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Tongue-Ties

Ankyloglossia (AKA tongue-tie) is a condition that restricts the proper range of motion of the tongue by an abnormally short or tight band of tissue called the lingual frenum, and causes the tongue to be anchored to the floor of the mouth. The severity of tongue-ties ranges from mild to severe, and every individual has a different sensitivity to their tongue-tie. The restricted movement of the tongue causes poor muscle function, and can produce a cascade effect of problems throughout a person’s lifetime and effect their overall health, wellbeing, and quality of life.

Identifying Tongue-Ties:

Unfortunately, many providers are not up to date on how to identify tongue-ties unless they are obvious or severe, and even then some don’t believe they are a problem. Sadly this causes a huge number of tongue-ties to be overlooked or untreated, and can result in lifelong consequences.

A myofunctional therapist can help to identify a tongue-tie and oral dysfunction through a comprehensive myofunctional evaluation and functional assessment and guide you though your tongue-tie journey.

Cause of Tongue-Ties:

A tongue-tie arises from the incorrect separation of the tongue from the floor of the mouth, and this typically happens weeks after conception. The tongue and the floor of the mouth start out as one component and as cell division occurs and the embryo grows, they separate. If this separation does not happen correctly or completely, a tongue-tie results.

There is a STRONG hereditary element to tongue-ties. If you have a tongue-tie it is very likely one or both of your parents have one, and that you will pass it on to your children.

Treating Tongue-Ties:

Tongue-ties are treated with a fairly simple procedure called a frenectomy. Not all tongue-ties require a release. It is only indicated if it is negatively affecting correct oral functioning.

If a release is recommended and you choose not to have it done, it is important to understand the long term consequences that may come along with that choice. Over time, the compensations that your body makes to “work around” the affects and symptoms of a tongue-tie will give out, and as we age symptoms usually increase. For some these symptoms become chronic and debilitating and vastly impact quality of life.

Myofunctional Therapy plays a huge role both before and after the release of a tongue-tie. Therapy prepares for the release, ensures proper healing, and restores correct function and habits of the tongue after a release. Below I discuss the importance of choosing the right provider to treat a tongue-tie…THIS IS VERY IMPORTANT TO ENSURE A PROPER RELEASE!

Tongue-tie Symptoms:

In infants, signs of a tongue-tie are usually tied to breastfeeding or eating/digestive concerns. Difficulty latching, messy eating, fussy, gassy, colicky, frequent nursing, reflux, frequent spitting up, frequent falling asleep at the breast, infant weight loss, failure to thrive, mother’s milk supply issues, painful nursing and mastitis.

In children and adults, symptoms may be present in many forms. Often times the individual is unaware that these are “symptoms” because they have been that way their entire life and consider it their normal. Often myofunctional therapy clients are unaware of their symptoms until they complete a comprehensive myofunctional evaluation and begin therapy.

  • Chronic Pain of Head / Neck / Shoulders / Jaw: The tongue is connected to an incredibly large amount of body structures. Because a tongue-tie is a structural problem, it puts increased strain and tension on the entire system, from your head to your toes. Often times tongue-tied individuals have forward head posture because the entire front of their body is being pulled forward and held by the tongue-tie. For every inch your head protrudes forward, an additional 12 pounds of pressure and strain are put on the neck and shoulders. Jaw pain is common in tongue-tied individuals because the tongue is not able to rest properly in the roof of the mouth, which supports the TMJ joints. Repetitive strain is another factor, since the jaw is overworking and compensating for the lack of movement performed by the tongue.
  • Dental Problems: People with tongue-ties are often mouth breathers, which puts them at an increased risk for tooth decay and periodontal disease. The tongue is also unable to cleanse the teeth due to the restrictions of a tongue-tie, so more food and bacteria is left to sit on the oral structures. Additionally, tongue-ties do not allow proper oral rest posture, which plays a major role in the early development of the face and oral structures both laterally (side to side) and forward. This results in craniofacial underdevelopment which leads to tooth crowding, insufficient airway development, forward head posture and structural misalignment and growth of the body.
  • Digestive Problems: Acid reflux, hiccupping, burping, gas and bloating, stomach aches, and choking are all common symptoms of someone with a tongue-tie. Chewing food is a chore with a tongue-tie, and often a person will chew food just enough to be able to swallow it down and experience rapid eating behaviors. This disrupts the digestive process in many ways. Aerophagia (swallowing air when eating and drinking) is also common in tongue-tied individuals and leads to several of the symptoms listed above. This happens because a proper suction and swallow cannot be achieved with a tongue-tie.
  • Food and Texture Aversions: Chewing and swallowing certain textures can be difficult for a person with a tongue-tie. This often leads to avoidance of these particular foods and the person is then labeled a “picky eater”. In adults this usually presents as avoiding foods that are hard to chew such as raw vegetables, salad, meat, etc. In small children transitioning to solids, this may first present as gagging on food and they may then develop aversions.
  • Chronic Ear Infections: A tongue-tie results in improper swallow patterns. A normal swallow assists in the proper draining of the eustachian tubes, so if the swallow is incorrect, fluid builds up in the ears and can lead to chronic ear infections. Many children with tongue-ties suffer from chronic ear infections and end up having tubes placed to help the eustachian tubes drain more effectively.
  • Speech Problems: Children with tongue-ties commonly suffer from delayed speech development because the extra work they have to put in to form speech sounds is exhausting, so they just choose not to do it. Other children will make up their own sounds and words to create speech patterns that are easier for them. Speech challenges can lead to changes in personality and a person may be considered shy, anti-social, or quiet. Others may speak rapidly in an effort to cover up speech errors.

Find the Right Tongue-Tie Release Provider:

NOT ALL RELEASE PROVIDERS ARE CREATED EQUAL. Many providers are able to perform a tongue-tie release, but MOST do not have additional training and knowledge on the proper diagnosis and treatment of tongue-ties. Your location may depend on your access to a good tongue-tie release provider, and you should be prepared and willing to travel for your release. Ask questions and advocate for yourself! Some questions you may ask are:

  • How many tongue-tie releases do you perform each week? (You want someone who has done ALOT of them!)
  • What method do you use? (Laser, scalpel, etc.) Why do you use this method? (They should be able to tell you something about how the wound heals, bleeding severity, etc.)
  • What ages do you work with?
  • Do you give detailed post-operative wound care instructions? (They should! A good provider understands the importance and should have standard protocols!)
  • Do you recommend myofunctional therapy? (Anyone doing quality releases these days should and will recommend myofunctional therapy before and after a release. If they don’t, or act like they don’t know what it is or that it’s not important, find another provider!)

If you are seeking a provider for an infant or very young child, you want to find someone who is experienced with this age group. A release on an infant is not the same as a release on an older child or adult. On this same token, an adult should not see a provider for a release that mostly has experience with small children.

A quality provider will be able to answer all of your questions confidently and easily. They will have wound care management protocols established and understand the significant importance of myofunctional therapy both before and after a release. Some of the best providers will not do a release unless the patient agrees to enter into a myofunctional therapy program, and then receive proof from the therapist that they have begun active therapy.

Myofunctional Therapy and Tongue-Tie Release:

As mentioned above, myofunctional therapy should be a part of every tongue-tie release treatment plan, unless the patient is an infant or very small child. It vastly improves the success of a tongue-tie release.

  • Pre-release: begin building strength and activating muscles of the tongue that have not been utilized due to the restriction, start working on coordination, awareness, and begin working on correct oral rest posture and breathing. A toned and controlled tongue will also provide for a better release and smaller wound.
  • Immediate post-release: post-procedure exercises and stretches are imperative to promote proper healing to prevent re-attachment of tissues.
  • Post-release: very similar to physical therapy after any other surgical procedure, myofunctional therapy aids in rehabilitating and retraining the muscles of the tongue and habituates proper oral rest postures to restore correct oral functions.