Children’s Dental Health

Tongue Ties: What Parents Need to Know

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Being tongue tied isn’t just a figure of speech. It’s a very real medical condition that can affect oral and facial development. Learn more in this article.

by Sarah Hornsby

Tongue Ties

For a long time, people just didn’t seem to know much about tongue ties. In the early years of my practice, few of my patients had ever heard of a tongue tie. When I pointed out that they or their children might be tongue tied, I was often the very first practitioner who’d mentioned it to them.

When I told them that a tongue tie might actually be the root cause of their oral myofunctional issues, or even their sleep apnea, I’m sure that some of them thought I was crazy.

But in the last few years, things have changed so much!

Initially, there was a small increase in the number of patients who were contacting me specifically about tongue ties. Dentists and orthodontists also began reaching out more frequently to discuss the application of myofunctional therapy exercises to tongue tie treatment.

But in the last year or so, that little bit of interest has become a surge of awareness. Tongue ties and their effects on health and craniofacial development are finally becoming mainstream. This is great news because it means that fewer people are going to suffer from the undiagnosed and untreated symptoms of a tongue tie.

Catching and treating a tongue tie early is vitally important, so in this article, I’ll cover everything parents need to know about tongue ties.

What Is A Tongue Tie?

Being tongue tied isn’t just a figure of speech. It’s a very real medical condition that can affect oral and facial development, and have a range of other serious health consequences.

We all have a lingual frenulum (or frenum) under our tongue. If you lift your tongue and look in the mirror, you’ll see it. The frenum is the tissue that connects the tongue to the floor of the mouth. In some people, it’s tighter or thicker than it should be, and this can physically restrict the movement of the tongue.

A tongue tie can also be referred to as Ankyloglossia or Tethered Oral Tissue (TOT).

How To Identify A Tongue Tie

Here are three examples of tongue ties to help you identify them:

Tongue Tie
This is an example of a less obvious tongue tie. This type is most often missed by most doctors and dentists. The tongue looks “normal”, but the full range of motion is not possible.

 

Tongue Tie Eiffel Tower Frenum
This is an example of an “Eiffel tower” frenum, as it is often referred to. The frenum is in a fanned out shape where it attaches to the floor of the mouth.

 

Tongue Tie Heart Shaped Tongue
This is an example of a severe tongue tie, indicated by the “heart-shape” tip of tongue, and a frenum that is thicker in appearance.

Why Does A Tongue Tie Matter?

As a myofunctional therapist, the position of the tongue is my key focus. The tongue should rest in the top of the mouth, filling up the entire palate from front to back. When the tongue is resting in the correct position, it shapes the maxilla (upper jaw) and guides the growth of the face. The tongue also provides an internal support system for the upper jaw.

But if a person is tongue tied, their tongue may not be able reach the top of the mouth because it’s physically restricted. This causes the palate to develop smaller and narrower, and the teeth to grow in crooked. Also, the mandible (lower jaw) is often smaller and set back, and the airway is restricted.

Because of this, children who grow into adults without having their tongue tie treated often experience a range of oral myofunctional symptoms including:

  • Speech issues
  • Mouth breathing
  • Jaw pain, clenching, and grinding
  • Headaches
  • Head, neck, and shoulder tension
  • Forward head posture
  • Snoring, sleep disordered breathing, Upper Airway Resistance Syndrome (UARS), and sleep apnea
  • Increased risk of cavities and gum disease
  • Slower orthodontic treatment
  • Orthodontic relapse

What Causes A Tongue Tie?

Recent research is showing that tongue ties are linked to a mutation in the MTHFR gene. The science behind this is quite complicated but basically, what’s happening is that a specific gene isn’t quite working as it should. In this case, the mutation involves a process known as “methylation”, which affects the body’s ability to deal with folate – an important element in prenatal nutrition. Tongue ties are just one of many conditions caused by this mutation.

Because tongue tie is linked to a genetic cause, it’s hereditary, and one or both parents can also be affected. I see this a lot in my practice; parents will reach out to me for help with a tongue tied child, only to find out that they’re tongue tied as well.

Tongue Ties Infographic

Can A Tongue Tie Affect Breastfeeding?

Breastfeeding is one of the first ways a tongue tie can be noticed. When mothers have trouble breastfeeding, a tongue tie can often be to blame. However, if babies are bottle fed, or meet weight-gain and growth markers, the tongue tie can be missed or overlooked.

Just because a mother managed to breastfeed her baby doesn’t mean that tongue tie isn’t an issue. Many times, a nurse or lactation consultant will notice a tongue tie but not recommend a release because the baby is gaining weight.

From a myofunctional perspective, the tongue tie still needs to be released so that proper oral development can take place.

Can A Tongue Tie Affect Speech?

A tongue tie can certainly affect a child’s speech but it doesn’t always. Sometimes doctors and dentists are reluctant to release a tongue tie if it’s not affecting speech. However, as I explained above, it comes down to much more than speech – growth and development of the jaws and teeth will be impacted by a tongue tie.

The most common sounds that kids struggle with if they are tongue tied are “r” and “l”. If your child has these specific speech issues, the first thing I’d recommend would be to screen for a tongue tie.

How Is A Tongue Tie Treated?

In most cases, tongue ties are treated with a minor surgical procedure to release the tie. This procedure is called a frenectomy but is also known as a frenotomy or frenulectomy.

The frenectomy is a simple procedure that only takes a few minutes. It’s usually done in-office by a dentist or ENT using a laser or scalpel without general anesthetic. I recommend finding a specialist who’s very experienced at performing the procedure. If it’s not done correctly, or released enough, there’s a high chance the frenectomy will need to be done again.

There’s more to treating a tongue tie than just releasing it, and this is where myofunctional therapy comes in.

It’s very important to do myofunctional therapy exercises for at least two to three weeks before the frenectomy. This helps prepare for the procedure by strengthening the muscles of the tongue.

After the frenectomy, caring for the wound is also critical. The mouth and tongue are great at healing, so it’s possible that the tongue will reattach, meaning it will literally heal back down the way it was. So I meet with my patients immediately following the release to guide them through caring for the wound, and to teach them new gentle exercises. This allows the tissues to heal without reattaching and affecting the end result.

Why Do We Need To Do Exercises After The Tongue Heals?

Once the tongue tie has been released, it’s time to train the tongue to move properly. Just because the tongue is now capable of a normal range of motion doesn’t mean it will be able to move the way it should.

Think of it like this – if your arm had been in a sling for a year, and you removed the sling one morning, your arm muscles would be weak and uncoordinated. You’d need to do some rehabilitation using physical therapy to strengthen the muscles.

In this case, the tongue has literally been tied down. It’s never moved or rested the way it should, but with myofunctional therapy, we can train it to rest in the correct position, and to move correctly in the mouth. Without these exercises, it’s entirely possible that the tongue will never regain its full range of motion.

What Happens If We Decide Not To Treat A Tongue Tie?

Given the list of possible symptoms connected to a tongue tie, and how easy the surgery is, if a tongue tie has been diagnosed in a child, in my opinion it’s always worth releasing it.

It’s difficult to predict exactly how a tongue tie could affect the growth of the face and jaw, or what the other potential health effects could be. However, a tongue tie always has some impact on craniofacial development and overall health.

For example, the latest research is showing that children who are tongue tied are more likely to have sleep apnea. So, in more extreme cases, airway-related issues are already happening in childhood.

It’s definitely possible that the negative effects of a tongue tie will only become obvious in adulthood. Basically, adults who are tongue tied have compromised orofacial development and airways. This puts them in high-risk categories for myofunctional problems.

Often, the adults I work with have jaw pain and headaches or sleep apnea that are linked to unreleased tongue ties. Most times, these patients have no idea they were tongue tied to begin with.

Should Adults Have Their Tongue Tie Released?

As I mentioned above, if a tongue tie has been diagnosed, it’s definitely worth having it released.

Some tongue tied adults may have few or even no symptoms for most of their life. But then out of the blue, they start having problems. The thing is, their symptoms didn’t just appear. They accumulated over decades of living with a compromised orofacial structure.

The body is an amazing organism, and it will do its very best to maintain health, but after enough time passes, things can start to go wrong. It’s never too late to have a tongue tie released and to get the benefits of myofunctional therapy.

What’s A Lip-Tie?

A lip-tie is similar to a tongue tie, and the two are often seen together.

With lip-ties, the small seams that we all have on the midline between our lips and gums are too short or thick, causing restricted lip movement. This can have a major impact on breastfeeding and speech, as well as dental development.

Lip-ties are treated exactly the same way as a tongue tie; the tie is surgically released, and myofunctional therapy exercises are prescribed.

Conclusion

I hope this article has helped clarify what a tongue tie is, and why it’s so important to take this condition seriously.

If I could sum up my experience with tongue ties, I’d say that the adults I meet who are tongue tied always wish they had known about it sooner. They also wish that their parents had known about tongue ties, and that they were able to get treatment earlier in life.

If your child is tongue tied, I’d urge you to find an experienced practitioner to perform the release, and a myofunctional therapist to work with before and after. Proper treatment really does make a huge difference!

Sarah Hornsby, RDH

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