrating. In this type, the tissue is down between your teeth but crosses over the bone and extends back into your palate.
Understanding Lip Ties
Since these attachments change as your baby grows, diagnosing a lip tie is sometimes controversial. Your baby will have a lip frenulum, but it doesn’t mean it’s a lip tie.
A lip tie is usually only diagnosed in babies if the lip’s movement is restricted because the attachment is too short and tight.
This is usually only defined when your baby has trouble breastfeeding, but this is controversial. Releasing a tongue tie can improve your baby’s ability to breastfeed, but there isn’t clear evidence about lip ties. There have been a lot of lip tie revisions done, but a short lip frenulum that causes tightness is considered rare.
Some research says it has no effect. Other research shows it might cause problems with latch and seal during breastfeeding. This might lead to reflux.
A lip tie might affect your teeth and gums, but the research is conflicting here, too. Severe attachments are more likely to cause problems.
What Causes a Lip Tie?
Some lip attachment is normal. Yet some conditions might be more likely to have unusual lip attachments. These include:
- Infantile hypertrophic pyloric stenosis
- Holoprosencephaly
- Ellis-van Creveld syndrome
- Ehlers-Danlos syndrome
- Oro-facial-digital syndrome
These conditions are inherited diseases that cause problems with muscles, connective tissue, or bones.
There isn’t enough research to understand why lip ties happen without other health conditions.
Signs and Symptoms of a Lip Tie
You might suspect a lip tie in your baby. The most obvious sign is a tight lip attachment. Some other signs that your baby has a lip tie might include:
- Slow weight gain
- Reflux, caused by swallowing too much air
- Irritability
- Long feedings
- Clicking or smacking noises while feeding
- Milk leaking from mouth while feeding
If you are breastfeeding a baby with a lip tie, you might have pain during or after feeding and swollen, painful breasts. This can happen because your baby might have a hard time getting the milk.
Signs of a lip tie in older kids and adults also include a tight or rigid attachment. Other signs can be:
- A space between your front teeth
- Loss of gum between your teeth
- Receding gums
- Trouble brushing your teeth
- Cavities
- Misaligned teeth
Diagnosing a Lip Tie
Your doctor will do a physical examination of your baby’s mouth to check for unusual lip attachments and specifically for lip movement. They might also watch you breastfeed to see your baby’s latch and how they suck.
For older children and adults, your dentist or orthodontist might diagnose it during a dental exam. This usually involves pulling on the attachment to see if the papilla, or the gum between the teeth, moves or turns white.
Lip Tie Revision
Some experts say that a lip tie revision can help babies feed better. This is true for a tongue tie, but it’s not clear for lip ties. Since attachments change as you grow, your doctor might want to leave the lip tie alone.
If the lip tie is severe and extends into your palate, your doctor might suggest surgery. This is called a frenectomy. This procedure involves a cut in the attachment. In some cases, it might include stitches into your palate. Your doctor might also use a laser.
Overall, experts have different opinions on lip ties. Surgery is usually only recommended if there are problems, so it’s best to talk to your doctor to see if it's a good fit for you.
