Tongue tie (ankyloglossia) is where the strip of connective tissue that connects an individual’s tongue to the floor of their mouth is shorter, thicker or tighter than usual which restricts the tongue’s range of motion. An individual with an oral restriction (tongue or lip tie) often has an unusually short, thick or tight band of tissue (lingual, labial or buccal frenulum) which inhibits the ability of the tongue, lips or cheeks to move freely in all directions necessary for speech, feeding, airway and speech. In babies this may interfere with breast or bottle feeding. And untreated oral restriction can lead to a multitude of compensatory health and oro-facial issues. Not all oral frenulums are restricted. However, when a restriction is present, it often requires a simple surgical procedure to correct and release.

Tongue tie is a congenital issue that may become apparent soon after birth and occurs when the tongue does not separate from the floor of the mouth during womb development. Note that an individual may be “tongue tied” or restricted to various degrees.

Tongue tie is estimated to affect 4-11% of newborns but may go unnoticed until other issues become evident – see signs and symptoms below.

Tongue ties limit tongue mobility which is important for speaking, chewing, drinking, breathing, swallowing and more. It is also extremely important for adequate craniofacial development. Without identification and intervention, a tongue tie in a child can have downstream affects as a child’s face and head develop.

Myofunctional therapy is an important aspect for treating tongue tie. Surgery alone does not guarantee success.

Many adults experience symptoms such as swallowing, breathing, and/or sleeping issues and/or upper body tension for years, not knowing that this is a negative consequence of tongue tie. As individuals develop from children to adults, a cascade of Orofacial Myofunctional Disorder (OMD) symptoms emerge as the body maladapts. These adaptations aren’t viewed as abnormal because the person just doesn’t know any different.

Adults most often complain of poor sleep quality, obstructive sleep apnea (OSA), digestive issues and swallowing problems, teeth grinding (Bruxism), Temprormandibular Joint Dysfunction (TMJ) pain, postural issues, upper body tension, speech impediments, head and neck pain and migraines just to name a few. Adults tend to learn about their own tongue-ties when a child is born with a tongue-tie, and the parents start to understand the familial relationship.

Tongue-tie correction is important for adults too. Even though the frenectomy is not done for breastfeeding issues (as it is done in an infant), or to prevent insufficient craniofacial growth and airway issues (as it is done in children), adults should proceed with a release if the lingual restriction is causing difficulty with correct oral lingual rest posture, nasal breathing, swallowing, speech, feeding or sleeping.

When parents hear about “tongue tie” or search on the internet, they most commonly see images where the tip of the tongue is tethered down to the floor of the mouth. Posterior oral restrictions cannot be visualized. With a posterior tongue tie (PTT) the anterior portion of the tongue is not “tied”. It is often not easily seen or identified as most practitioners are not trained to assess it. One of the most common statements from medical professionals is that “posterior tongue tie is not a thing”. Some of this confusion is the result of a misunderstanding of the anatomy and/or assuming that the tie is located in the posterior oral cavity near the tonsils. This is not accurate.

A posterior tongue tie is the presence of abnormal collagen fibers in a submucosal location surrounded by abnormally tight mucous membranes under the front of the tongue. ALL anterior ties have a posterior element. Therefore, any tongue tie causing breastfeeding problems is truly a posterior tongue tie; a percentage of those ties also have an anterior component. Failure to release ALL of the abnormal collagen fibers result in a continued lingual restriction. When providers are only able to release part of the restriction (incomplete release) there can be very limited improvement in tongue mobility and function. I see this all the time in my practice. 

Ideally, lingual restriction is identified and treated in infancy. When a lingual restriction (tongue tie) is not identified or treated during infancy, it can lead to many issues in childhood and well into adulthood.

Most clients have adopted several negative compensations that must be addressed before and after a tongue-tie surgery is performed. 

• Difficulty in swallowing
• Breathing troubles
• Difficulty in chewing and speaking
• Bruxism (teeth grinding)
• Difficulty in moving the jaw
• Gagging, gasping, and choking during feeding 
• Irritability and fussiness

Click here to learn more about tongue tie in babies.

Your dentist may have referred you for speech/myofunctional therapy related to your tongue tie. Your speech pathologist can help to identify the need for the procedures described below. Speech pathologists also provide valuable training around pre- and post procedure exercises  that improve the results of these procedures. The tongue is one of the most critical organs in our bodies as it has the ability to regulate and shape orofacial structure and musculature. Free mobility of the tongue is required for optimal speech, chewing, swallowing, oral hygiene, and breathing functions, as well as for development of the skeletal structures of the jaw and the airway. Because the tongue plays such an important role in so many functions, restricted mobility of the tongue may lead to compensatory behaviors that may negatively affect nasal breathing and cause snoring due to low tongue posture or contribute to chronic stress on the other muscles of the head and neck. The tongue also has connections to the whole body through a system of connective tissue known as fascia, and a restrictive tongue may place tension on the fascia networks causing neck tension, pain, and postural dysfunction.

Your doctor will opt for one of the following procedures:

Quick and simple procedure with CO2 laser that does not require stitches. 

When the frenulum is too thick for a quick snip, your doctor may choose to perform a frenuloplasty.  This usually requires anesthetics and special tools and will require stitches that usually dissolve as the wound heals. Lasers are becoming more prevalent and do not require stitches.
 

Are you concerned that you may have an unidentified oral restriction? Please contact me for more information