When we fix the ties early, we get the most movement in the mid-face including the jaw and sinuses. If there is a tongue tie connected to the jaw, then it is holding the jaw back and preventing normal growth of the jaw. The younger the child is to have this released, then the more forward movement of the jaw. The younger the child, the fewer teeth for biting parents fingers. We want spaces between all the teeth especially so there is room for the larger adult teeth to come in. Also, the older the child, the less likely they will change their feeding and speaking behaviors. They will often need further Occupational and Speech therapy and are prone to oral aversion. Younger children also forgive and forget better and are easily distractible. The lasered areas are well healed within two weeks. This is a very short time compared to the need for years of Orthodontics. If the tongue is not resting on the roof of the mouth, or palate, then the palate is not getting expanded naturally and the jaw and teeth will have to be moved later. Painful Orthodontics, including palatal expanders and orthodontic appliances, can be in the mouth for months to years. Jaw surgery for late teens needs to be done after puberty. The oral surgeon breaks the jaw and resets it forward to allow new bone to form. Yes, it is as awful as it sounds. Remember, when we get the sinus area to develop properly, then there will be fewer ear and sinus infections which means less pain and antibiotics. The list goes on and on…

Dr. Sacker has used all three and she knows first-hand! Scissors are sharp and make an even cut that can more likely reattach. It is also very common to not cut enough or not be able to cut enough because of the tie depth, location, or extent of restriction. The doctor can only cut what can be seen and what is safe to cut. Since the doctor cannot see what is under the area being clipped, he or she would have to stop short. It is very common for providers to cut the anterior, or front portion, of the tongue tie in front of the salivary glands and leave the posterior portion intact. The problem is that the posterior portion is what controls the middle and back portion of the tongue; which is the area that is needed for breastfeeding and swallowing. It is also very difficult to cut into a submucosal tie that is more of a sheath attached to the surface of the tongue. It will bleed and the doctor cannot open it fully as a result of the bleeding and safety issues. Buccal ties also cannot be cut with scissors because of their location and size. Upper lip ties can be partially cut by skimming the gumline with a sharp instrument. The upper lip tie is covered by a sheath of sensitive tissue so it always hurts and bleeds with scissors. The doctor would be unable to cut it completely into the groove between where the teeth form, leaving the remainder of the cord attached to the bony area and upper gumline. The clip with scissors does help elevate the lip for eating food off a spoon, but it often regrows and will affect teeth location and make teeth brushing difficult or painful. It is not safe to put sharp scissors in a child's mouth, so most providers will insist on sedating your child. Lasers can repair an incompletely released lip tie at a later date, but the area is more sensitive and has scarring from the previous clip so more laser energy is required, making the procedure itself and the healing more challenging. ​ The CO2 laser is the most gentle soft tissue laser on the market right now. Most of the time, there is no bleeding. Using this laser can also be faster than using scissors. It is safer than scissors because it works above the tissue, cauterizing while vaporizing the tissue in a bloodless field. This allows for a clear view of vessels and nerves. The diode laser works with heat and requires more energy to release the tissue, causing more scarring, especially with submucosal ties. The diode laser is also very hot and unsafe to use on buccal ties, unlike the CO2 laser. Just like our iPhones and other similar technology, we have better ways to do things now; we just need the medical community and insurance companies to catch up so our families can get the best care possible!

When we fix the ties early, then we get the most movement in the mid-face including the jaw and sinuses. Babies do their most growth in the first 6 months of life. When a baby is sucking and is using the jaw to move up and down instead of gliding forward, then the jaw joint is not growing properly. When we change this motion by releasing the a restricted tongue, then the baby can make the wave-like motion and the jaw can glide forward. When more time is spent gliding, then the baby will stretch out the joint and allow the jaw to move forward with facial growth. If there is a tongue tie connected to the jaw, then it is holding the jaw back and this prevents normal growth of the jaw. Babies start solids after 6 months and the jaw naturally changes at this age to an up and down motion. Also, the older the baby, the less likely they will change their feeding and nursing behaviors. Young babies live in the moment and their brains do not have object permanence yet, so they forget and are easily distractible. The older the baby gets, the more they are aware of the situation and remember when they see your finger approach their mouth. We still try to keep it fun and don't worry, babies are very forgiving. The areas are well healed within two weeks, which is a very short time compared to the need for years of Orthodontics. If the tongue is not resting up on the palate or roof of the mouth then the palate is not getting expanded naturally and the jaw and teeth will have to be moved later. This is where painful Orthodontics, including palatal expanders and orthodontic appliances, are in the mouth for months to years. Jaw surgery for late teens needs to be done after puberty. The oral surgeon breaks the jaw and resets it forward to allow new bone to form. Yes, it is as awful as it sounds. Remember, when we get the sinus area to develop properly, then there will be fewer ear and sinus infections which means less pain and fewer antibiotics. The list goes on and on...

We need your baby to be feeding themselves and not you feeding your babies. Moms will have a hormonal response to the baby that usually lasts 3-5 months. The baby will stimulate the breast and cause a letdown of milk. Some babies are just sitting there at the breast and swallowing the milk. We call this "riding the letdown.” We need the baby to trigger the supply and demand cycle so the breast empties and fills back up. If this does not happen, then the supply will slowly decrease over time and it can be difficult to build back up. We want to fix the ties before this happens. If your baby is not actively using the tongue, then the muscle does not strengthen. This causes weight issues later on because the baby needs to take more volume to gain weight. This is sometimes when we see Moms constantly moving the baby from one breast to the other to continue to trigger letdowns. If the baby is not nursing past the initial letdown and moves to the other side, then there is very little hindmilk extracted. This compares to when we eat simple carbs all day and no protein or fat. It is very unsatisfying and not conducive to healthy brain and muscle growth.

​Dr. Sacker has used all 3 so she knows first-hand! Scissors are sharp and make an even cut that can more likely reattach. It is also very common to not cut enough or not be able to cut enough because of the tie depth, location, or extent of restriction. The doctor can only cut what he or she can see and what is safe to cut. Since the doctor cannot see what is under the area being clipped, he or she would have to stop short. It is very common for providers to cut the anterior, or front portion, of the tongue tie in front of the salivary glands and leave the posterior portion intact. The problem with this is that the posterior portion is what controls the middle and back portion of the tongue- the area that is needed for breastfeeding and swallowing. It is also very difficult to cut into a submucosal tie that is more of a sheath attached to the surface of the tongue. It will bleed and the doctor cannot open it fully as a result of the bleeding and safety issues. Buccal ties also cannot be cut with scissors because of their location and size. Upper lip ties can be partially cut by skimming the gumline with a sharp instrument. The upper lip tie is covered by a sheath of sensitive tissue so it always hurts and bleeds with scissors. The doctor would be unable to cut it completely into the groove between where the teeth form, leaving the remainder of the cord attached to the bony area and upper gumline. The clip with scissors does help elevate the lip for breastfeeding, but it often regrows and will affect teeth location and make teeth brushing difficult or painful. Lasers can repair an incompletely released lip tie at a later date, but the area is more sensitive and has scarring from the previous clip so more laser energy is required, making the procedure itself and the healing more challenging. ​ The CO2 laser is the most gentle soft tissue laser on the market right now. Most of the time, there is no bleeding. Using this laser can also be faster than using scissors. It is safer than scissors because it works above the tissue, cauterizing while vaporizing the tissue in a bloodless field. This allows for a clear view of vessels and nerves. The diode laser works with heat and requires more energy to release the tissue, causing more scarring, especially with submucosal ties. The diode laser is also very hot and unsafe to use on buccal ties, unlike the CO2 laser. Just like our iPhones and other similar technology, we have better ways to do things now; we just need the medical community and insurance companies to catch up so our families can get the best care possible!

It is very difficult for the baby to figure out what to do with the tongue muscle if we do not take out the ability to use the lips and cheeks to compensate. Also, the lips and cheeks are the easy part of the procedure as far as a release, aftercare exercises, pain, and healing. The tongue tie is what takes skill to release fully and properly while using the type of equipment that causes the least amount of pain, scarring, and risk of reattachment. Releasing just the tongue and not the other ties reminds me of serving a healthy salad to eat but keeping the plate of cookies there too. We will still eat the cookies, or at least I would, lol.

We numb the lip, which is more sensitive with a strong topical gel, with a mixture of lidocaine and tetracaine anesthetics. The lip tie procedure takes about five seconds, but the topical gel lasts for 30-60 minutes. After the procedure, the numbness often confuses them while breastfeeding because they are used to incorrectly holding the breast with their lip and jaws. They are supposed to hold the breast with their tongue. The posterior portion of the tongue creates negative pressure by moving up and down which allows the milk to be drawn in from the breast. After the procedure, it makes it easier for your baby to nurse by holding and compressing the breast to match the mouth (make a “breast sandwich.”) The nipple should be free-floating back towards the throat and not pinched to the roof of the mouth.

It takes approximately 3-5 seconds to laser the tongue tie with our CO2 laser. There is no nerve in the cord or near the area that is lasered. Because there is usually no bleeding during the laser procedure, it is easy for us to see and not go too far or hurt the surrounding tissue, muscle, or blood vessels. This is not the case with an unskilled hand or with a sharp pair of scissors that makes a blind cut into the tie. The laser depth is about the width of a hair and it takes time to vaporize the tissue so there is no risk of “slipping” and hurting a nearby structure. What babies do not like is that we have to lift the tongue up with a tongue retractor to see. When the tongue releases it feels awkward because they have never felt their tongue elevate freely. The tongue is still attached by the muscle to the floor of the mouth so there is no risk of choking on the tongue or having it fall back in the throat. It is just now free at the center to have its full function and range of motion.

Your baby is still at risk for hemorrhagic disease of the newborn without a vitamin K injection or oral Vitamin K dosing. The C02 laser does not touch the tissue and cauterizes as it cuts so the risk is lower than with a diode laser and much lower risk that a scissors cut. Dr. Sacker is comfortable doing the procedure as long as you realize that the risk of bleeding afterwards is higher and you may need to seek further care if this is because of a problem with delayed clotting.

Dr. Sacker will show you how to do the aftercare stretches. You will then practice so that we can make sure that you are doing them correctly. Dr. Berger will see you back in 2 to 4 days for an initial recheck to check the sites. The sites can be checked as often as needed, until the 2 week post-procedure visit. Anytime you feel that the sites are healing incorrectly, you may text us a picture or email us a video. The media can show talking, crying, or just lifting and moving the tongue around. Some children with weak tongue muscles will take 6-8 weeks to improve. We recommend starting our tongue strengthening exercises 2 days after the procedure. If your child continues to struggle, myofunctional therapy is highly recommended and will be discussed at your visits. For those children with continued muscle tension in the posterior tongue and neck, it is important to start bodywork with a pediatric chiropractor early and continue 1-2 times per week until muscle tension resolves which may take 6-8 weeks.

It is very important to start stretching the tongue and lip area at least 4 hours after the procedure to maintain patency of the opening. The mouth heals very rapidly and we don't want the diamond opening to close up or reattach to the inner gum line. We would like to see it stretched and expanded to help with eating and speech development. You may read elsewhere that stretches have not been taught or recommended or that they should be done differently. Each patient’s ties open differently and will want to close differently, so we will tailor the stretches as those areas heal. If the muscles in the tongue were strong enough and could coordinate perfectly after the release of the ties, then stretches may not be needed, but that is rarely the case. The tongue muscles are often underdeveloped. It takes time for the jaw and lip muscles to weaken as the tongue learns to lift. The tongue needs to get stronger and function independently. Just like any new workout, it takes about six to eight weeks to build new muscle.

Bodywork includes therapy done by chiropractors, osteopaths, physical therapists, myofunctional therapists, speech therapists, and craniosacral therapists (CST). We tell parents that we have the easiest part of this equation because fixing ties with a skilled hand and using an amazing C02 laser is what we do. We cannot release the muscular tension that exists under the ties or from compensating for so long. It is often helpful for a hands-on treatment to reset the nervous system after the release. Chiropractors and cranial osteopaths that work on children use gentle pressure similar to checking if a piece of fruit is ripe. This type of therapy helps with releasing the tension from using the wrong muscles to compensate for inadequate tongue function.

It does not hurt to touch the areas. The issue is that the muscle of the tongue is now sore because it has not developed properly and is now being used differently. This is a new workout for the tongue. It would be as if you were doing a series of twenty minutes of squats or lunges and then resting for a few hours and repeating the series over and over again. The affected muscles would become sore and by the third time or so, you would be fatigued. It would then feel better to move around and stretch, however, the affected muscles would still be sore. After a few days of doing this series of new exercises, relief would come. This is the same idea post-procedure. Ibuprofen will help during the healing. Patients tend to do better as far as pain and eating if they stay ahead of the pain instead of trying to catch up from behind. When parents are proactive and give the medication regularly for the first 2-3 days, we find better feeding, less cranky kids, and happier families. Ice cream and popsicles are always helpful! The goal with the aftercare is to get in quickly and stretch the areas; to get them moving and to help them to heal, while helping the sites to heal as open as possible.

It is very challenging to get a good picture of the released areas. You can lift and pull in different directions and the area may look reattached, when it is not. It is very important for us to feel the area so we can tell whether there is an early reattachment or just muscular tension that is lifting the area. This tension can get worked on by your chiropractor and/or a trained physical therapist. We are always happy to look at videos or pictures to see how the stretches are going. To take a picture of the upper lip, lift with both hands on either side of the site and flip the lip up to the nose while another person takes the picture. As far as the tongue, put your index fingers on either side of the diamond and lift up to the roof of the mouth while someone takes the picture.

​The tongue tie is often holding down the salivary glands and when we release the tie, the salivary glands are free and tend to be overactive. It takes 7-10 days for this to better regulate. You also are pushing right along the duct with your stretches. This action stimulates and releases more saliva which does help the area heal. This saliva is therapeutic and should not be worrisome.

In the first 2 days, there is often bleeding along the edges of the areas because they try to close in so fast. Just keep using firm pressure to stretch. You cannot push too hard or make the areas bigger. Remember, we had to open these with a laser. You will have to push even more firmly if your child is pushing against you. Be firm, quick, and fast. Often your last stretch was not hard enough and then if you get a good stretch, you are just opening what had closed in the past 4 hours. Make sure your stretches are frequent and with consistent firm pressure. Doing them more frequently actually feels better. Waiting longer makes the stretches hurt more. When the tongue is still resting on the floor of the mouth and there are still lip and cheek muscles that have formed and are tense, reattachment is more likely. The more the areas are functioning correctly and the more you are guiding the healing then the better the outcome and function will be.

​Yes! When the lip is very tight from the tie, often there is some swelling in the evening after the procedure. That is why we use our cold laser first as it prevents pain and swelling. It would be much worse without that treatment. Our older kids and adults say that it is not uncomfortable, but that it just looks puffy. It is usually better within 1-2 days. Sometimes, we see the same thing with the buccal (cheek) tie release if they were very tight.

When the lasered areas heal, the tissue may look white, gray, or yellowish. There has never been a reported infection after frenectomy. In thousands of these, I have never seen one either. But if the tongue is hot, red, and swollen or your child has a fever, then please reach out to us. You can always send a picture for us to look at too.

The deeper or tighter the fibers of the ties, the bigger the diamond opening tends to be. This goes for upper and lower lip ties as well. We are only removing the thick collagenous fibers. We do not touch the muscles. This is what stretching, massage, and bodywork are for. We want full function of the area without restrictive fibers. The areas will contract in some and get covered with new soft tissue, which is why you are rubbing over the areas to keep them smooth, soft, and flat.

​Yes! It is from the odor of the healing tissue and the fact that the mouth is open more because the tongue is tired. It gets better about a week after the procedure. Try running a cool mist humidifier at night to help with congestion and with keeping the healing tissue moist. Make sure you child is drinking enough water to help. Continue to brush your child's teeth twice a day as normal.

Yes, the topical lidocaine and tetracaine gel can cause some irritation of the tissue. It is not painful, just unsightly. We see it more in older children and adults from the topical sitting on the areas to allow for proper anesthesia. Stay hydrated and use the coconut oil on the areas to help with healing.

No! Your child may play, swim, go to the beach and attend camp or school as normal. Have fun, just remember to do your exercises at least every 4 hours.

You may eat anything you like after the procedure once the topical anesthetic wears off. Softer foods, like oatmeal or yogurt, that do not require much chewing may be easier and less work for your tongue. Remember what is sore is the muscle of the tongue. Food that goes everywhere in your mouth like rice or salad, will require more movement of your tongue. There is a balance between pain and movement. Move your tongue enough so the muscle does not get too stiff, but not too much that it fatigues and you have trouble lifting. The amount of movement before fatigue is different for everyone. Spicy foods, vinegar, and alcohol may burn for some, but not for others. Even though the sites sometimes look like a hole, not to worry as food will not get stuck in the sites. Bottom line...there are no food restrictions so if you want it, you may eat it.

Food can be a powerful and fun motivator. Here are some fun games to play and even bring out a competitive edge. Fill shot glasses with whipping cream and race your child to see who can lick out the whipping cream faster without using hands to help. Same idea of lining up pieces of dry cereal on the table and who can eat them up faster. Put small pieces of cut up marshmallow up in the cheeks and use only the tongue to fish them out. Use only your tongue to lick peanut butter or sticky frosting off the roof of your mouth and above and around your lips. Have fun!

Your baby or child has built up muscle just under the nose which helped to engage the lip to hold onto the breast, bottle, or cup. It takes 3-6 weeks of not using the muscle (like when we cast a broken bone) for the muscle to weaken and get smaller. It is often hard to keep the lip flipped over the muscle that is there, especially if they continue to use it as the tongue fatigues. Continue to rub the outside of the lip like a mustache, pull the lip up to the nose, and rub the lip in various directions to try to relax the muscle. Continue to watch your baby at the breast or bottle and flip the lip out when you see it curled. In time, the muscle will get smaller and the bad habit will break.

This is often caused by overeating. Your baby is more efficient at the breast and is now getting more milk faster. Their brain has not caught up with their stomach knowing it is full already. As long as the spit up or vomit is milk or digested milk and not bright green, projectile, or painful, then spitting up is normal. Be prepared to do more laundry until your breasts regulate some. Try to substitute the MAM original orthodontic pacifier towards the end of a feeding when your baby slows, starts to fall asleep, and is doing a faster, twitchy suck without many swallows.

Over time, it is very difficult to continue to keep your milk supply up by just pumping. We praise Moms that want to provide breastmilk for their baby which is certainly better than formula on so many levels. We would never fault Moms that want to do this and offer only praise for the dedication. We just want the opportunity to make a difference if we can fix the nursing experience when there are ties involved. Pumping does get very tedious and old after a while. The newer cordless pumps will allow more frequent pumping sessions but after a while, without the bonding of your babies, the ability to trigger a letdown may dwindle. We are understanding so much more about the importance of direct breastfeeding. The exchange of your baby's saliva onto and into the breast will allow the breastmilk to change the composition and alter the kind of good bacteria that are secreted. It also will trigger immune responses which allow antibodies to pass from Mom to baby. Amazing and fascinating. And, of course, the bonding experience between Mom and baby while breastfeeding is like no other.

The white coating on the tongue is from not elevating to the palate to clean it naturally. If the tongue is tied to the lower jaw then it cannot lift to the palate and clean itself naturally. This may also cause sleeping with the mouth open which further dries out the surface of the tongue and makes the residue thicker. After we release the tongue tie, the tongue can build muscle strength with proper feeding, Mam pacifier use to lift the tongue, sleep posture hold exercises and tongue strengthening exercises (all under aftercare education). It takes time and practice to build muscle strength. This can take 6-8 weeks. Once the tongue is consistently up to the palate, especially during sleep, then the white coating will resolve.

We have tried all the pacifiers on the market to find the best one for tied babies. We use the pacifier as an exercise to strengthen the tongue muscle and train the tongue to stay up to the palate. It is similar to lifting a light weight with lots of reps while breastfeeding correctly is like lifting a heavy weight with fewer reps. The pacifier is good for tone and coordination while breastfeeding correctly will build strong muscle. The Soothie is very firm and round so it pushes the tongue down. It also has a ridge near the lips and gums which stimulates the baby to bite instead of suck. Any baby can hold a Soothie pacifier in the mouth which is why there are so commonly used in the hospital setting. Dentists also do not like the Soothie or Bib because of the way that they mold the upper jaw into a V-shaped when we want a nice oval U shape. The Nuk follows the slant of the tongue when it is tied by allowing the back portion to hump up and the front portion to stay down on the floor of the mouth. We want the tip of the tongue to stay just behind the gum line and the rest of the muscle to be up towards the palate. The Mam pacifier is soft, smooth, and in a nice wide, flatter shape to allow this to happen. We recommend buying the Original and not the comfort, sensitive skin, or MAM air types because they have creases and indents that cause lip, jaw, and cheek suction to hold them in and this is what we are trying to discourage. Using the Mam pacifier 3 times per day or more is what we recommend. Check out the Tug of War exercise under the pre-procedure therapy section.

This is a very frustrating issue. Unfortunately, ties are still not being taught in Medical School or Dental School. We are probably years from this. Right now, it is all about Continuing Education. As doctors, we get to decide what we learn for continued education. The doctors that spend the time to learn about ties will be familiar with how to diagnose, understand the different treatment options, and know whom to refer to for treatment. Schooling teaches us how to identify disease, not how to make anatomy more functional. This is a specialized field, which is why this is all we do at Team Tongue Tie. What we hope is that your Physician will see the red flags of tie issues and refer you to someone who specializes in ties. When there is a red flag for an eye problem, we refer to an eye specialist. Hopefully, ties will go in the same direction. We refer you to a physical therapist for jaw pain but then your therapist cannot make a diagnosis because it is not in their scope of practice. Also, if your therapist is not recently educated or continued their education in ties, then they may fall short there too. This is the disconnect. We are trying hard to fix this problem by educating providers and we hope you will too after you have learned from your experience with us.

Myofunctional Therapists are specialized providers, usually speech therapists or registered dental hygienists, who train patients how to use their tongues and orofacial muscles how to function properly. Dr. Sacker and Dr. Berger have been trained in myofunctional therapy via an intensive educational course, but are not certified. We completed the course to better understand what myofunctional therapy is, how it works, and whom it can help. It is best designed for cooperative children over age 4, teenagers, and adults with weak tongue muscles or difficulty re-establishing the brain to tongue connection. We have a set of exercises to start with found in the pre-procedure section. When we find it is needed, we can refer you to a therapist. Feel free to check for certified therapists in your area on the AOMT website.

This is such a loaded question and there are so many factors that may be an issue here. We did not know what we did not know. Sleep medicine is a relatively new field and we are understanding how important the airway anatomy and tongue position affect sleep and behavior. This can be complicated by the fact that adults also have additional issues related to sleep hygiene including excessive media time, poor diet, alcohol intake, and smoking that can interfere with sleep. Sleep specialists see the rise in sleep apnea is often related to tongue position and airway management. When we fix babies and young children, we see improvement in the anatomy to prevent these issues. During sleep, the tongue should be up and the lips sealed. Air should be moving from the nose to the lungs but if this cannot happen then the mouth will open to get the tongue out of the airway. When air is being filtered through the mouth, the tonsils and adenoids get irritated and grow which also pushes the tongue forward. And the cycle continues and progresses. With our patients, we have seen that fixing this positioning and changing the anatomy stops the cycle. It will take time for this clinical evidence to become proven research, especially since doctors frown on prospective studies. There are a few other reasons that we may be seeing more ties. We are looking for them so we can make a difference and improve quality of life. Adults are doing their own research and questioning for themselves. This is where the internet and blogging have been helpful. We encourage our patients to share their stories! We follow our patients and have a great success rate because we make sure the procedure is done right and heals correctly to give our patients the best outcomes. Poor outcomes or repeated revisions often come from incomplete removal of ties or lack of aftercare and follow up which is so important. The body is amazing and can learn to compensate which can be fine for a while but may cause issues later. More patients are being proactive with their health to have a better future. At this point, we have an easy procedure to fix the problems (and possibly prevent future issues) until we can prevent it from happening in the first place.

We base our need for an initial assessment on symptoms. If you or your children are symptomatic, we are always happy to check their mouths in the office for ties. Most of the kids that we fix have speech issues, excessive drooling, eating issues, sleeping issues, dental/orthodontic issues, and/or chronic neck pain/headaches. Most adults that we release have sleep issues including apnea or snoring, chronic headaches/jaw/neck pain, speech issues, dental/orthodontic, and/or mouth fatigue after talking all day. Bottom line, the most important sign would be airway compromise. Children and adults should be sleeping with their mouths closed and breathing through the nose. If the mouth is closed then pull down the jaw and make sure the tongue stays suctioned up to the palate. If you do not see this, then we need to check your anatomy in the office. The tongue needs to stay up to the palate so it is out of the airway. We do not want even a partial obstruction affecting sleep, breathing, and oxygenation of the body. The pressure of the tongue on the palate will widen the hard palate making room for the teeth and allowing aeration of the sinuses, keep the soft palate firm and elevated, and prevent the tonsils from enlarging and moving forward over time.

We take full payment for services at the time of the procedure which includes your follow-up visits. We provide you with a superbill, or paper invoice, for you to submit to your insurance for reimbursement for services. These superbills are available on your patient portal after the procedure and 2 week follow up visit. There will be an address on the back of your insurance card stating where to submit your claim. Your insurance company will have a form for you to fill out that you can find on their website or by calling their member services. Everything that they need to process the claim is documented on our superbills. We will provide a superbill for reimbursement. The amount of medical or dental reimbursement depends on the type of plan that you or your employer purchases so each plan will reimburse differently. There are hundreds of different plans out there which is why we cannot provide a reimbursement estimate for you. We find it does help, especially when making a medical appeal after an administrative denial, to write a personal letter explaining why the procedure was necessary for you or your child and include the before and after pictures that we have taken that are available on your patient portal. You can use the information on our website to help create the letter as well. Were you going to stop breastfeeding which you know was best for your baby? Is your baby having breathing or sleeping problems from the ties? Speech or feeding issues? Tell your story from the heart! Make sure to check the boxes correctly when you fill out the claim forms and sign the appropriate areas so that they send the reimbursement check to you and not to Team Tongue Tie.

​We are not in any insurance network. We are not a preferred provider for any insurance. We are not a Medi-cal provider. This all means that we do not take your insurance card for payment or bill your insurance and you do not need a referral to be seen in our office. We take a payment upfront in the form of a credit card, HSA card that works like a credit card, Care Credit card, or cash. We provide you with a superbill (or invoice) to submit to your insurance to get reimbursement for services provided. It is always best to contact your medical and dental insurance company first to find out their process of reimbursement after seeing an out of network provider. We recommend speaking to more than one person if what they are telling you does not seem correct. Medi-Cal does not provide reimbursement to you for these services. We have looked into joining local insurance plans like Blue Shield, Aetna, and others, but it would mean that Dr. Sacker would have to be affiliated with local hospitals and take care of sick patients as well. We are not seeing regular pediatric patients in the office so we can focus on our specialty and we also want to provide a safe environment for our patients.

​Often NOT! We are just taking a payment upfront and the other offices are taking your insurance copay or nothing upfront and then you pay the balance of the payment after insurance reimbursement. So, in the end, it ends up the same cost to you either way. We are not a preferred or in-network provider on any insurance so make sure that you know what your medical and dental insurance covers for your particular plan. Unfortunately, many medical and dental plans do not cover this procedure. Hopefully, in time, and with parent letters explaining why this is important and how this has helped, the insurance coverage will change. Insurance plans are never comprehensive for all conditions.

We take full payment for services at the time of the procedure which includes your follow-up visits. We provide you with a superbill, or paper invoice, for you to submit to your insurance for reimbursement for services. These superbills are available on your patient portal after the procedure and 2 week follow up visit. There will be an address on the back of your insurance card stating where to submit your claim. Your insurance company will have a form for you to fill out that you can find on their website or by calling their member services. Everything that they need to process the claim is documented on our superbills. We will provide a superbill for reimbursement. The amount of medical or dental reimbursement depends on the type of plan that you or your employer purchases so each plan will reimburse differently. There are hundreds of different plans out there which is why we cannot provide a reimbursement estimate for you. We find it does help, especially when making a medical appeal after an administrative denial, to write a personal letter explaining why the procedure was necessary for you and include the before and after pictures that we have taken that are available on your patient portal. You can use the information on our website to help create the letter as well. Were you going to stop breastfeeding which you know was best for your baby? Is your baby having breathing or sleeping problems from the ties? Speech or feeding issues? Tell your story from the heart! Make sure to check the boxes correctly when you fill out the claim forms and sign the appropriate areas so that they send the reimbursement check to you and not to Team Tongue Tie.