Pediatric frenotomy practice patterns: A survey of pediatric dentists, otolaryngologists and surgeons

Abstract

Introduction: Upper lip and tongue-tie diagnosis and frenotomy procedures are increasing. Practice pattern variations exist within specialties, but little is known about differences among providers with different training.

Methods: Pediatric dentists, otolaryngologists and surgeons from three professional organizations were surveyed electronically to evaluate oral tie diagnosis and treatment practice patterns between surgical and dental specialties. Response frequencies were tabulated and compared using chi square analysis.

Results: 286 providers completed the survey (24.1 % DDS/DMD, 31.8 % otolaryngology, 44.1 % surgery). 71.4 % respondents had <9 consults/month and 4.6 % staffed ≥36 consults/month. Otolaryngologists were more likely to see infants <2 months of age and dentists more likely to report average age >12 months. Fewer than half of providers aware of lingual frenulum appearance and functional classification scores use them regularly. Providers rely heavily on history and feeding evaluations for lingual frenotomy decision-making. 30.5 % of surgeons reported always using sedation for frenotomy, and dentists were more likely than medically trained providers to report no age limit for awake procedures. Otolaryngologists were more likely to perform lingual and labial frenotomies sharply, and dentists were more likely to use a laser. Dentists were more likely to recommend post-procedure exercises and refer to physical therapy than other providers.

Conclusions: While practice pattern variations occur within each specialty, there are clear differences in how patients are evaluated and managed among dental, otolaryngology and surgery providers. More research is needed to clarify a standard of care for patients with ankyloglossia and upper lip ties.

Keywords: Ankyloglossia; Frenotomy; Infant feeding difficulties; Practice patterns; Upper lip tie.