What is a Buccal Tie or Cheek Tie?

There are seven folds of tissue in the mouth called frena, with four of them located in the cheeks, known as "buccal frena." While some frena are considered normal, others can cause issues and are...

There are seven folds of tissue in the mouth called frena, with four of them located in the cheeks, known as "buccal frena." While some frena are considered normal, others can cause issues and are referred to as "ties," such as tongue-ties, lip-ties, or cheek ties. A buccal tie specifically refers to an abnormally tight frenum in the cheeks [^1^].

Understanding the Impact of Buccal Ties

In most cases, a tongue-tie is the most significant frenum affecting breastfeeding, bottle-feeding, speech, solid feeding, and sleep patterns. The maxillary lip-tie can also cause issues, such as gap between teeth or difficulty nursing and bottle-feeding. However, it is the maxillary or upper jaw buccal frena that often pose the most problems, although a mandibular buccal frenum can also be restrictive [^1^].

When the cheeks are pulled back, it is possible to observe the frenum blanching the gingiva, causing pain to the patient. This appearance can resemble the sail of a sailboat. While these factors are important to assess, it is crucial to note that appearance alone is not sufficient justification for release [^1^].

A New Classification System for Buccal Ties

The Alabama Tongue-Tie Center has recently introduced the Baxter classification system for buccal ties. This system categorizes each buccal tie based on its attachment point, potential symptoms, and the tension it creates. By understanding the unique characteristics of each buccal tie, professionals can provide more effective treatment strategies [^1^].


Effects of Buccal Ties

Buccal ties can potentially interfere with nursing, nipple stabilization, and seal issues in infants. Although there is currently no quality research to support this claim, it is believed that buccal ties can also cause gum recession in adults and lead to excessive fascial tension around the mouth, making it harder to move the lips. Additionally, buccal ties may even be the likely cause of dimples. When the frena are too tight and restrictive, the cheek pulls in and creates dimples [^1^].

Balancing Treatment Risks and Benefits

At the Alabama Tongue-Tie Center, the professionals always prioritize caution and avoid overtreatment. However, they also consider the potential benefits of treating buccal ties if they are contributing to the patient's issues. Buccal tie releases are sometimes performed in infants (approximately 1 in 10 babies treated for tongue-tie) or children (approximately 1 in 100), but only when the ties are restrictive and the benefits outweigh the risks. Ultimately, the decision to treat buccal ties is made after a thorough discussion of the risks and benefits with the parents [^1^].

The main risks associated with releasing buccal ties include bleeding, reattachment, and discomfort. However, using a CO2 laser minimizes the risk of bleeding, and proper stretching techniques can help prevent reattachment. While discomfort is possible, it is generally manageable. It is important to note that the primary source of discomfort for babies is typically the tongue wound, as the tongue plays a more active role in infant feeding compared to the lips and cheeks. Additionally, stretching the cheeks along with the lip and/or tongue release may add a few extra seconds to the stretching routine [^1^].

Treating Tongue-Tie and Lip-Tie

When dealing with infants, the primary area for release is the tongue. If a baby is struggling, tongue release should be the primary focus, with lip-tie release secondary, as it contributes to seal issues such as excessive gas, clicking sounds, colic, reflux, and milk leaking. Buccal ties are tertiary in importance but may still have an impact. An example is provided where a baby had a lip-tie and a right buccal tie released by another dentist. However, they continued to struggle until a proper tongue release was performed, along with the left buccal tie release to restore symmetry. Significant improvements were observed following these procedures [^1^].

Shared Decision-Making and Aftercare

At the Alabama Tongue-Tie Center, parents are provided with a comprehensive examination, along with a detailed explanation of the risks and potential benefits of treating buccal ties. However, the center does not charge for buccal tie releases, as there is limited research supporting their efficacy. Releasing a buccal tie typically takes only a few extra seconds, ensuring minimal impact on the overall procedure [^1^].

While most babies do well with proper lip and tongue releases, there is a possibility that buccal tie releases may further enhance their outcomes if the ties are restrictive. In summary, it is important to assess buccal ties, inform parents of potential treatment options, and engage in shared decision-making to formulate the best plan for each individual patient [^1^].

If you suspect your child has buccal ties, tongue-ties, or lip-ties, you can contact the Alabama Tongue-Tie Center at 205-419-4333 or schedule a consultation. Additionally, you can download a free copy of the book "Tongue-Tied" or explore their comprehensive online course called "Tongue-Tied Academy" for further information [^1^].

Reference: [^1^]: "What is a Buccal Tie or Cheek Tie? - Alabama Tongue-Tie Center | Dr. Baxter & Dr. Trego | Birmingham, AL" by Alabama Tongue-Tie Center.