We are lucky in Chapel Hill to have this amazing resource for parents who child has a possible tongue or lip tie! Dr. Shaina Holman of Holman Family Dental Care is a wonderful dentist who approaches possible infant feeding issues from a holistic approach. On staff, she has a lactation consultant and bodywork therapist that are able to evaluate each baby on an individual basis. The three then come together to discuss each patient and figure out together the best approach. This collaboration helps to make sure each baby receives the best treatment for them!
Fun tidbit: Dr. Holman and I went to East Chapel Hill High School together! We were a year apart and did not know each other, but it always fun to meet another person who has been in Chapel Hill for a long time!
What appealed to you about working in dentistry and lactation?
Before starting dental school, I had majored in Biological Anthropology which is about the evolution of human anatomy. I had been actively involved in research and ultimately decided to do a PhD while in dental school. My lab studied the anatomy and physiology of sucking and swallowing in infant mammals. While in training I had 2 babies that I breastfed and it was a wonderful experience. When I opened my practice I took many other courses in the airway, lasers, frenectomy and frenuloplasty techniques and orofacial myology. Given my experience as a mom, my research and dental background I felt uniquely positioned to help moms in our community. I really feel for the frustration mom's have when it doesn't go smoothly and the stress they feel about weight gain and the pressure to breastfeed in our society. I love being able to figure out what is going on that is causing the trouble and to reassure them and support them and help them with a release of the tongue tie and/or help with connecting them to people in our community that can help.
What are early signs that parents may notice their infant is in need of your services?
Early signs of a tongue and/or lip tie are a baby that is doing more chomping than sucking, losing their latch quickly, causing pain to mom when nursing, taking a very long time to nurse, a white coating on the tongue, reflux, vomiting, sensitive gag reflex, dribbling a lot of milk as their are sucking. The first step is to see a lactation consultant for a full assessment and they will refer to us if they are concerned. Some lactation consultants are not well trained in this area so they may miss these signs. There are many other things that may be going on that are not a tongue tie which is why a full assessment is helpful with a multidisciplinary team if possible.
What does a typical consult look like at your office?
You will first meet with our lactation consultant who will not do a traditional lactation visit, but focus on what has been working or not working so far, they will watch the baby drink from bottle and/or breast and make notes if they are seeing signs of a tongue or lip tie. The bodyworker, who is a LMBT, and trained in infant medical massage will then assess body position and look for asymmetries in the shape of the head and body. Sometimes after birth babies can have areas in their head that are flat which can affect nerves and muscles that are needed in breastfeeding. She will then start doing massage on areas that are asymmetric and intraorally on the floor of the mouth. It is very important for the floor of the mouth to be maximally relaxed before I do my assessment. Once this is done I come and do my assessment of the anatomy and range of motion of the tongue. The three of us will then step out of the room and discuss what we think is causing the problem and then come back and discuss with the parents. If the frenectomy is recommended, we will do that procedure same day if they want to move forward. We sometimes recommend more work with a bodyworker, lactation consultant or other providers like speech and language pathologists or occupational therapists if we think there could be another explanation for their symptoms. Sometimes the recommendation is a combination of a frenectomy and then followup with these providers. We aim to be very thorough and talk though timing and expectations with our parents.
What does a typical revision entail?
When a frenectomy is done we give the parent the option to be present. Almost no one wants to be present, but there is always the option. The baby is swaddled, protective eyewear is worn and we take a before & after photo. The procedure is done with a CO2 laser, the LightScalpel, which is a laser that removed soft tissue with the laser itself, as opposed to a diode laser which heats a glass tip and then the glass tip is used to remove the soft tissue. It is very delicate and accurate and causes minimal trauma to the surrounding tissue and minimal bleeding. Once it is done, the baby is returned to the parents as soon as possible. Some babies want to nurse right away, some just want some snuggles and then they typically go to sleep very soon after that.
When you aren’t working with clients, where can we find you?
You can generally find me with my kids and husband. We are often out about in Chapel Hill going to different parks and play areas or at the Sportsplex ice skating. We have a large local extended family so we also spend a lot of time with our parents, cousins and siblings.
