Comparison of ChatGPT knowledge against 2020 consensus statement on ankyloglossia in children

OBJECTIVE

This paper evaluates ChatGPT's accuracy and consistency in providing information on ankyloglossia, a congenital oral condition. Assessing alignment with expert consensus, the study explores potential implications for patients relying on AI for medical information.

METHODS

Statements from the 2020 clinical consensus statement on ankyloglossia were presented to ChatGPT, and its responses were scored using a 9-point Likert scale. The study analyzed the mean and standard deviation of ChatGPT scores for each statement. Statistical analysis was conducted using Excel.

RESULTS

Among the 63 statements assessed, 67 % of ChatGPT responses closely aligned with expert consensus mean scores. However, 17 % (11/63) were statements in which the ChatGPT mean response was different from the CCS mean by 2.0 or greater, raising concerns about ChatGPT's potential influence in disseminating uncertain or debated medical information. Variations in mean scores highlighted discrepancies, with some statements showing significant deviations from expert opinions.

CONCLUSION

While ChatGPT mirrored medical viewpoints on ankyloglossia, alignment with non-consensus statements raises caution in relying on it for medical advice. Future research should refine AI models, address inaccuracies, and explore diverse user queries for safe integration into medical decision-making. Despite potential benefits, ongoing examination of ChatGPT's power and limitations is crucial, considering its impact on health equity and information access.

Maternal folic acid supplementation and the risk of ankyloglossia (tongue-tie) in infants; a systematic review

BACKGROUND

Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have raised concerns about a causal relationship between folic acid supplementation, particularly after the first trimester, and ankyloglossia (tongue-tie) in infants. Non-evidence-based communications are potentially harmful because they could adversely affect adherence to folic acid supplementation, increasing NTD occurrence. This study aimed to review evidence on the relationships between maternal folic acid supplementation during preconception and/or pregnancy and the risk of ankyloglossia in infants.

METHODS

We searched the databases MEDLINE, EMBASE, Cochrane CENTRAL, and Scopus. We searched for observational, and interventional studies, and systematic reviews investigating the effect of maternal folic acid supplementation during preconception or pregnancy on the occurrence of ankyloglossia in offspring. The search was registered on PROSPERO on 01/12/2022, ID: CRD42022375862.

RESULTS

The database searches yielded 93 articles. After removing duplicates and screening titles and abstracts, 26 remained. One article was judged relevant for inclusion in analyses; a case-control study that directly mentions the relationship between folic acid supplementation and ankyloglossia. This study reported that regular intake of folic acid supplements was higher in women with infants with ankyloglossia. However, this study has limitations regarding design, selection bias, and confounding, calling the findings into question.

CONCLUSIONS

Insufficient evidence exists for a relationship between folic acid supplementation and ankyloglossia. Currently, the benefits of folic acid supplementation far outweigh the risks. This must be clearly communicated to patients by their clinicians during preconception and antenatal care.

Orofacial-Myofunctional therapy after lingual frenectomy in patient with tongue-tie: a systemic postural approach with mezieres method and postural bench

AIM

In this study we present the new postoperative oro-myofunctional protocol following frenectomy by atmospheric plasma associated with a systemic postural approach, which determines functional recovery through body symmetry restoration based on the concepts of the French "Mezieres Method" and postural bench.

METHODS

A total of 130 patients (76 female, 54 male) affected by ankyloglossia of class III/IV, according to Kotlow's Tongue Tie Classification have been treated with atmospheric plasma followed by oro-myofunctional therapy associated with a systemic postural approach. The overall change, improved/worsened speech, feeding, or sleep has been evaluated through the 10 points Parents Speech Satisfaction (PSS) Score after one week and two months.

CONCLUSION

Based on the findings of the current investigation, myofunctional therapy in tongue-tie results in a consistent significant functional ameliorating of feeding capability, speech and sleeping of subject treated as reported with traditional oro-myofunctional therapy.

Ankyloglossia in Monochorionic Diamniotic and Dichorionic Diamniotic Twins: A Cross-Sectional Study

Objective: To determine the prevalence of ankyloglossia in diamniotic monochorionic and diamniotic dichorionic twins, as well as to verify the relationship between gender and type of pregnancy. Study Design: A cross-sectional observational study, carried out with 52 pairs of dichorionic/diamniotic twins and 49 monochorionic/diamniotic pairs. The data collection was carried out through the analysis of medical records and the results of the Neonatal Screening of the Tongue Frenulum Assessment Protocol in Babies, and corresponded to the period of 2 years (2020-2022). Statistical analysis of data was performed, considering the significance value of 5%. The study was approved by the Human Research Ethics Committee of the institution. Results: The statistical analysis of multiple logistic regression between the two groups of twins (Mono/Di and Di/Di) according to the socioeconomic, demographic, and clinical-epidemiological profile was statistically significant for some variables. The prevalence of ankyloglossia, according to the type of twin pregnancy, showed a statistically significant difference. There was no statistical difference in relation to sex and ankyloglossia, or between couples diagnosed with ankyloglossia according to the type of pregnancy. Conclusion: Monochorionic/diamniotic twins had a higher prevalence of ankyloglossia, regardless of gender.

Does neonatal ankyloglossia interfere in the growth of infants during the first 6 months of life? A case series nested in a cohort study

BACKGROUND

Ankyloglossia is commonly reported as one of the major causes of breastfeeding difficulty. There is a lack of research on infant growth and latching performance with clinical measures.

CASES PRESENTATION

We describe a series of eight clinical cases (three female and five male infants) in a specialized breastfeeding center in a tertiary hospital in Northeast Brazil. The mothers were of mixed race and ranged from 13 to 41 years of age. Ankyloglossia was diagnosed within the first 48 hours after delivery. We measured the standards of growth, the mothers' perception of breastfeeding, and a pain indicator, and performed an assessment of breastfeeding. The regularity of breastfeeding was maintained despite the early diagnosis of ankyloglossia. Growth indicators were not affected in the sixth month in any of the babies, with only one measuring below expectations in the third month, with no impact on general health.

CONCLUSIONS

In the cases reported in this paper, the infants overcame the initial difficulties in breastfeeding and maintained their normal growth course in the first 6 months of life.

Breastfeeding Experiences and Changes in Feeding Plans Among Parents of Infants Diagnosed With Tongue-Tie

OBJECTIVE

To explore parents' plans for infant feeding before birth and their perceptions of feeding success in light of tongue-tie diagnosis for their infants.

DESIGN

A qualitative descriptive study design using content and thematic analysis was used.

SETTING

A dental office in Massachusetts with parent-neonate dyads undergoing infant frenotomy procedures.

PARTICIPANTS

Twenty-five parents between the ages of 27 and 40 years with infants from 1 week to 28.6 weeks of age were surveyed.

MEASUREMENT

Data were collected in an electronic survey using the Research Electronic Data Capture (REDCap) data capture tool.

RESULTS

Content analysis of the data from surveys showed themes that correspond to parents' plans for feeding before birth and the ways in which feeding plans or goals may have changed based on the presence of infant tongue-tie. Themes were categorized into three main categories: feeding plans and breastfeeding goals before birth, the parent's experience with breastfeeding an infant with tongue-tie, and how plans or goals changed because of perceived challenges with tongue-tie.

CONCLUSION

Findings suggest that there are challenges feeding infants with tongue-tie and that feeding plans may change as a result of those challenges. Implications for further research and practice include exploring how these perceptions and challenges affect the maternal role, success for individuals wishing to breastfeed, and parental self-confidence.

Relationship Between Infant Tongue-Tie and Maternal Wellbeing

BACKGROUND

Tongue-tie is a mild oral anomaly that can cause feeding challenges, especially for breastfeeding mothers and infants. Delayed diagnosis may place mothers at increased risk of stress and impaired mother-infant bonding when feeding does not go as planned. The purpose of this study was to explore the risk for altered maternal wellbeing (e.g., stress and maternal-infant bonding) in mothers of infants with tongue-tie-using-a mixed-methods, cross-sectional study.

METHODS

We recruited mothers from two sites to participate in a survey about their experiences with tongue-tie: Facebook™ tongue-tie support group and a local pediatric dental office where frenotomy is commonly performed. Inclusion criteria were mothers 18 or older; able to read, write, and understand English. Infants were under the age of 1 year when diagnosed with tongue-tie. The survey contained both selection and open-text entry questions. Maternal-infant bonding was assessed using the Postpartum Bonding Questionnaire and maternal stress was measured using the Parental Stress Scale.

RESULTS

N = 113 mothers participated. Findings suggest that mothers of infants with tongue-tie report increased stress, especially when a diagnosis of tongue-tie is delayed. After correction, maternal wellbeing, the breastfeeding relationship, and maternal report of infant temperament improved.

CLINICAL IMPLICATIONS

Early assessment, diagnosis, and management of tongue-tie are important. Partner support is helpful in fostering the mother-infant relationship. Future research is needed to understand barriers to appropriate referrals and delay in treatment of tongue-tie.

Miofrenuloplasty for Full Functional Tongue Release in Ankyloglossia in Adults and Adolescents-Preliminary Report and Step-by-Step Technique Showcase

Background and Objectives: Ankyloglossia is a functional term describing limitations of motor activity of the tongue due to the embryological malformation of the lingual frenulum. The lingual frenulum has a complex, three-dimensional structure, it is not only a mucosal fold, which connects the ventral surface of the tongue and the floor of the mouth. Such knowledge forced us to develop more advanced techniques for tongue release in ankyloglossia. The aim of this study is to describe a novel, precise surgical technique for tongue release. Materials and Methods: Miofrenuloplasty was performed in six patients with impaired tongue movements due to anatomical limitations. All of them were prepared for surgery and evaluated after the procedure by a speech therapist. Results: The healing process was uneventful in all patients. We did not observe any major complications. Tongue mobility and neck muscle tension improved significantly in all cases. In one case, the speech improvement was minor. Conclusions: Miofrenuloplasty is an advanced, but effective and highly predictable procedure for full functional tongue release in cases caused by MFGG complex. It should be done by experienced surgeon.

Relationship between Breastfeeding Difficulties, Ankyloglossia, and Frenotomy: A Literature Review

OBJECTIVE

Breastfeeding plays a key role in the development of the baby, in addition to the benefits to the mother and this dyad. Among the possible difficulties in this process, we have ankyloglossia. Some professionals opt for the frenotomy, although the literature is controversial. This paper aims to present how the literature provides subsidies for health professionals' decision and action in the intersection of the themes: breastfeeding, ankyloglossia, and frenotomy.

MATERIALS AND METHODS

The research on the platforms SciELO and PubMed used the terms: "ankyloglossia," "frenotomy," and "lingual frenulum" and the same ones associated with "breastfeeding." A specific inclusion and exclusion criteria were applied and validated by the American Speech-Language-Hearing Association to reduce any bias in the analysis. In the end, 16 papers were included and, by thematic equivalence, divided into two domains: association between lingual frenulum alteration and breastfeeding and between frenotomy and breastfeeding.

RESULTS

The literature does not assure that the frenotomy is the "standard conduct" to be adopted in cases of difficulty in breastfeeding and ankyloglossia.

CONCLUSION

Further studies are needed on the different types of ankyloglossia and their direct influence on the sucking function and lactation difficulties.

Tongue Restriction Questionnaire: A New Screening Tool to Identify Tongue-Tied Patients

PURPOSE

This study was intended to determine the prevalence of tongue restrictions in a pediatric population and develop a screening tool for tongue-tie symptoms.

METHODS

Patients were screened for tongue elevation and common symptoms using a novel Tongue Restriction Questionnaire (TRQ) that assesses symptoms throughout the lifespan.

RESULTS

In total, 314 children (47.5% male) with a mean age of 5.8 years were screened; 25.5% of children were grade 1 (could elevate the tongue >80% to the incisive papilla), 51.3% were grade 2 (50%-80%), 20.4% were grade 3 (25%-50%), and 2.9% were grade 4 (less than 25% elevation) or most restricted. Inter-rater reliability between the dentist and the hygienist's independent grades was highly significant (ᴋ = .915, P less than .001). With regard to consideration of the child's symptoms in addition to the functional grade (tongue elevation), 26.1% of parents were interested in a referral for possible treatment; 24.5% chose to wait and consider treatment in the future if symptoms worsened; 49.4% of children had excellent mobility and/or were unaffected. Childhood symptoms that correlated with more restricted tongue grades were spitting out food (P = .004) and slow eating (P = .021), and a history of prolonged feeding (P = .052) and milk dribbling out of the mouth (P = .027) as infants. A higher symptom score in infancy correlated with a higher score in childhood (r = .386, P less than .001) and a greater likelihood of referral in childhood (P less than .001).

CONCLUSIONS

Tongue restrictions are common in pediatric patients presenting to dental practices, and symptom presentations vary between patients. Tongue elevation is an easy and reliable test of tongue mobility. Shared decision-making and proper assessments help prevent undertreatment and overtreatment.

[Diagnosis and treatment of ankyloglossia in newborns and infants]

Ankyloglossia is a congenital condition characterized by a short lingual frenulum, which may result in the restriction of tongue movement and function. Considerable controversy regarding the diagnosis, clinical significance, and management of the condition remains, and great variations in practice have been recorded. Indeed, attitudes toward ankyloglossia differ among professional groups, and opinions may vary remarkably even among those within the same specialty. This article reviews the embryology, genetics, diagnosis, clinical presentation, and treatment of ankyloglossia to help physicians better understand and treat the condition.

Tongue-tied: a case of magnetic balls constricting the lingual frenum

The health risks associated with aspiration and ingestion of foreign bodies in children are well known. The increased availability of magnetic toys have added to these risks. A 7-year-old girl presented at the Department of Maxillofacial and Oral Surgery at the University of Pretoria Oral and Dental Hospital with a complaint of pain under the tongue. Examination revealed that magnetic balls had been lodged on either side of the lingual frenum. The patient experienced pain and was unable to dislodge the magnets. This case report documents patient presentation and management and concludes with a brief discussion of potential complications associated with the oral intake of magnets. Though multiple cases documenting the complications associated with ingestion of magnets have been reported, reports of primary oral complications are scant. This case contributes to existing evidence for the dangers associated with high strength magnets used as toys by children.

[Treatment for tongue-tie]

Ankyloglossia, or tongue-tie, is a congenital malformation, in which a short, lingual frenulum or a tight genioglossus muscle restricts tongue movement. In newborns, the reported prevalence is 2-11%. However, only 18% of newborns, in whom clinical findings suggest ankyloglossia, develop symptoms. Several randomised clinical trials report a significant reduction in maternal nipple pain after frenotomy. Frenotomy is a low-procedure surgery, but the benefits are sparsely documented. Parents should be presented with risk and benefits, before a frenotomy is offered.

Lingual frenotomy in neonates: past, present, and future

During the last decade, increasing awareness of breastfeeding and its health benefits has not been reflected in the provision of lingual frenotomy in neonates with tongue-tie. This could be because of inconsistencies in our understanding of the importance and treatment of ankyloglossia. In this review, we discuss the current clinical guidance on diagnosis and management, and the future of such a service in the early postpartum period.

Clinical inquiry: does frenotomy help infants with tongue-tie overcome breastfeeding difficulties?

No evidence exists for improved latching after frenotomy, and evidence concerning improvements in maternal comfort is conflicting. At best, frenotomy improves maternal nipple pain by 10% and maternal subjective sense of improvement over the short term (0 to 2 weeks).

Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management

Examination of the oral cavity can provide significant diagnostic information regarding the general health of the patient. The oral cavity is affected by a multitude of pathologic conditions of variable cause and significance; however, there are numerous normal variations of oral soft tissue structures that may resemble a pathologic state. Understanding these variations assists practitioners to discriminate between normal versus abnormal findings and determine the appropriate course of management, if necessary.

Growth and development of children prenatally exposed to telbivudine administered for the treatment of chronic hepatitis B in their mothers

OBJECTIVES

We studied the growth and development of children prenatally exposed to telbivudine used to treat chronic hepatitis B virus (HBV) infection in their mothers.

METHODS

Maternal abnormalities during pregnancy and delivery and infant congenital anomalies, physical development status, developmental quotient (DQ), HBV vertical transmission status, and HBV vaccination outcomes of 54 infants were evaluated (2010-2013).

RESULTS

No fetal abnormalities were observed during pregnancy or delivery. Postpartum, three infants (5.56%) had abnormalities: ankyloglossia, cutaneous hemangioma, and vaginal canal leak. Height and weight were within the normal range at birth and at 6 weeks, but were higher than the reference at 12 months (p<0.05). Body mass index increased gradually with age (p<0.05). DQ scores were normal (84.81%, 229/270) in 37 children (68.52%), abnormal or suspicious for a developmental delay (15.19%, 41/270) in 17 children (31.48%), and indicated a developmental delay (4.07%, 11/270) in seven children (12.96%). There were no significant differences in developmental delay between children prenatally exposed to telbivudine and controls (p>0.05). HBV vertical transmission was successfully blocked in all infants. The effective HBV vaccination rate was 98.15% (53/54).

CONCLUSIONS

The growth and development of children prenatally exposed to telbivudine was normal, indicating that telbivudine treatment during pregnancy is safe and effective.

A rare case of ankyloglossia and bilateral fusion of mandibular incisors

Dental anomalies may occur both in primary and permanent dentitions. Abnormalities in tooth size, shape, and structure result from disturbances during the morphodifferentiation stage of development. They are observed frequently during routine dental examinations and might be associated with a syndrome. Dentists must be familiar with the prevalence of such anomalies, as early diagnosis can prevent complications such as compromised aesthetics, space loss, midline shift, and carious exposure. This article describes a rare presentation of bilaterally fused permanent mandibular central and lateral incisors, along with ankyloglossia and fluorosis in a 22-year-old man with the chief complaint of "dirty teeth."

Ankyloglossia its impact breastfeeding

This article contrasts two very different experiences of one mother breastfeeding her two sons to demonstrate the potential impact of ankyloglossia on breastfeeding. When too restrictive, ankyloglossia, also known as tongue-tie, can cause the newborn to ineffectively suckle at the breast. Breastfeeding difficulties can occur, such as long feedings or damaged nipples. When nurses, lactation consultants and other providers recognize this situation, they can refer women for further care and treatment, which can ultimately lead to breastfeeding success.

Comparisons of the latching on between newborns with tongue-tie and normal newborns

BACKGROUND

Breastfeeding is recommended as the exclusive feeding for the first six months of the newborns life. Difficulty in latching and breastfeeding resulting from tongue-tie are believed to be a problem.

OBJECTIVE

To compare the latching on between newborns with tongue-tie (ankyloglossia) and normal newborns.

MATERIAL AND METHOD

The subjects were 833 normal, postpartum women who delivered without complications at HRH Princess Maha Chakri Sririndhorn Medical Center in Nakhon Nayok Province between January and June 2013. Their newborns oral cavities' were checked for tongue-tie screening and diagnoses using Kotlow's criteria. Latch scores were used for latch-on assessment at the second day postpartum. Demographic data and latch scores were collected and analyzed by the t-test, Chi-square test, Odds ratio with 95% confidence interval and One-way of ANOVA test.

RESULTS

The data shows that the incidence of tongue-tie was 13.4% (6.2% with mild tongue-tie, 5.5% with moderate tongue-tie, and 1.7% with severe tongue-tie). The mean of latch scores in the tongue-tied groups were significantly lower than that in the normal group, especially in the moderate and severe tongue-tie subgroups. The odds ratios for latch scores were < or = 8 compared between the moderate and severe tongue-tied subgroups and the score in the normal and mild tongue-tied subgroups was 1.4.

CONCLUSION

The latch scores in tongue-tied newborns were significantly lower than those in normal newborns.

Office frenotomy for neonates: resolving dysphagia, parental satisfaction and cost-effectiveness

OBJECTIVE

To determine parental satisfaction and cost-effectiveness of having a frenotomy performed in the office setting versus in the operating room under general anesthesia.

METHOD

After obtaining IRB approval at The Children's Hospital of Philadelphia (CHOP), we performed a retrospective chart review of patients having a frenotomy in the office between 2003-2008. 55 patients met the criteria and 25 were consented and their parents interviewed.

CONCLUSION

All participants reported an improvement in feeding within one day and up to two weeks following the procedure. Parents also reported being somewhat satisfied to very satisfied with having the frenotomy performed in the office versus under general anesthesia. There were no complications reported. Performing the frenotomy in the office provided patients with satisfaction as well as cost savings. The surgical fee for a frenotomy in the office is $850 and is the same as if the procedure is performed in the operating room. Performing a frenotomy under general anesthesia includes extra cost which consists of an anesthesia fee of $500-$900 and hospital charges ranging from $500-$8,000. Performing the frenotomy in the office on our 25 patients has resulted in a cost savings of more than $240,000 and the avoidance of general anesthesia in the first few weeks of life. Office frenotomy should be considered in children with ankyloglossia who present with difficulty nursing in the first week of life.

The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review

OBJECTIVE

To systematically review the outcomes of tongue-tie division procedures in patients with ankyloglossia with the goal of (1) deriving clinically oriented insights into the effect of tongue-tie division procedures and (2) identifying needs in knowledge to stimulate further research.

DATA SOURCES

Medline, EMBASE, and Cochrane databases were searched without any limitations, for studies published between 1966 and June 2012.

REVIEW METHODS

Studies were included (level 4 evidence or above) if subjects of any age had ankyloglossia and underwent tongue-tie release. Outcome measures of interest were any subjective or objective measures of breastfeeding and speech outcomes, or reports of adverse events.

RESULTS

In all, 378 abstracts were generated from the literature searches; 20 studies met the criteria for data extraction and analysis. Of those, 15 studies were observational and 5 were randomized controlled trials. Tongue-tie division provided objective improvements in the following: LATCH scores (3 studies); SF-MPQ index (2 studies); IBFAT (1 study); milk production and feeding characteristics (3 studies); and infant weight gain (1 study). Subjective improvements were also noted in maternal perception of breastfeeding (14 studies) and maternal pain scores (4 studies). No definitive improvements in speech function were reported. The only significant adverse events were recurrent tongue-ties that required repeat procedures.

CONCLUSION

Ankyloglossia is a well-tolerated procedure that provides objective and subjective benefits in breastfeeding; however, there was a limited number of studies available with quality evidence. There are no significant data to suggest a causative association between ankyloglossia and speech articulation problems. Aspects of ankyloglossia that would benefit from further research are described, and recommendations for tongue-tie release candidacy criteria are provided.

[Use of Z plasty for ankyloglossia: report of 38 cases]

Z plasty was used in 38 children (male 22, female 16) aged from 0.5 to 6 years with ankyloglossia. There were no infection, dehiscence and tongue adhesion. The wound healed more quickly, and tongue protrusion improved from 13.5 mm preoperatively to 24.6 mm postoperatively. Similarly, tongue elevation improved from 4.8 to 20.6 mm.