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What Is Tongue-Tie?

Updated: Apr 3

baby with pacifier standing in crib

What Is Tongue-Tie?

What is Tongue-Tie? A tongue-tie is when the lingual frenulum is abnormally short and restricts the movement of the tongue. The lingual frenulum connects the floor of the mouth, where the tongue sits, to the top of the mouth. The frenulum allows the tongue to move from side to side. When the tongue is tied, it’s unable to move freely. This can affect the child’s ability to breastfeed, eat, and talk. While a tongue-tie affects children, it can also affect adults.

Symptoms Of Tongue Tie

The symptoms of ties oftentimes present in infancy. Ties can cause issues in breastfeeding for both mother and child. If a breastfeeding infant has trouble latching, chews excessively, isn’t gaining weight as expected, fusses while feeding, or makes clicking noises, they could have tongue tie. Tongue tie also oftentimes presents alongside lip tie, but we’ll save that one for another post.

In older patients, these ties are most commonly diagnosed because of its impact on speech patterns. Myofunctional therapy can play a large role in rectifying these speech problems – we’ll get to that shortly.

Classifying Tongue-Ties

There are four classes of ties. While class 1 is the most noticeable and severe, all classes of ties can cause problems – it just depends on the individual circumstances of the case. In a class 1 tie, the lingual frenulum is attached far forward, almost to the tip of the tongue. Class 2 and 3 tongue ties attach progressively further back on the tongue, but can still be seen by lifting the tongue. Class 1-3 tongue ties are known as anterior ties, while a class 4 tie is called a posterior tie.

In a class 4 tongue tie, the connection point of the lingual frenulum may be submucosal, meaning beneath the mucus membrane. This class of tie must be diagnosed by feel rather than by sight. Babies with class 4 tongue ties are sometimes misdiagnosed as having a short tongue, since the lingual frenulum cannot readily be seen.

Why does It Seem Like We’re Seeing More And More Cases Of Tongue Tie?

Babies have been born with tongue ties for a very long time. In the old days, many midwives used to keep one sharp fingernail so they could correct tongue ties at birth. However, when bottle feeding began to gain widespread popularity around the middle of the twentieth century – oftentimes because it was promoted by doctors as a superior alternative to breastfeeding – fewer tongue ties were diagnosed in infants because they weren’t being breastfed. Now that science has come around again to promoting breastfeeding over bottle feeding, we are once again seeing many cases of tongue tie getting diagnosed in infants.

How Is Tongue-Tie Treated?

Tongue-tie can be treated by frenectomy. A frenectomy is a minor dental procedure that removes the tissue that connects the tongue to the floor of the mouth. Doing so can resolve issues with breastfeeding and speech development.

In tongue tie cases where surgical intervention is required to restore proper function and range of motion of the tongue, the key question is this: what is the smallest possible revision a surgeon can make to achieve the desired result? This is important to consider because the less tissue has to be revised, the faster the patients recovery will generally be, and the less pain they will generally experience. Historically, if the lingual frenulum was causing any problems, doctors would perform a large revision. This usually solves the problem, but it’s a bit like going after a cockroach with a sledgehammer. Any modern, researched performer of frenuloplasty will only perform the surgery when absolutely necessary, and only revise the minimum possible amount of frenulum to achieve the desired result.

When Does Tongue-Tie Require Treatment?

Tongue-tie can cause a number of problems with breastfeeding and feeding. The severity of symptoms can range based on the degree of tongue-tie.

When the frenulum is large and restricts tongue movement, breastfeeding can cause pain. The baby may find it hard to draw milk from the breast, which can cause them to become frustrated and fall asleep at the breast. Additionally, the restricted tongue movement can lead to poor latch on the breast. The baby may gag or pull off the breast.

Here is a list of conditions related to tongue-tie:

  • Breast-feeding requires a baby to keep their tongue over the lower gum while sucking. If the baby is unable to keep the tongue in the correct position. This interferes with the baby’s ability to drink. Poor breast-feeding can lead to inadequate nutrition and failure to thrive.

  • Sleep apnea has been linked to tongue-tie.

  • Tongue-tie can interfere with the speech.

  • TMJ disorder, headaches and backaches have been associated with tongue-tie.

  • Tongue-tie can interfere with “licking” functions such as eating a lollypop or playing a wind instrument.

  • The tongue “posture” can become out of alignment.

How many times when you were growing up did you hear your mom or dad say “sit up straight” or “stand up straight”?  Ensuring proper tongue posture goes a long way to maintaining oral health just like standing up straight goes a long way to maintaining correct posture.

Proper posture is when the teeth are together, the lips seal and the tongue rests gently against the palate.  People who have good posture breathe correctly, in and out through their nose. People who have tongue-tie tend to “gulp” air and breath in and out through their mouth. A person with tongue-tie is also more likely to develop a sleep disorder because their airways can’t remain opening while asleep.

For infants, having a tongue-tie corrected may increase the ability to breastfeed, enabling all the benefits that come from nursing.

For adults, having a Functional Frenuloplasty procedure is almost an instant release of tension, with many patience reporting relief from chronic pain. 

Sometimes just the frenuloplasty procedure is not enough. People who have been living with a tongue-tie may need to address the negative habits that have developed over a lifetime. Combining frenuloplasty with myofunctional therapy treatment has been proven to be very successful in restoring oral health. 

Functional Frenuloplasty And Myofunctional Therapy

While tongue tie has occurred in humans in humans as far back as we’re aware, and even frenuloplasty has been around for generations, myofunctional therapy is a relatively new field by comparison. While the treatment for tongue tie is nearly always surgical, myofunctional therapy still has an important role to play in these cases.

After the frenulum has been appropriately revised, the next step is to get the patient into myofunctional therapy. First of all, this will help accelerate their recovery. But, more importantly, the muscles and structures of the mouth need to be retrained. They’ve become accustomed to the pre-surgical condition of the mouth, which means they essentially need to be taught new patterns of functional movement. This is particularly true in older patients whose speech was affected by the tongue tie. Under the guidance of a myofunctional therapist, a simple routine of exercises can strengthen and retrain the muscles of the tongue, face, and jaw to speed recovery and ensure proper post-surgical function.

How A Tongue-Tie Affects Adults

How a tongue-tie affects adults and its contributing factor to other medical conditions. The tongue has many duties. Duties that include assisting with breathing, chewing, swallowing, facial development, speech and digestion. 

If a tongue-tie remains untreated it impacts the whole body creating stiffness and tightness. The four muscles, located above the hyoid bone in the neck, are no exception. When these muscles become stiff headaches, neck aches, shoulder pain and poor posture can develop.

The muscles in the jaw, when taut, can force the jaw backwards and downwards, creating TMJ issues.

A tight jaw muscle can also restrict air flow. This can be a huge problem at night. Without a clear airway normal breathing can’t happen, resulting in sleep apnea and loud snoring. During the day, it lends itself towards mouth breathing.  

Another condition in adults from a tongue-tie is speech problems. For example; mumbling and talking softly or finding yourself with a gravelly voice or sore throat by the end of the day. 

Did you know 1 in 4 adults are affected by indigestion? A healthy tongue will move food from side to side, ensuring it is properly broken down and easily digested. When movement of the tongue is restricted the food doesn’t get swapped from side to side. We end up swallowing unchewed food which is hard on the stomach.  

Do You Have A “Hidden” Tongue Tie

Do you have a “hidden” or what dentists refer to as a posterior tongue tie? A posterior tongue tie is when the band of tissue causing the tongue tie is found toward the back of the mouth and further under the tongue.  

Anterior tongue ties, which are more common and easier to diagnose, are in the front of the mouth near the gumline but a posterior tongue tie is deeper in the mouth and can be hidden by mucous membranes.  This makes it harder to identify and why it has been dubbed a “hidden” tongue tie.

In fact, some cases may not be visible at all, even when the whole tongue is lifted and the entire lingual frenulum is visible.

Signs of a Hidden Tongue Tie  

If you suspect you or your child has a posterior tongue tie, set up a consultation with a dentist who specializes in tethered oral tissues like Dr. Snyder in Albuquerque, NM.  A dentist can give you a conclusive diagnosis to ensure that you or your child gets the best treatment to correct the tongue tie.

Here is a List of Possible Symptoms:

  • Difficulty breastfeeding

  • Speech impairment

  • Excessive drooling

  • A square, heart shaped, or indented tongue shape the tongue is stuck out

  • Messy eating

  • An open bite

  • Colic

  • Over-use of the lips

  • Swallowing

How Do You Treat a Tongue Tie?

The most common treatment for a posterior or hidden tongue ties is a surgery called a lingual frenuloplasty. Dr. Snyder’s technique for lingual frenuloplasty is based on precision; releasing the appropriate amount of tissue for maximal relief – not too much, and not too little.

Alongside surgery, Dr. Snyder integrates myofunctional therapy, and sometimes craniosacral therapy, both before, during, and after surgery.

Addressing the compensatory muscular and joint tension through manual therapy can significantly help optimize rehabilitation in cases of tongue tie.

Take The Tongue-Tie Quiz

  • Do you snore?

  • Do you stop breathing while sleeping?

  • Do you feel rested after a night’s sleep?

  • Do you have pain in your neck and shoulders?

  • Is your mouth opened during the day?

  • Can your tongue reach its palate when your mouth is wide open?

  • Do you grind your teeth?

  • Do you get sore throats?

  • Do you have frequent headaches?

  • Do you have acid reflux?

  • Do you have trouble swallowing?

If you’ve answered yes to these questions it’s a good bet you have a tongue-tie. Myofunctional therapy is a program used to correct the improper function of the tongue and facial muscles. Myofunctional therapy involves strengthening the tongue and orofacial muscles by teaching individuals how to reposition muscles to the appropriate posture.

What Are The Benefits Of Having Surgery For Tongue Tie?

Tongue tie has been linked to:

  • Several sleep conditions such as snoring and sleep apnea.  

  • Mouth breathing. There is a reason we breathe through our nose.  The nose filters, moisturizes and humidifies the air before it enters the lungs. Mouth breathing skips this entire process. 

  • Dental issues. Did you know our tongues help keep your teeth clean? It also encourages saliva production, which neutralizes the acids in the mouth so that they don’t damage the enamel on the teeth.  Restricted range of motion due to a tongue tie might mean more decay and cavities, especially to the molars. 

What Should You Expect After Tongue Tie Surgery?

You may experience:

  • Some bleeding

  • Swelling

  • Soreness 

Let your doctor know if any of the symptoms are severe.  Typical recovery time is about one week.

To find out more about the dental services offered by our dentist in Albuquerque NM, Dr. Snyder, call (505)-293-7611, schedule an online consultation or visit us at 4830 Juan Tabo Blvd. NE, Ste. K, Albuquerque, NM, 87111.



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