Author: holmanfamilydentalcare

Tongue Ties and Breastfeeding


As a mom of two young children, I can appreciate how stressful it can be if your baby is not eating enough. Some babies struggle a lot to latch onto a bottle or the breast. It often can take a lot of support from a lactation consultant or cranio-sacral therapist/bodyworker in order to find the correct position, posture and to relax the baby’s muscles enough that they can latch properly.

Other babies can only bottle feed even though the mother would rather be breastfeeding. This can lead to a lot of frustration as well.

Oral restrictions- like tongue or lip frenums which restrict movement can sometimes explain why a baby may have difficulty latching to breast or bottle. In my research, one thing I fully appreciated was how some babies can adapt easily to restrictions and others can have a lot of difficulty. It is not black and white. What works for one baby may not work for another.

A “frenum” refers to the tissue under the tongue that connects it to the floor of the mouth. In some babies it is thin and elastic and in others it is thick and fibrous. In some it connects at the base of the tongue and in some it connects at the very tip of the tongue. In some babies, the frenum can restrict the movement of the tongue and the baby is not able to adapt. A “tongue tie” is used to describe a frenum that is restricting the movement of the tongue. A “lip tie” similarly restricts the movement of the lips.

It is often difficult to figure out if your baby has a lip or tongue tie if it is deeper and not as easily visible. If you do find out your baby has one, it is also difficult to decide what to do if your baby has a frenum that is restricting tongue or lip movement.

A frenectomy is a procedure where that tethered tissue is “released” by making an incision with scissors or laser. This allows the tongue to be able to move and can help achieve a better latch to a bottle or breast. But when is this procedure appropriate? And will it work?

Lactation consultants often work with babies to achieve a better latch when breastfeeding, but they often can not overcome these anatomical restrictions.
CSTs or bodyworkers are providers that can help a baby that has difficulty latching due to muscle tightness or cranial nerve function. They also can often not overcome an anatomical restriction. A dentist or medical doctor are able to diagnose a restrictive frenum or tongue tie.

After having 2 babies and my extensive research in the role of oral sensory information in the suckling process, I decided to invest in continuing education to be able to diagnose oral restrictions and to be able to perform laser frenectomy or tongue/lip tie release surgery.

At our tongue tie clinic at Holman Family Dental Care, we have a multidisciplinary approach to care. We have Ayden from Harvest Moon Bodywork and Victoria from Durham Lactation on site to provide care.

All appointments are one-on-one. You will have a thorough assessment from Victoria, a full 45 minutes of bodywork, a diagnosis from myself and a laser frenectomy if needed. After the procedure, you will receive guidance from Victoria to learn some strategies to be successful. Follow-up with other providers may be recommended depending on the situation.

The laser we have is a CO2 laser, the LightScalpel. This soft tissue laser does not emit heat and cuts while cauterizing the tissue leading to minimal scar tissue and a quick, accurate procedure. The laser is used within my practice for a wide range of procedures including infant frenectomy.

To learn more about our tongue tie clinic and the providers – check out our website or call the office.

Patient Spotlight- Rudolph Tempesta


If you are from Chapel Hill, you likely know Rudy! We asked for him to share his amazing career and story with us. He wrote us this letter and asked that we share it to the internet community. It was our honor to treat one of the last WWII veterans! Thank you for your service Rudy and being such a ray of sunshine in our office! – Dr. Holman
Black and white image of smiling soldier in uniform cap and shirt.
“I was born in the year 1925- The same year as Barbara Bush! I was born in Brooklyn, NY.
America was in a Great Depression, we had nothing but family, love and friends. Every mother was our mother, every family shared the little they had.
In high school, I was a gymnast. I played in the orchestra and band and was popular.
I was 16 years of age when WWII broke out. I tried to enlist, but they would not let me. When I was 17 years old I enlisted. I was in the US Air Force and my crew of 9 men went to Europe. I flew 25 missions over Germany, Austria, Hungary, North Italy and many young men died, just shot out of the sky.
After the war I joined the US Postal Service in NYC and worked the Empire State Building.
The Postal Service in Chapel Hill would not hire me. The post office in Chapel Hill was a family affair. After a year I asked Senator Jordan to help me and he did. I was called in one week thanks to the Great Senator. I was made the President of The Union and lasted for 40 years.
The post office was a typical Southern place. They would not allow African Americans to work in the post office. With the help of Senator Jordan I got two African Americans to work. This was a great victory against discrimination and the doors were opened. Chapel Hill became a shining Hill in NC.
After I retired from the Post Office after 68 years of service I needed help to fix my teeth and tried to get help from the dental school to no avail, then tried various dental offices to no avail, from the VA- but no help to cover a combat veteran.
Then my son, Nick Tempesta, told me to go to Holman Family Dental Care. There I found a great Humanitarian. She filled all my teeth and saved my life. The office as a great team of ladies who are very helpful. I finally found someone who would help me.
Thank you Dr. Holman for your help and for taking care of a WWII combat veteran!
– R. Tempesta”

Pregnancy and Dental Health


Pregnant or planning to get pregnant? Here is what you need to know about your dental health.

Changes to expect with your teeth while you are pregnant

  1. Due to hormonal changes, you may develop “Pregnancy Gingivitis” where your gums may bleed more and appear more puffy. You may notice bleeding occasionally when brushing or flossing when that did not happen prior

What to do about it: Continue brushing 2x/day with a soft toothbrush or electric toothbrush moving in gentle circles along the gumline and all surfaces of the teeth. Floss at the end of each day being careful to wrap the floss along the teeth and not straight into the gums. Consult your dentist for instruction if you are not clear.

  1. If you suffer from acid reflux or vomiting you may develop more cavities or acid erosion that wears your teeth

What to do about it: Before brushing, rinse your mouth with water and/or listerine to neutralize your mouth. Drink water frequently to keep the acid off of your teeth. Consider using higher fluoride toothpaste (prescription strength from your dentist) to strengthen your tooth structure and make it more resistant to erosion.

  1. Changes in your diet or timing of meals/snacks may lead to more cavities

What to do about it: Be aware that eating more simple carbohydrates (crackers, chips, or my personal favorite, cookies), sugary foods (candy, juice, etc.) could lead to more cavities. If you eat late at night or more frequently throughout the day this could also lead to cavities. Make sure to continue to brush morning after breakfast and night before going to bed. Drink mostly water thoughout the day. Be mindful of what you eat.

Is dental treatment safe?

  1. It is best to treat cavities, oral infections and gum disease to minimize risk to you and your baby. Inflammation puts strain on you and your baby. Gum disease is linked to cardiovascular problems. Abscesses could spread to different areas of your body and lead to a medical emergency.
  2. Local Anesthetics (with or without Epinephrine) is safe.
  3. NO Laughing Gas AKA Nitrous Oxide- This has been linked to risk to your growing baby. It is safe during labor though (I did this with my son!)
  4. Antibiotics are safe if you develop a tooth related infection. The types of pain medications recommended are dependent on your health so your doctor may be consulted.
  5. Radiographs are safe with lead protection over the belly and thyroid. Most dentists will do routine radiographs based on risk of getting cavities. If there is an infection or treatment is needed, a radiograph is likely going to be needed in order to perform the procedure safely.

What to know about Medicaid in North Carolina

Many women will find that once they are pregnant they may qualify for Medicaid if they are lower income. Medicaid fully covers preventative dental work (x-rays, cleanings, exams) as well as fillings, root canals on front teeth, removing teeth and making dentures. They will not cover root canals of back teeth, crowns/caps, implants, orthodontics/braces or certain types of dentures. Absolutely take advantage of this and get seen as soon as possible in your pregnancy so you can get treatment and have healthy gums and teeth! Make sure your dental provider accepts Medicaid prior to scheduling.

For more information visit these sites below or feel free to contact me, Dr. Holman at Dr.Holman@HolmanFDC.com

https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co569.pdf?dmc=1&ts=20161014T1326459399

https://www.ada.org/en/member-center/oral-health-topics/pregnancy

https://ehp.niehs.nih.gov/wp-content/uploads/2017/09/EHP655.alt_.pdf

“I didn’t think Dentists had Ph.D.s…”


You’re right! Dentists typically have a D.D.S. or a D.M.D. (completely equivalent degrees, just depends on the school). My training was unique in that I also decided to do a Ph.D.

I started doing scientific research in high school. I have always been a hands on learner, so it was fun for me to be learning from a book but also applying that knowledge and critically thinking about it in the research setting. My project from high school resulted in my first co-authorship in a peer-reviewed journal! I continued to work in different labs throughout college for the same reason. I enjoyed the whole process of learning different research techniques, figuring out what we know about a topic and what we need to learn and then figuring out a way to find the answer.

CostaRica

My last year in college I did a thesis project looking at the shape of carnivore teeth and the link to their diet. This information could help us learn about diet of extinct species based on their shapes of their teeth. I took impressions of jaws from the Museum of Natural Sciences in Raleigh and from the collection at Duke. My project was later published along with the supervising Ph.D. student I was working under. I also was able to present my work twice during a poster session at Duke.

My dream had always been to be a dentist. I envisioned myself working a long career then in my retirement working at a school and teaching and being involved with research projects. When University of Maryland approached me about their dual degree D.D.S. and Ph.D. program my eyes lit up! I started to explore the idea of who I would work with and got connected to Dr. Rebecca German at Johns Hopkins University School of Medicine who had a background similar to mine in Biological Anthropology but did research that was very clinically translatable studying swallowing physiology. I decided to enroll in the program. I completed 2 years of dental school, then focused on my Ph.D. work for 3 years until I defended and after my defense I returned to dental school to complete my 2 clinical years. It was an amazing experience!

Me serving as the Secretary of the AADR NSRG (American Association for Dental Research National Student Research Group)

My research was about understanding the role of oral sensory information during suckling in infants. By giving local anesthetic to numb oral sensory areas, we were able to understand how this information helps signal the coordination of the suck, swallow and respiratory cycles. I was able to be published as a first author in the Journal of Veterinary Dentistry, Journal of Physiology and Dysphagia. I presented my research at national and international meetings and was recognized with a grant to fund my graduate work.

While I am not actively involved in research at the moment, my training has allowed me to confidently be able to evaluate scientific literature and to make evidence based treatment decisions. I am always striving to learn more through continuing education and always go to primary research when evaluating new products or materials. I use my research training on a daily basis and I believe it has made me a strong clinician as well.