Cutting the Ties That Bind by Dr. Ben Curtis

Using dental lasers to alleviate tongue-tie

by Dr. Ben Curtis

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• Vitamin K status. At birth, infants have naturally low levels of Vitamin K, which helps with coagulation, so newborns can be at risk for a condition called Vitamin K deficiency bleeding. Infants are usually given a Vitamin K booster shot within 24 hours of birth, but to prevent spontaneous bleeds, it’s important to screen patients to ensure that they have received this booster.
• Anesthetics. The use of topical anesthetics for patients under 12 months of age should be either eliminated or used very cautiously because of infants’ higher risk of the blood disorder acute toxic methemoglobinemia. Similarly, injections of local anesthetics such as lidocaine HCL should not be administered to infants under six months of age.
• Floppy airway. A weak airway, also known as floppy airway (congenital tracheomalacia), occurs when the walls of the windpipe collapse. Though the symptoms—which include noisy breathing, especially when there is increased airflow, for instance when the baby is crying—normally resolve by 18 to 24 months, the condition poses an aspiration risk during the procedure and postoperatively.
• Gagging and vomiting. While frequent vomiting is normal in patients under the age of 12 months, it is not normal in older children and can be a symptom of tonguetie. Whatever the age, however, a higher risk of vomiting during the procedure puts the patient at increased risk of aspiration.
• G-tube patients. Infants who are fully or partially fed through a gastrostomy tube, which delivers nutrition directly to the stomach, or even those who are being considered for a G-tube, are naturally at higher risk for aspiration. In some of these cases, the failure to thrive may be because of tongue-tie.
• Bleeding conditions. Bleeding conditions such as hemophilia, thrombocytopenia, von Willebrand disease, liver disease and some medications pose bleeding risks that require careful management, as well as special precautions before and after the procedure. Consultation with a specialist such as a hematologist is recommended.
  
• Anatomy. When it comes to bleeding risks, it’s important to familiarize yourself with the ducts and blood vessels of the mouth (i.e., lingual arteries and veins) so you know what to avoid. While a laser is safer than a scalpel because it has a small active zone and you can turn it off instantly, it’s still best to be prepared.

Dr. Ben Curtis attended Texas A&M University, where he graduated summa cum laude with a degree in biomedical sciences. He attended dental school at Texas A&M University Baylor College of Dentistry in Dallas and completed his pediatric specialty residency at Children’s Medical Center Dallas, Scottish Rite Hospital for Children and Baylor College of Dentistry.

As a resident, Curtis was named provider of the month for the Children’s Medical Center system—the only resident to ever have received this award. He also was honored with the American Academy of Pediatric Dentistry Samuel D. Harris Research and Policy Fellowship.

Curtis, a board-certified pediatric dentist, owns and practices at Curtis Kids Dentistry in Canton, Texas. He is a diplomate of the American Board of Pediatric Dentistry and an advisor, speaker and trainer for Biolase.