Forums Laser Treatment Tips and Techniques Hard Tissue Procedures A question on tongue tie releases

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  • #3492 Reply

    Glenn van As
    Spectator

    Hi folks, tomorrow I have a lady coming to my office that has a son who is 26 months old and has a severe tongue tie. He is coming from several hundred miles away and will be on Versed ( anti anxiety sedative ) when I see him.

    Larry Kotlow who is a pedodontist in Albany NY has done alot of these and he has coached me a little on this one. The mom is a former hygienist and you know that can be great and also a little nerve racking.

    I plan to anesthetize him (hes too old to try without) and then release it with the erbium and if necessary stop the bleeding with the Argon.

    I will try ( cant promise) to get photos of the case.

    Any one here done any and if so any helpful pointers………

    Glenn

    #11776 Reply

    Robert Gregg
    Participant

    Glenn–

    No need to anesthetize in our experience, especially if they are on Versed and/or that young. The release will be so quick that the anesthesia will cause more pain than the erbium–especially if you cut mid-belly of the frenum. Bleeding will be non-existant due to the fibrous nature of the tissue and small capillary diameter in connective tissue, so no need to coagulate. If you take more than 30-60 seconds, I’ll be surprised.

    Good luck!!

    Let me know what and how you did!!

    Bob

    #11775 Reply

    Glenn van As
    Spectator

    Well Bob I took your advice. What a tough case.

    When the patient came in the mom was concerned alot about the little boy.

    I asked the boy if he could stick out his tongue …….he could already.

    I looked and saw a very thin fibrous attachment definitely from his tonque to the lingual of the incisors but not thick like I was expecting.

    The little guy was on Versed but not dopy enough at all.

    He started screaming ALOT just when I looked at it.

    I knew that there was ZERO chance of anesthetic and it was gonna be tough.

    THis is how we eventually got it done but it took 15 mins of explanation to both parents, coddling, and restraint and about 5-7 secs of actual erbium on the tongue when I finally got him held down.

    I had mom lying in the chair holding him tightly to her. I had mom holding his hands so he couldnt grab me.

    I had one assistant holding his legs.

    One assistant holding his head still.

    One assistant propping his mouth open with a Rinn instrument (she works part time in a pedo office).

    I had the erbium in one hand and after playing tag trying to get the laser on the frenum , I finally had to grab his tongue without anesthetic at the frenum with a hemostat……..I never heard a scream that loud. I cut for 5 secs or so at 120 mj and 30 Hz with a laser tip and it pulled away and started to bleed the kid was so strong he pulled his head moved the prop out of his mouth and bit as hard as he could on my left index finger.

    I cursed (under my breath), mom was crying , the kid was crying, (tears were welling to my eyes), my one assistant was almost in tears (she hates me grabbing tissue), dad was pacing the hallways with the little brother who started crying once the older one did.

    Patients in the waiting room wondering who I was beating………..

    God isnt laser dentistry fun wilthout anesthetic.

    Well I almost felt guilty charging the darn 200 dollars for the 5 second job but it did take a bloody 15 minutes to get him to hold still.

    I never did get another look in his mouth , he stopped bleeding pretty quickly but the little guys head was absolutely drenched.

    I felt bad but given the fact that the parents drove 3-4 hours to have it done , it was completed and I hope that his speech improves………

    Just wanted to give you a follow up to why I didnt get any photos!!

    My advice , do the procedure when they are very young, older or when the kid is son drugged they are almost asleep.

    Glenn

    #11777 Reply

    Robert Gregg
    Participant

    Glenn–

    You did an EXCELLENT service.

    I witnessed the very scene you described with Dr. McCarthy and his 2 year old granddaughter. No Versed, no anesthesia.

    The kids scream because they are not in CONTROL,………NOT because they are in pain.

    He was screaming so loud and had so much adrenaline from the screaming and the fussing and all the fighting, he probably felt nothing from the laser.

    After you were through, did the crying stop? Did the kid start running around?

    Bob

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