Ankyloglossia and breastfeeding: what is the evidence of association between them?

Rev. CEFAC. 2020;22(3):e12219 http://dx.doi.org/10.1590/1982-0216/202022312219 Review articles Ankyloglossia and breastfeeding: what is the evidence of association between them? Mariana do Rêgo Barros de Andrade Fraga1 https://orcid.org/0000-0001-8019-5984 Kamilla Azoubel Barreto1 https://orcid.org/0000-0002-4691-5826 Thaís Christine Barbosa Lira1 https://orcid.org/0000-0003-1989-7076 Pâmella Robertha Rosselinne Paixão Celerino1 https://orcid.org/0000-0002-4607-6161 Izi Tuanny da Silva Tavares1 https://orcid.org/0000-0003-2300-8964 Valdenice Aparecida de Menezes1 https://orcid.org/0000-0003-4183-3239 1 Faculdade de Odontologia da Universidade de Pernambuco – FOP/ UPE, Recife, Pernambuco, Brasil. Research support source: This study was financed, in part, by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior- Brasil (CAPES) – Finance Code 001. Conflict of interests: Nonexistent ABSTRACT Purpose: to investigate the scientific evidence, in the literature, of the relationship between ankyloglossia and breastfeeding difficulties. Methods: an integrative review of the literature. The MEDLINE and PubMed databases were searched, using the following descriptors in combination: “ankyloglossia”, “newborn” and “breastfeeding”. The searches included articles published between 2014 and 2019, in Portuguese, English and Spanish. Original articles demonstrating an association between ankyloglossia and breastfeeding issues were selected. Results: a total of 31 articles was fully read in the analysis, 22 of which were excluded and 9 included in the review. There was a diversity of instruments used for the diagnosis of ankyloglossia. In four studies, no standardized evaluation instrument was used for the diagnosis of ankyloglossia, which may limit the analysis of the results. However, most studies have evidenced a possible influence of ankyloglossia on breastfeeding. According to the studies, babies with altered lingual frenulum were more likely to experience difficulties in sucking, showing early weaning, which shows the importance of neonatal screening as a routine protocol in maternity hospitals for the cases of ankyloglossia. Conclusions: ankyloglossia may be related to impaired breastfeeding. The standardization of instruments for the diagnosis of ankyloglossia is necessary to improve the evidence in future research. Keywords: Ankyloglossia; Newborn; Breastfeeding Received on: August 7, 2019 Accepted on: March 19, 2020 Corresponding address: Mariana do Rêgo Barros de Andrade Fraga Rua da Fundição, 377, apto 1601, Santo Amaro CEP: 50040-100 - Recife, Pernambuco, Brasil E-mail: marianaandrade.odonto@gmail. com 1/8 2/8 | Fraga MRBA, Barreto KA, Lira TCB, Celerino PRRP, Tavares ITS, Menezes VA INTRODUCTION Ankyloglossia is a congenital anomaly characterized by an abnormally short lingual frenulum or whose insertion is located near the tip of the tongue, thus limiting the tongue movements in terms of both protrusion and elevation1-3. The etiology of this alteration is still unknown. Some cases have a hereditary component, while others are not explained by genetics. It is characterized by the remaining residual tissue that did not suffer the expected apoptosis during embryonic development4. The prevalence of ankyloglossia in newborns ranges from 0.52% to 21%, being more frequent in males5-18. Some authors consider such a prevalence to be underestimated, as cases of limited symptomatology are sometimes not diagnosed17. Restricted tongue movement can have implications for oral hygiene, predisposing to dental caries, as well as speech disorders, and bullying in childhood and adolescence, with consequential social and developmental problems. Regarding the newborn, ankyloglossia is a controversial issue within and among medical specialties and multidisciplinary teams, when the nature of its interference in breastfeeding is discussed, as well as the most indicated treatment2,19-23. The usual treatments for newborns with altered lingual frenulum include speech-language-hearing therapy and/or frenotomy. The surgical procedure is still discussed in the literature. There is no scientific evidence proving the procedure to be necessary to improve and prolong exclusive breastfeeding, concerning criteria such as the latch, and diminished nipple pain and crack15,21,24-29. In Brazil, considering the importance of breastfeeding for the newborn’s growth and development and the possible interference of ankyloglossia in the breastfeeding process, the federal law no. 13,002 was proposed and approved in June 2014. It made the lingual frenulum evaluation protocol – also known in Portuguese as little tongue test – mandatory for babies, with the purpose of the multidisciplinary team’s early diagnosing, treating and following up the cases9. However, the obligatoriness of performing the test in all maternity hospitals in the country is still discussed by various professional categories, such as dental surgeons, physicians, and speech-language-hearing therapists. Those who oppose neonatal screening state that there is no difficulty to clinically diagnose the severe cases during the newborn’s general evaluation; hence, they criticize the adoption of a standardized protocol Rev. CEFAC. 2020;22(3):e12219 | doi: 10.1590/1982-0216/202022312219 for the screening because there is no gold standard protocol for the diagnosis of this alteration. The critical remarks also consider the absence of available evidence of an association between ankyloglossia and breastfeeding, and of the benefits of surgical treatment as a means of avoiding early weaning due to possible difficulties30,31. Considering that neonatal lingual frenulum screening is a simple, painless, noninvasive, low-cost examination, which can be conducted by various trained professionals, and that ankyloglossia is more prevalent than other alterations diagnosed in a maternity hospital – such as the neonatal hearing screening (little ear test), which ranges from 0.1 to 0.6% of the newborns – the speech-language-hearing therapists defend that it be carried out as a means of early diagnosing and informing the parents about the presence of the alteration. Furthermore, it is important in offering guidance regarding the follow-up or treatment due to possible difficulties in breastfeeding, aiming to avoid early weaning and its consequences to the mother’s and baby’s general health32,33. Thus, this paper aimed to investigate, in the literature, the scientific evidence of the relationship between ankyloglossia and breastfeeding difficulties. METHODS This article’s method is an integrative literature review, whose intent is to gather and synthesize the scientific knowledge produced on the subject, making it possible to evaluate and summarize the evidence, contributing to its development. As it does not involve living beings, it was not necessary to have this paper approved by the Research Ethics Committee. After the thematic issue had been (...truncated)