The Real Story of the “Booming Business of Tongue-Tie” – NYT Article Response

by | Dec 20, 2023

A recent New York Times (NYT) article accused tongue-tie providers of over-treatment, harming babies, taking advantage of vulnerable moms and babies, and, of course, doing it purely for financial gain. Tongue-tie naysayers jump on the article and share it –  “See! I told you so!” and, in so doing, put more weight on a one-sided propaganda piece (not real journalism) and no weight on the countless research studies showing the benefit and safety of treatment when properly performed.

Many people have asked for my response since I wrote a book called Tongue-Tied in 2018, published research on the topic in medical / dental journals, and created a course, Tongue-Tied Academy (of which we donate 100% of the course fee, and not for financial gain) to teach providers how to perform the procedure safely and effectively. In fact, I was invited to interview for the article by Katie Thomas, one of the authors of the piece, which I politely declined because I looked up her previous hit pieces on other medical issues.

Every few years, a sensational piece about tongue-tie is published. Last time, it was The Atlantic (and our response), and this time, it’s the Times. Now, the NY Post, Yahoo, and Daily Mail all ran with the NYT story and published their own versions, which is like the telephone game. The Daily Mail’s title was laughably fear-mongering and slanderous: “US doctors are wrongly slicing off bits of babies’ TONGUES to make breastfeeding easier and leaving them with life-long deformities, investigation finds.” It is unbelievable what these media companies do to drive the enraged public and healthcare professionals to their site (‘if it’s enraging, it’s engaging”) just for advertising revenue. The writers of the article do not care about moms and babies. They write these articles for a living and move on to the next topic they can exploit and report half-truths or completely false statements about. 

I have spoken with other well-respected providers in our field and Drs. Zaghi, Kotlow, and Siegel all explained the research evidence to the NYT for hours. They shared countless patient success stories, shared a balanced perspective, and, in fact, at Dr. Siegel’s office, the three patients the NYT writers observed (including the one photographed for the article) all improved and fed better afterward! Dr. Siegel allowed them to follow up with them because the NYT told Dr. Siegel they were objective and focused on the evidence and, in reality, were deceptive about what kind of story they were really publishing. Did they publish any of these success stories, or check out Dr. Siegel’s reviews, which include 1,051 5-star, one 3-star, and only one 1-star review? Now ask yourself, if he is the boogeyman (or if we are, at over 900 5-star reviews), then you would expect to see the opposite, right? All 1-star reviews about how terrible their baby fed afterward and how they were left with “life-long deformities.” But in reality, if you read the reviews, they share the true story the NYT should have reported on. 

Levels of evidence by the Oxford Centre for Evidence Based Medicine

(Image credit Gonzalez-Garcia 2019)

We always practice Evidence-Based Medicine, which is the process of critically reviewing and ranking research articles and combining that with clinical experience to achieve the best outcomes for patients. It’s basically the opposite of what this NYT article did. They purposefully did not report on the randomized controlled trials (RCTs) showing a benefit to tongue-tie release (of which there are 6, Hogan 2005, Dollberg 2006, Buryk 2011, Berry 2012, Emond 2014, and Ghaheri 2022). According to Buryk 2011 published in Pediatrics, there is a “clear and immediate improvement” in nipple pain and breastfeeding scores after the procedure, which is “rapid, simple, and without complications.” People who dismiss or disregard this evidence are outright lying, and their opinion, considered Level 5 evidence, doesn’t compare to the Level 1 evidence of an RCT. The NYT and Daily Mail overstated the complications and used fear-mongering tactics to drive clicks to their website. With any procedure, there are risks and benefits, but for tongue-tie procedures, the benefits are significant for almost all patients and in many cases, life-changing. People drive from around the USA and fly from other countries to seek care at our office. Why would they do that if it didn’t help? The risks are minimal and can be further minimized with a team approach to care involving other disciplines. In the story from the article, Dr. Siegel disclosed that the patient was treated during COVID, had no follow-up visits, and did not see any other professionals. Likely, the string under the tongue grew back and led to feeding difficulties. This can happen easily; if you get your ear pierced but don’t wear the earring, the hole will close up. If stretches are not performed to guide the healing after the procedure, it can easily grow back together. 

Here’s the TRUE story that is worth publishing. Every day, countless tongue-tie release providers help families not just in the USA but around the world whom the medical establishment has failed and dismissed. Many well-meaning primary care providers say that reflux, colic, spitting up, gassiness, nipple pain, trouble bottle-feeding, and more are all “normal.” They say that speech delay, slow and picky eating, choking on solids, sleep-disordered breathing, snoring, and teeth grinding are “normal” as well. (We have published research evidence, Level 2 and higher, to back up all these claims). None of these things are normal or optimal but rather common. Just like cavities in teeth are common, but certainly not normal. So, the babies struggle until the moms hear about a potential fix for the issues they are struggling with, which can also worsen post-partum depression for many mothers (and mothers often see improvement after a proper tongue-tie release when we assess them with a validated EPDS-10 questionnaire). 

The babies who don’t get treatment sadly do not outgrow a restricted tongue but can often (not always) have issues with speech, eating, sleep, and more. The confounding factor is that not all tongue-tied patients have speech or breastfeeding difficulties, just like not every patient who had COVID ended up in the ICU or had significant symptoms. A restricted tongue causes different symptoms for each individual baby, so an individualized and team approach involving therapists of various disciplines is critical to proper diagnosis and treatment. If it were easy to diagnose with a blood test like diabetes, then it would be easier to measure and study. Sadly, it is not taught in medical or dental schools, speech or lactation programs, or if it is, there is misinformation given out that “it will stretch out”, it won’t cause a problem, etc., which we addressed in an earlier post. 

I have another post on the financial aspect of tongue-tie treatment, and I will briefly discuss it here because that seems to be the main point of their article. Dentistry is more productive than tongue-ties. Dentists can do some fillings and a crown or check some hygiene patients and make more money than if they did a tongue-tie release on a baby. So why do we do it? It’s rewarding to help moms and babies feed better, to hear a kid say the “R” sound for the first time, to eat a whole meal without choking, or to sleep soundly through the night. They could just as easily (and maybe this is the NYT’s next article) write a hit piece about those “rich pediatric dentists who are fixing baby teeth for profit even though they know the teeth will fall out!” 

If you want to talk about a money grab… we have patients come to us who have spent thousands of dollars on therapy, or been in the NICU for weeks longer than necessary, or been admitted to the Intensive Feeding Program at the Children’s Hospital (where I am coincidentally writing this article from…), and they had a $1 million hospital stay. They are discharged and see us, and there, plain as day, is an extremely tight tongue restriction that no one noticed or thought could be affecting the baby or child’s feeding. Or if a child is treated by an ENT, almost always this includes general anesthesia, and along with it often $5,000 of medical bills and the unknown effects of general anesthesia on the developing brain. There is indeed a massive lack of education on the topic, and the NYT writers could have chosen to push the field forward and help many families who are surviving with a child with a tongue restriction but are definitely not thriving. 

Additionally, circumcision is a procedure performed on around 64% of male infants, that could also be called a “money grab” that is done almost exclusively for cosmetic reasons, with little to no evidence of benefit according to the CDC and AAP. It is also not without complications, at a rate of 2-3%, and many children need a revision which requires a procedure to fix the penis under general anesthesia. A circumcision is done for zero benefit to the baby, and a possible (but shaky) decrease in UTI or penile cancer (which are both very rare) as the child ages. Circumcision takes around 10 minutes. A tongue-tie release on the other hand is performed for functional limitations (nursing or breastfeeding issues in babies) of a restricted tongue, and takes around 10 seconds. We vaporize the tissue with an ultra-precise CO2 laser, which does not burn or damage the tissue, but turns the water molecules to steam, and it just erases the tissue with minimal to no bleeding. This method allows a greater degree of control and much greater ability to navigate complex anatomy and avoid blood vessels, nerves, etc. Almost anyone who talks about lasers to fear-monger, or say that it is overkill have never used a surgical laser to treat a tongue-tie. There are also diode lasers which do heat the tissue to 1000 C and work by burning the tissue, but that is not the tool that most providers such as Dr. Siegel, Ghaheri, Zaghi, Kotlow, or myself use. We all use CO2 which has been used since 1985 in dentistry and was developed in 1964. This is not new technology, or a new procedure.

Why is there an uptick in procedures? It’s multifactorial. There is better education on the topic for mothers and providers with the advent of social media, books like Tongue-Tied, and more awareness in general. But also, there does seem to be a rise in how common the condition is, possibly due to genetics (it’s often a dominant trait, so if a parent has it, likely many but not all of the kids will, too). Another hypothesis is folic acid supplementation, which began in the late 20th century, and an upper limit is not established, so if a little is good, then a lot of folic acid is great, and it could possibly thicken midline tissues, leading to increasing rates of lip and tongue-tie. 

I could go on and on, but if you want to learn more, you can download Tongue-Tied for free, or if you’re a provider, we have a course, Tongue-Tied Academy, to teach others how to do it properly and minimize risks and maximize results for families who truly do need and benefit from the procedure. And we donate all the proceeds from our book, online, and live courses, so this is not a money grab by another “rich dentist,” as the NYT would declare. If you have any questions or concerns, you can always send us a message. I hope this is helpful. Let’s push the field forward together to help as many families as possible thrive. – Dr. Baxter 

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