Maxillary Lip "Tie": My Opinion by Alison K. Hazelbaker, PhD, IBCLC, FILCA, CST-T, RCST, PPNE
When we dialogue about “maxillary lip tie” we wander into no person’s land. A dearth of information exists; it almost seems as if lip tie’s existence is a legend, one craftily created by greed. Maxillary lip tie was first formally mentioned in a case report appearing in the Journal of Human Lactation. Not much happened as a result of this report; lactation clinicians paid little heed. That either speaks to ignorance or wisdom depending on future evidence: Ignorance if there is really a thing called maxillary lip tie that proves to, in fact, affect breastfeeding and caries formation; Wisdom if the fears generating the panic over maxillary lip tie on Facebook prove to be unfounded.
Right now, the jury is still out. Why? Because there is no formal evidence to demonstrate that maxillary lip tie is actually a “thing.” That’s not something I made up, that’s a fact. One study speaks to incidence. Sadly, the same study lacks both a conceptual and an operational definition of maxillary lip tie and fails to delineate the assessment process used to make the determination of incidence. So we cannot rely on the study or claim that the results or conclusions of the study are valid.
It appears that we live in a “professional” culture where opinion turns into fact just by forceful and persistent repetition of that opinion. Do we live in the dark ages?
Do I believe in maxillary lip tie? Belief has nothing to do with it; only the facts matter. The welfare of babies is at stake.
Have I sent a baby for lip frenectomy? Yes, once. Did it make a difference? I don’t know. She had her lingual frenulum divided at the same time. Since that time I have seen several “Class 3 and 4” maxillary frena. None affected breastfeeding adversely so none were sent for surgical “correction.” All to date are still breastfeeding, some still exclusively at the time of this post. None of the mothers have any complaints related to the symptoms thought to be associated with maxillary lip tie.
Do I care about diastema and dental caries. I am not sure I should care about diastema. It is a cosmetic issue. In some cultures it represents the epitome of female beauty. And, of course, I care about dental caries. But given there is no evidence that facial caries are more prevalent with a prominent maxillary frenum and that caries formation is a complex business involving not one but over 800 different strains of bacteria, I feel loathe to simplify the caries argument into the “trapped breastmilk causes facial caries formation so let’s just remove the labial frenum” that is so popularly and ubiquitously expressed on social media.
What I intensely care about is ethics. Ethics dictate my restrained attitude. In the absence of clinical data and given my own personal and extensive clinical experience, it would be unethical for me to refer for maxillary lip revision when there is no breastfeeding issue and there is a paucity of evidence to support preventive revision for dental issues. As a lactation consultant, I cannot ethically refer for SURGERY on a baby, who has no say in the matter, based on vapor.
At the end of the line, when more evidence becomes available, and I mean solid evidence, the kind that stems from carefully crafted scientific research, someone will be on the right side of this issue and someone will be on the wrong side. Only time and research will tell… Right now, I choose to err on the side of caution even if it ultimately puts me on the wrong side of the argument.