Transformative Tongue Ties: Uncovering Infant Health

Transformative Tongue Ties: Uncovering Infant Health

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Welcome back everyone to the More Than Teeth podcast. I am Dr. Michael Bennett, and I'm really excited to once again have Sherry Gunn back with us — the nurse practitioner, lactation consultant, and myofunctional therapist, and all-around awesome person. So welcome back, Sherry.

Thank you! I'm happy to be back. You can always get me to talk about this kind of stuff.

I know, it’s a fun topic, isn’t it?

Love it.

Mm-hmm. Well good. In the last podcast, we spoke a lot about infants, tongue releases, and why we do it — what’s important about that. Just a quick review: when we release the tongue and establish proper function, we know that function eventually results in a beautiful, healthy face, jaw, and airway. And when a person can breathe, they can sleep better, live better, and generally achieve a higher level of health. As a clinician, we get to experience that often — those success stories.

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Celebrating Success Stories

So I wanted to start out this podcast celebrating a little bit — maybe a lot — about an experience that you had right before we started recording. We were talking a little about it, so tell us about your experience today.

Yeah! So I am so blessed to be able to work with all ages, but my heart is always in the infants and babies.

This baby I worked with last week was really struggling — hardly able to breastfeed at all, mostly bottle-fed. The mom had breastfed before, so she knew something was wrong and came to us. After evaluation, we noticed a very thick lip tie, tongue tie, and both cheek ties on each side.

This morning, we were able to release those with a CO₂ laser. And I was telling Dr. Mike here that I was so happy I got to see the whole picture because I went in afterwards and helped her breastfeed. The baby latched right on, and the mom said, “It doesn’t hurt! I can’t believe this!”

It was like night and day. Now, not all babies have that kind of instant success, and I don’t want parents to think that’s always the case, but for this baby today, it was. He latched on and didn’t come off the entire feeding — before, it had been constant on-and-off re-latching, which is very painful for moms.

He snuggled in, nursed, we heard gulps, and he completed the full feeding while we sat there chatting. When he finished, he pulled off content as could be. Mama was amazed — for her and him, that’s all it took to get that deeper, proper latch.

I also told her, “This might be the best latch he has for a couple of days,” because after that, the swelling and soreness begin. But seeing that immediate change in a baby — it’s the best feeling.

Oh my gosh, yeah, that’s fantastic! So the mom wasn’t hurting — she was able to nurse immediately. And it takes two to tango, right? The mom and the baby both have to want it.

Yep. Yep.

Yeah. And…

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Challenges and Solutions in Infant Tongue Tie

But again, babies — I always try to tell parents that first feeding is sometimes the best for the first 24 hours, because the baby’s numb and doesn’t know they’re hurting yet. Things haven’t swollen up yet. A lot of times, that first feeding goes very well, and then the next few go downhill and parents wonder, ‘Why did we do this?’

Exactly. I always try to prepare parents for that — that it’s going to get worse before it gets better. There’s an intense healing phase at the beginning where everything swells and gets sore. I tell parents, “I don’t think I ate a full meal for a week after my own tongue-tie release.”

Wow. I went and had Mexican food after my tongue was released and had salsa — tears running down my face. But it was really good! Sometimes you just have to push through.

Oh my gosh!

True story — but no, ice cream all the way for me for days.

Ice cream, yes. For sure.

“Every successful latch isn’t just a feeding win — it’s a foundation for lifelong breathing, sleeping, and growth.”

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Numbing Techniques and Controversies

So besides releasing the tongue, you mentioned anesthetic. Can you tell everyone what you use to numb the baby — how do you keep them comfortable?

Yeah, actually, for this baby, we didn’t numb at all.

Okay.

Which might sound controversial, but let me explain. As a NICU nurse, we used “Sweeties” — a sugar solution — all the time for IV sticks and blood draws. For a baby that small, that burst of sugar gives them a brief high where they really don’t care about life for a minute.

The lasering itself takes less than a minute. In the past, when we used intense numbing creams — which we have to be careful with in infants because of potential complications — we noticed problems. Those creams spread everywhere, not just on the frenum.

We never do lidocaine injections in infants. But after using the cream, we’d take babies back to nurse and they would scream for a half hour because they couldn’t feel anything in their mouth. They’d try to feel the breast or bottle, but couldn’t. That tingly numb feeling can actually be more distressing than the pain itself.

So, for these tiny ones, that numbing cream was terrifying. They wouldn’t eat well afterwards. Now, we just use sugar water and, as soon as the release is done, we apply aloe vera gel on the wound to soothe it, then take them straight to mom.

The difference is night and day — no numbing, better latch, and calmer babies. That skin-to-skin contact, the suckling, the breast milk or bottle, and the snuggling with mom all calm their nervous systems far better than numbing agents.

For kids and adults, though, we do use lidocaine injections or numbing jelly, since those procedures include suturing and longer lasering time. But for infants — none.

Yeah, I’m glad you brought that up. Traditionally, that’s how I’ve done it as well — I don’t numb infants for that reason. Once they get a taste of mom’s milk, they forget everything. It’s like a dopamine hit for them.

Yes! I tell parents, “You know that feeling when you eat a Snickers bar and feel great for 30 seconds? That’s what babies get.”

Exactly. It’s not much — just a CC of sugar water — but it’s enough to help them reset and soothe their system. They can feel their muscles and coordinate suckling again.

Yep!

There’s also a potential complication with benzocaine gels, right — if I’m saying it correctly — methemoglobinemia?

Yes! I never say it right either, but that’s it. It’s scary because babies can’t metabolize it properly. They can have severe complications and even need emergency care, which is why we’re so careful.

Exactly. And that’s an important molecule — hemoglobin carries oxygen throughout the body. We don’t want to interfere with that.

Right.

So I’m glad we discussed this. And now we’ve got a little one who’s going to have the best chance for proper jaw development, facial growth, and airway health.

“Comfort doesn’t always come from medicine. Sometimes it’s touch, warmth, and connection that heal faster than any anesthetic.”

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Evaluating the Need for Tongue Tie Release

So we’ve got a success story and a baby who’s now set up for healthy facial and airway development. But there’s some controversy out there, right? Some people think every tongue tie must be released — and that’s not necessarily the case. We need a good reason to do it. I’ve seen plenty of moms whose babies have visible ties but are nursing perfectly fine. How do you decide when to release and when to wait?

I just said this today to two different parents — I wish tongue ties were black and white, like a broken bone. It’s either broken or it’s not. That would make life so much easier because tongues vary so much in how they look and function.

We use objective data as best we can — scoring tools and assessments — but everyone has a frenulum. Everyone needs a frenulum. What matters is where it attaches under the tongue and floor of the mouth, and how elastic it is.

Some frenums look bad but function well because they’re stretchy. Others look mild but restrict movement significantly. So, do we release every one? No. If it’s functioning fine, we don’t touch it. If it’s restricting motion or causing feeding issues, then yes, we discuss release.

At our office, we love the “wait and watch” approach. We want to be proven that it’s necessary. Parents often come in worried, but if I see a baby gaining weight, feeding without pain, and meeting milestones, I’ll say, “Let’s wait and see.” We give parents specific signs to watch for at home — open-mouth breathing, snoring, grinding, restless sleep.

Many parents don’t realize their child snores until we talk about it. I tell them, “Go watch your child sleep. Take a video.” You’d be amazed at what they discover — mouth breathing, teeth grinding, even apnea episodes.

“Tongue ties aren’t black and white. Some need to be released immediately, others never — the key is function, not fear.”

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Personal Experiences and Observations

I have six kids, and I’m six for six on tongue ties. Their mother’s tongue-tied, so they never had a chance! But what’s fascinating is that all six were affected differently.

Two of mine had open-mouth breathing from birth. Both had their tonsils removed between ages three and five. Both struggled with sleep and attention. They ticked every box on the tongue-tie checklist. But I didn’t know about any of that when they were little.

One of my daughters was just a tongue thruster. She slept fine, spoke fine, and had no feeding issues. When I asked her to do myofunctional therapy, she said, “Mom, why am I even doing this?” But her swallow pattern and palate told me she needed it.

So, I released her tongue not because of symptoms but because of function — she couldn’t swallow correctly. Would that have caused problems later? Maybe, maybe not. But since we were already doing therapy as a family, it made sense.

That’s such a good point. You can’t always predict what might happen later. Sometimes the best decision is to watch and collect data.

Exactly. We can’t treat every potential problem preemptively, because not all of them will appear. But when parents come back years later and say, “Wow, you were right — this became an issue,” that’s validating.

On the flip side, being too aggressive can backfire. That’s why I take time before recommending procedures — every case must make functional sense.

Right. You also mentioned before how important it is for the tongue to have a home — the palate needs to be developed enough for it to rest properly.

Yes! Exactly. That’s why I don’t release tongues without ensuring the palate can accommodate the tongue afterward. Otherwise, we set the child up for reattachment or dysfunction.

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Pacifiers and Tongue Development

That’s a perfect transition. Let’s talk about pacifiers — they’re controversial too.

Oh yes, they are. I was just at a conference with a pediatric dentist from Puerto Rico, and we had a lively debate about pacifiers. I said I like pacifiers that allow the tongue to cup, like when holding onto a breast. She disagreed, saying that shape causes a “pacifier palate” — a narrow, high arch.

We were both right in a way. She was talking about kids using pacifiers for years, and I was talking about the first six months only. I want that cupping motion early on to strengthen the tongue, but I don’t want the pacifier to stay in the mouth day and night beyond that age.

Exactly. I see pacifiers with guards that push against the front teeth — almost like headgear. I call it an “anti-growth device.” If it’s used during sleep, especially when growth hormones spike, it can stunt jaw development.

Totally agree. That pacifier reflex is designed to soothe infants, but it’s supposed to fade as they transition to solid foods. Once that reflex integrates, the tongue should replace the pacifier as the natural “calming” mechanism, resting on the palate.

That’s what shapes the palate — the upward pressure of the tongue. When the tongue stays low, the cheeks push inward, collapsing the structure. I’m a perfect example — I’m the mouth-breather profile with a 26-millimeter palate. Doing myofunctional therapy has helped, but there’s simply not enough space.

So for my younger patients, expansion first is critical. When they’re little and malleable, we can guide development easily. I’d much rather create that space early than try to correct it in adulthood.

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The Invisalign Trays Incident

That reminds me of your story about your daughter’s retainer — tell that again.

Oh yes! My second daughter had braces, and after they came off, we went on vacation. It ended up being three months before she got her retainer. The office called constantly saying, “Come get your retainer!”

When we finally went in, the hygienist said, “We’ve all taken bets on whether this will even fit.” My daughter rolled her eyes and said, “Yes, mother — my tongue has been up there.”

They put it in — and it fit perfectly! Everyone was shocked. I laughed and said, “It better fit, because her tongue better be holding it there!”

That’s amazing. It’s proof that tongue posture provides natural retention — nature’s own retainer.

Exactly. That’s why it’s so important to think long-term. Orthodontics can move teeth beautifully, but if tongue function doesn’t support it, relapse is inevitable.

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Long-Term Solutions for Orthodontic Issues

That’s such a great principle — when orthodontists put those teeth in perfect alignment, it’s a short-term solution unless we address the underlying function. Orthodontics straightens teeth, but myofunctional therapy stabilizes them.

Exactly. The short-term solution fixes appearance, but the long-term solution creates stability. Most people don’t realize that lifetime retainers are standard now. You get new ones every few years, but those retainers wear down — and where does that plastic go? Into your body.

We’re breathing and swallowing microplastics daily because of that constant retainer use. I’m not saying orthodontics is bad — it’s incredible work — but we can do better. If we fix the root cause instead of chasing symptoms, we won’t need to rely on those retainers forever.

Yes, that’s what we’re seeing. Every symptom-based treatment has a downside. If we address structure and function early, we can eliminate the need for long-term retention altogether.

Absolutely. And that’s why I always ask adult patients during my evaluations, “Have you had braces before?” Most say yes, but then they add, “They didn’t work,” or “I need them again.” It’s so common.

If we straighten teeth but never teach the tongue where to rest or how to swallow properly, relapse is inevitable. The body reverts to what it knows.

“You can’t force stability — you build it. True alignment comes from the muscles and tongue, not just the wire and bracket.”

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Challenges with Infant Tongue Release

Let’s shift to the younger age group. When are you not comfortable releasing an infant tongue tie?

That’s a great question. We can break it down by age — infants (0–6 months), toddlers (6–24 months), and early childhood (2–6 years).

For infants (0–6 months), I’m cautious if the baby has low tone — like my babies with Down syndrome or certain genetic conditions. If the tongue doesn’t have the strength to move properly after release, it can reattach. I can’t tell a baby, “Lift your tongue to the roof of your mouth,” so I rely on exercises.

For newborns to about four months, parents become the therapists. They play with the tongue — have the baby bite on their finger, mimic tongue movements, make faces. At 4–6 months, therapy becomes more sensory — O-balls, vibrating teethers, chew straws.

Once babies start solids, food itself becomes the best therapy. Harder, textured foods strengthen the tongue naturally.

But if a baby’s tongue can’t move at all pre-release, I hesitate. The risk of reattachment is high if we don’t first build awareness and tone.

Another factor: if parents aren’t willing or able to do the aftercare stretches, I don’t release. The tongue will heal tighter and create scar tissue.

That’s such a good point — sometimes doing nothing is better than doing the wrong thing.

Exactly. If I see a baby who’s severely underweight, I’ll wait too. A body in starvation mode can’t heal. I’ll say, “Let’s get baby stable first — feed, rest, grow — then we’ll revisit the release.”

Each case is unique. Some babies are ready immediately; others need weeks of preparation.

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Parental Involvement in Therapy

That’s so insightful. What about when the baby gets a little older — say, six to twelve months?

That’s when oral aversion risk increases. I evaluate whether the baby can tolerate the procedure emotionally and physically. Can we even touch their lips without distress? If not, we might delay and focus on bodywork, feeding therapy, or nervous system regulation first.

I’ve had parents come in saying, “You’re our last hope. We’re on our way to Primary Children’s for a G-tube.” Those are the hardest moments. One baby I’ll never forget had been starving for two months — every test done, but no answers. I could tell immediately he was tongue-tied just from watching his bottle feeding.

When I examined him, I asked, “Did anyone put their fingers in his mouth?” The mom said, “No.” He wasn’t thriving because no one had looked functionally. We released his tongue, and a week later, the mom called me crying. “He’s gained a pound,” she said. “The daycare thinks he’s a different baby.”

Stories like that keep me going. But I also tell parents honestly — every release carries risk. Not every case looks like that one. Some babies need multiple interventions before they thrive.

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The Toughest Age Group: Toddlers

So what about toddlers — that one-to-two-year age range?

Oh, that’s my least favorite age to treat! There’s no logic or cooperation yet. You can’t reason with them, can’t explain why you’re doing exercises. Parents end up holding them down two or three times a day for stretches — and by then, they’ve got teeth!

So I’m brutally honest with families. I tell them, “If we do this, it’s going to be tough.”

But sometimes, it’s worth it. One little girl I worked with was 18 months old, underweight, still breastfeeding, barely speaking. I was terrified. But we went ahead, used pain control, cold therapy, and lots of love. She walked in the next week smiling. Her mom said she was eating, talking, and walking better.

It changed her life — and mine.

That’s powerful. How did you keep her calm during the procedure?

We used nasal Versed — a mild sedative — and only for kids two and up. I watched Dr. Baxter in Alabama perform a release on a calm 4-year-old using only numbing gel. No sedation. It was amazing.

It depends on personality — some kids are sensitive, some fearless. Personally, I prefer using a little sedation if it prevents trauma. They have many years left in the dental chair, and I don’t want their first experience to be frightening.

That’s wise. Trauma at that age can last a lifetime.

Exactly.

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The Role of Myofunctional Therapy

Let’s move into the next stage — the role of myofunctional therapy. You wear many hats: nurse practitioner, lactation consultant, and myofunctional therapist. How does therapy fit into all of this, especially for toddlers and young children?

Coming from the myofunctional therapy perspective, I always ask: How can we get the tongue to rest in the right place? How do we teach a proper swallow and achieve full range of motion?

For therapy to work, participation is key. A three-year-old doesn’t always understand instructions, so I use play. We make it fun — silly faces, songs, and games. My goal is to strengthen the tongue, improve breathing, and normalize swallowing.

Once children reach grade school, around age five or six, we can really begin structured therapy. They can sit still, follow directions, and commit to exercises. That’s when we see the best results.

But it has to be a family effort. If one child out of four does the exercises, it won’t last. I tell families, “If one of you has oral restrictions, someone else probably does too.” So we all learn together. Parents, siblings — everyone practices proper breathing, chewing, and posture.

That turns therapy into teamwork, not treatment. It removes the stigma of “something’s wrong with me” and replaces it with “we’re doing this for our health.”

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The Impact of Sleep on Health

That’s such a powerful concept — a family model of healthcare. And that ties right into sleep, doesn’t it? The quality of rest affects everything.

Totally. Sleep is where I’ve seen the biggest transformations. I was reading studies recently showing that the current senior generation in the U.S. is dying younger, on average, than the one before it. There are many reasons, but one is chronic inflammation — often linked to poor sleep.

Our medical system trains us to treat problems after they occur — not prevent them. I’m grateful for modern medicine, but most of our education focuses on fixing disease, not avoiding it.

When we teach families to prioritize proper breathing, posture, and airway development early, we set the foundation for lifelong health. We’re made of systems — tubes, really — for air, blood, and lymph. If our skeletal structures are underdeveloped, those tubes get kinked.

Exactly — incomplete development means restricted flow, whether it’s oxygen or blood. That’s why airway-centered care is so critical.

Yes, and it’s not just physical — it’s behavioral. I used to think my 7-year-old was just an “active sleeper.” Every morning, he’d wake up in a different spot — the floor, the closet, even his drawer! We joked about it, but that should’ve been a red flag.

Once we expanded his palate and released his tongue, everything changed. He started sleeping in one spot all night, with his mouth closed and nose breathing. I stood there and cried. I realized he’d been suffering for years, and I hadn’t known.

Looking back, I see how poor sleep affected his behavior — meltdowns, tantrums, attention issues. But I tell parents: don’t beat yourself up. You can only act on what you know. The moment you learn, you can change everything.

“Snoring is never normal — not in adults, not in kids. It’s the body’s cry for air.”

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The Importance of Education and Awareness

That’s such a good reminder. You mentioned that during your nurse practitioner training, tongue ties barely came up in the curriculum, right?

Yes, it shocked me. I searched all my medical textbooks during my pediatric rotation, and I found one paragraph. It said: “Ankyloglossia may or may not cause breastfeeding problems. If problems occur, a release may or may not improve them.”

That was it — one vague paragraph. No mention of speech, sleep, airway, or development. So I don’t fault my colleagues who don’t recognize tongue ties. They simply weren’t taught.

During my pulmonology rotation, I saw patient after patient with sleep apnea. Every one of them had obvious tongue and palate restrictions — I could see it from across the room. But I was just a student, so I couldn’t intervene. It broke my heart.

And those same patterns show up in adults — high, narrow palates, crowded teeth, small airways. The structural issues start in infancy.

Exactly. What we see as adult sleep apnea is often the result of underdeveloped jaws, mouth breathing, and tongue dysfunction from childhood. The epidemic isn’t just genetic — it’s developmental.

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Final Thoughts and Encouragement

We could talk forever about this. You’re such a wealth of knowledge, and I appreciate your time. Before we close, what final message would you give to parents and caregivers listening?

Don’t beat yourself up. You’re doing the best you can with the knowledge you have today. Once you know better, you can do better.

Be your child’s advocate. Ask questions. Notice how they breathe, eat, and sleep. Small signs can mean big things.

I love that. And for dads out there — support your partners through this. Be involved, patient, and informed.

Yes! Dads are so important in this process. It truly takes a family.

Thank you again, Sherry. You’re amazing — we’ll definitely have you back soon.

Thank you, Dr. Mike.

And to our listeners: remember, healthy development starts with awareness, connection, and teamwork. Until next time, take care.

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If you found this episode valuable, share it with a colleague or friend who wants to breathe better, sleep deeper, and live healthier. Your support helps us expand the conversation around airway-focused care and whole-body wellness.

Together, we can move dentistry beyond the chair.

Michael Bennett, DDS, PhD

Board-Certified Dentist | Healthcare Professions Educator

Empowering total health through airway-focused dentistry

Advanced Dental Care – Dr. Bennett’s clinical practice and patient-centered services

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About Guest: Sherri Gunn

Sherri is passionate about helping individuals and families on the road to better health. She is a wife and mother of 6 and all of her kids were tongue tied. She started as a NICU RN, became an IBCLC to help mothers and infants on their breastfeeding journeys, then took a deep dive into tongue ties and became a myofunctional therapist. She knew she wanted to create a space for families and with her partner Anne Tullis, the Utah Breastfeeding and Tongue Tie Center was born. There with incredible team members they have created a space that offers craniosacral therapy, speech therapy, myofunctional therapy as well as lactation education and support. They do weekly tongue/lip tie releases with local pediatric dentists and support their families through their journeys. Sherri loves traveling with her family, baking, driving carpool to dance and taking care of their mini farm.

Website: https://www.utahbreastfeedingandtonguetie.com/

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