Lactation experts Ashana Gupta and Sarah Oakley analyse the case of a dentist who was suspended for failing to gain adequate consent while treating an infant’s lip and tongue ties.
The terms tongue and lip tie refer to congenital conditions whereby the frenulum connecting the lip or tongue to the mouth is too tight. In newborn babies, they can cause challenges with latch, milk transfer, maternal discomfort during breastfeeding, or prolonged feeding times.
While accusations of overdiagnosis have led lip and tongue ties to be the subject of controversy in recent times, it was not the procedure itself that caused the issue in this case. Instead, the dentist was found to have failed to obtain informed consent for some aspects of the treatment.
We spoke to Sarah Oakley, a lactation specialist and tongue tie practitioner, and Ashana Gupta, an oral surgeon and lactation consultant, to gain some insight into what went wrong.
Communication and consent
Both experts stressed that the dentist in question was not criticised for their management of the patient’s tongue and lip tie. Ashana said: ‘The key themes from this case relate less to whether tongue tie release itself is an appropriate treatment, and more to the importance of transparent communication, informed consent and shared decision making throughout the entire patient journey.’
The dentist was also found to have obtained valid consent for the initial tongue tie procedure, informing the parents of the potential risks and even sending them an information pack that they had to sign prior to treatment.
However, the GDC concluded that they did not gain sufficient consent to reopen the wounds at a follow-up appointment.
For Sarah, this raises an important debate around what adequate consent is and how it is perceived by professionals and patients or their parents.
She said: ‘Parents frequently come to practitioners in a heightened state of stress, having experienced significant feeding difficulties for a sustained period of time. They are also often recovering from a traumatic birth experience. Most parents have little experience of surgical procedures, and many have accessed misleading information online and conflicting information and poor support from other healthcare professionals in relation to frenotomy and infant feeding.’
Addressing misconceptions can be very difficult, but is often key to managing expectations and ensuring patients fully understand their treatment.
What misconceptions surround tongue ties?
Sarah has found that many parents believe tongue tie treatment is a ‘quick snip’ which will result in instant improvement. In this case, reopening wounds caused the patient to bleed, which they and their parents found distressing.
She said: ‘Where practitioners are doing anything for which the evidence base is limited or conflicting, parents need to be made aware of that, along with the risks, benefits and alternatives prior to intervention.’
There is strong evidence that tongue tie can lead to reduced tongue mobility and feeding issues in young babies. However, Ashana notes that the evidence is less straightforward surrounding other possible effects of tongue ties such as speech impediments.
She continued: ‘Beyond infancy, a restricted tongue movement may, in some individuals, be associated with functional concerns such as difficulty producing certain speech sounds (for example, some “th” sounds), although the relationship between tongue tie and later speech difficulties is complex and not every child with a tongue tie will experience these problems.
‘This is why assessment should focus on function rather than appearance alone, and decisions should be made based on the individual child’s needs.’
How can consent for treatment of tongue ties be properly established?
Ashana believes that creating an environment that feels safe for the patient and their parents is crucial in tongue tie assessment and treatment. She said: ‘Parents should feel supported with clear, balanced information so they understand the diagnosis, the available options, the potential benefits and risks, and are able to make an informed decision at every stage of care.’
Checking that patients or parents have understood the information provided and keeping detailed records are both central to proving that consent has been established. Ashana advised a thorough explanation of what is being proposed, why it is being considered, the risks and the alternatives – ensuring these conversations are clearly documented.
The suspended dentist informed the patient’s parents that they were going to ‘apply some pressure to release the wound as it looked a bit tight’, and received a nod by way of agreement. This was not considered sufficient by the GDC.
Sarah said: ‘Practitioners offering division, or any surgical procedure, need to ascertain that the parents have fully understood the implications of proceeding with surgery, but this is not always straightforward and overwhelmed, sleep-deprived parents may not assimilate or recollect everything that is said to them.’
Ideally, parents would be given time to consider their options and do further research after an initial consultation. However, Sarah notes that many parents travel to access tongue tie treatment and may be reluctant to delay a procedure while coping with acute feeding issues.
Another crucial precursor to adequate consent is the practitioner’s own understanding of current professional discussions around lip and tongue ties.
What do dental professionals need to know about tongue ties?
Appropriate training is essential for any dental professional undertaking assessment and treatment of oral ties in newborns. According to Ashana, this might include:
- Understanding infant feeding
- A strong grounding in neonatal oral anatomy,
- Knowing the indications for intervention
- Appropriate consent processes
- Aftercare
- Recognising when referral or additional support is required.
There are a number of different techniques for treating tongue and lip ties, including sterile scissors and laser therapy. Ashana said: ‘Laser can provide a precise approach and may offer some haemostatic benefit by coagulating small blood vessels during treatment. As with any procedure, appropriate patient selection, clinical skill, consent and aftercare planning remain fundamental.’
The two experts agreed that the suspended dentist’s approach to treatment went against current thinking at times. While Ashana cited the Association of Tongue Tie Practitioners’ statement that releasing an upper lip tie is not supported for managing feeding difficulties to the same degree as with tongue ties, Sarah explained that reopening wounds after a tongue tie procedure is not a widespread practice as it could promote the formation of more scar tissue.
Sarah concluded: ‘I think all practitioners involved in tongue tie division – be they dentists, doctors, surgeons, nurses or midwives – can learn from this case and we can all take steps to improve our practice as a result.’
Overall, the specialists advised ‘careful assessment and appropriate discussion of the evidence base’ where tongue and lip tie management is concerned.
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