Mouth breathing? Headaches? Neck/shoulder tension? Eating, sleep, digestive issues? Infant having difficulty with nursing, bottles, and/or transitioning to solids? Speech issues? All of these, and more, are possible signs and symptoms of a tongue tie.
In dental hygiene school we learned about ankyloglossia–the tip of the tongue being attached to the floor of the mouth (AKA: a tongue tie). It was a topic we spent very little time on. In fact, we probably learned the word, saw a picture similar to this one, and moved on.
When we went through our myofunctional therapy mentorship, we spent weeks learning about tongue ties. We started noticing some form of a “tongue tie” in our hygiene patients on a daily basis.
Everyone has a band of connective tissue attaching the underside of the tongue to the floor of the mouth. It’s called the lingual frenum. On some people, the lingual frenum is tight and restrictive. When there is any restriction (seen or unseen) of the tongue’s ideal ability to move and function, it is referred to as a tongue tie.
Some tongue ties are obvious–the tongue might not be able to stick outside of the mouth, lift up at all, and/or is visibly “stuck” to the floor of the mouth. Other tongue ties are very difficult to determine. The tongue might have great movement and the frenum visually look fine, but the tightness and restriction can still be present further back. Sometimes a tongue tie isn’t even determined until myofunctional therapy has begun and the therapist realizes that the client is unable to do some of the exercises.
Both obvious and non obvious tongue ties can cause a multitude of health issues.
Some symptoms or health issues of a tongue tie begin at birth while others may not show up until later in life. Generally, the symptoms will worsen as one gets older.
Infants: For infants, a tongue tie can cause mouth breathing, low tongue rest posture, and difficulties with feeding–especially breast feeding but also bottle feeding and transitioning to solids. It can lead to underdevelopment of the jaw as they grow and also cause a tongue thrust swallowing pattern. This can lead to digestive issues. Most of the symptoms experienced by an infant will worsen as the child gets older, and into adulthood. Evaluating for a tongue tie is one of many reasons to go to the dentist by age 1, or when the first tooth erupts (Age of 1st Dental Visit and Why). Depending on the child’s age, and the severity of the tongue tie, a release procedure might be recommended right away or when the child gets older. It is important to note that not all dental providers will look for a tongue tie or may only be looking for the very obvious/severe type.
Children: For children, the obvious effects of a tongue tie are feeding issues and speech issues. It can also cause mouth breathing, low tongue rest posture, poor sleep quality, underdevelopment of the jaw, and a tongue thrust swallowing pattern. Kids with a tongue tie are also at increased risk for cavities.
Adults: Adults with a tongue tie often have an underdeveloped jaw. This leads to crowding issues, a smaller airway, a smaller nasal cavity, and a lack of space for the tongue. These adults usually have airway issues, especially when sleeping. Sleep issues include upper airway resistance syndrome, snoring, sleep apnea, or other forms of sleep disordered breathing. Adults with a tongue tie are also at increased risk for cavities, periodontal disease, headaches, jaw pain, digestive issues, and neck/shoulder tension.
Click here for a list version of symptoms.
Wonder if you have a tongue tie?
Having an evaluation by a myofunctional therapist is a good place to start to determine if someone has a tongue tie. The range of motion, strength, coordination, and visual appearance of the tongue will be evaluated, and symptoms will be discussed. If the tongue tie is determined to be restrictive and/or causing symptoms, a release procedure will be recommended. It is important to have a release procedure done by a skilled and knowledgable provider as there is a difference in the type of release provided and therefore the results from it. A myofunctional therapist can help you find the right provider for your release procedure.
Myofunctional therapy is key to getting the most benefit from a release procedure for kids age 5 and up. The therapy should be started at least 6 weeks before the procedure and the myofunctional therapist will help determine when the client is ready for the procedure. The pre-release exercises focus on tongue placement and nasal breathing, along with bringing the muscles to their best functioning ability with the restriction. These exercises help the release provider know how much needs released and decreases bleeding during the procedure. The post-release exercises promote adequate healing and help get the most improvement from the release. The muscles need to be trained to function with more range of motion. Therapy will likely continue many weeks or even months after the release procedure, and end when the 4 goals of myofunctional therapy have been met.
Infants and young children cannot participate in myofunctional therapy because it requires being able to follow directions. The parents of an infant having a tongue tie release procedure should be given exercises/stretches to do with the infant for many weeks after the procedure to ensure the best results. Kids that are too old to have parents successfully be able to do the post release stretches, but are not old enough to do myofunctional therapy, may be advised to hold off on the release procedure until myofunctional therapy can be accomplished.
The release procedure may be referred to as a:
Frenotomy: a small clip–usually done for infants
Frenectomy or Frenulectomy: a small removal of tissue–done for all ages
Functional Frenuloplasty or Functional Release: A removal of tissue and muscle fibers, with special consideration to function. To remove the tight tissue, a laser or scissors (or both) may be used. Sutures are generally placed after this type of a release. Myofunctional therapy is always required for this type of release. While other methods can give favorable results, this technique has been known to give some of the best functional results. This technique is ideal for adults or children that can participate in myofunctional therapy and sit through a longer procedure.
Providers offering a traditional frenectomy may not have had much, or any, additional training on tongue ties. Providers offering functional releases likely had specialized training in addition to their standard professional training.
Contact us if you have questions about tongue ties or want to schedule an evaluation. Also, check out Hannah’s story where she shares her own myofunctional therapy journey–which includes realizing she had a non-obvious tongue tie and had a functional release procedure.
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