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Lip and Tongue Tie
What is Lip and Tongue Tie?
Frenectomy
Lip Tie
Effect on not treating
How do we Treat Lip and Tongue Tie
What are the Treatment Steps
What are the benefits of Treatment
Helpful Links and Resources
Snipping Vs Laser
Bodywork Therapy
Post-Operative care following Frenectomy
Questions and Answers
Lip and Tongue Tie Treatment Mackay, QLD
Pre-Orthodontic Treatment for Children
Pre-orthodontics for Children
Pre-Orthodontic Appliances
Orthodontic
Orthodontic Treatment in Mackay
Repairs & Breakages
Clear Aligners or Other Ortho Termination
Orofacial Myology
What is Orofacial Myology?
What does an OM Program involve?
OM for Kids
Jaw Play for Toddlers
Thumb Sucking Program
Airways and Sleep in Children
OM and Orthodontics
OM for Adults
KIDS Care Dentistry
What makes us different?
KID Friendly
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Lip and Tongue Tie
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New Child Patient Form
Expectations After Lip and Tongue Tie
Care for After Lip and Tongue Tie
Health Professional Communication Form
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Dentist
Locum Dentist
Oral Health Therapist
Dental Assistant
Mackay (07) 4942 5111
Communication Form
Aziz
2022-11-04T05:41:39+10:00
Communication Form
Ensuring the best possible outcomes for our patients
Referrer Details
Referring Clinic
*
Practitioner First Name
*
Practitioner Surname
*
Referring Practitioner Email
*
If you are not the above Practitioner please complete your name below.
Other Practitioner First Name
Other Practitioner Surname Name
Patient Details
Child's First Name
*
Child's Last Name
*
Child's Date Of Birth
Month
Day
Year
Parent First Name
*
Parent Surname
*
Mobile
*
Email
*
Confirm Email
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Degree of Urgency
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High
Medium
Low
Symptoms
Unsettled Baby
Yes
No
Incorrect Swallow Pattern
Yes
No
Learning Difficulties
Yes
No
Colic Symptoms
Yes
No
Incorrect Chewing Patterns
Yes
No
Narrow Upper Arch
Yes
No
Communication Difficulties
Yes
No
Poor Lip Competence
Yes
No
Cross Bite
Yes
No
Feeding Swallowing Difficulties
Yes
No
Bedwetting
Yes
No
Crowded Teeth
Yes
No
Mouth Breathing
Yes
No
Low Tone
Yes
No
Difficulty with Breast Feeding
Yes
No
Snoring
Yes
No
Poor Head Control
Yes
No
Traumatic/Complications During Birth
Yes
No
TMJ Dysfunction
Yes
No
Poor Posture
Yes
No
Tongue thrust
Yes
No
Thumb/Finger/Dummy Sucking Habits
Yes
No
Incorrect Tongue Resting Position
Yes
No
Family History
Family History
Pre-Treatment Recommendation:
Lactation Consultant Date
MM slash DD slash YYYY
Started OM Exercises Date
MM slash DD slash YYYY
Paediatric Chiropractor Date
MM slash DD slash YYYY
3 week Review Date
MM slash DD slash YYYY
Speech Pathologist Date
MM slash DD slash YYYY
Dentist Date of Release
MM slash DD slash YYYY
Referring Practitioner Comments
Referring Practitioner Comments
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