Newsletter: November 2017

Our last newsletter contained an article in Practitioner’s Corner on oral health practitioners and tongue ties.

It created considerable interest and extensive feedback. You can read the article here. 

Dr Juliet Gray, a special needs dentistry specialist with the Canterbury District Health Board, wrote regarding an initiative in Canterbury outlining key changes to tongue tie assessment, referral and treatment in newborns with feeding difficulties. The Canterbury District Health Board had a higher than average surgical intervention rate for babies with ankyloglossia (tongue-tie) and until 2015 this rate was increasing annually.

In mid-2015, intervention reached a peak with 13% of Canterbury newborn babies receiving surgery for ankyloglossia. Despite the high intervention rate, breastfeeding rates in Canterbury have been static, which suggests tongue-tie release surgery has made little difference in increasing the number of women breastfeeding.

Over the last 18 months, a Canterbury initiative working group involving multiple clinicians has been looking at international and national literature about newborn feeding and tongue-ties, auditing the Christchurch Women’s Hospital clinic and has trialled the Bristol Tongue Tie Assessment tool (BTAT). Internationally, the incidence of ankyloglossia is reported to be between 0.02 and 10 percent, but only 25-50 percent of babies with ankyloglossia will have feeding problems related to ankyloglossia. International data supports a target rate for tongue-tie release surgery between 0.2-5 percent.

International guidelines cautiously support tongue-tie release surgery for babies with ankyloglossia and feeding difficulties, while acknowledging that evidence is weak due to the subjective nature of the measurable outcomes. In Canterbury, there has been consultation with clinicians and consumers to understand the rise in tongue-tie surgery for newborns, clinical outcomes and evidence base for practice. As a result of this work, a more consistent approach to tongue-tie assessment at Christchurch Women’s Hospital has been implemented, and this has led to a reduction in the intervention level to 3.9 percent by mid-2017. 

Oral health practitioners have an obligation to be up to date with the research and the evidence base to support their diagnosis and treatment protocols. At the very least, a recognised diagnostic and classification model, based on the appropriate assessment should be applied by those electing to surgically manage tongue ties in neonates. A decision, by oral health practitioners, to treat neonates needs to be shared with registered practitioners with the training, qualifications and experience in managing this age group.