Tongue/lip tie is a inherited condition (oral anomaly) characterised by a limited tongue movement due to a short or too thick band which attaches the tongue to the lower jaw (lingual frenulum).
The extent to which tongue tie causes clinical symptoms have long been a subject of controversy. Some practitioners believe that no ill effect will result however more practitioners are now thinking that limited movement may contribute to feeding, speech, jaw development and mechanical problems.
What is tongue tie?
The incidence of tongue tie in adolescents and adults, and their frequency, have traditionally been overlooked. Mechanical (non-speech-related) symptoms and social concerns due to impaired tongue mobility are common and may not become apparent until later in childhood. Tongue tie is not just about being able to suckle as a child. Ankyloglossia symptoms should be taken into account, and looked for in every assessment of jaw development and functional problems.
Why does a tongue tie matter?
Tongue-ties can contribute to lowered tongue posture and have now been identified as a risk factor for obstructive sleep apnoea. It is very difficult to identify and quantify level of the tongue tie present and many criteria exists, and due to this confusion, a lot of practitioners try and stay away from the diagnosis as part of the bigger picture.
Also with the lower tongue position and the resulting lower jaw position, migraines, chronic headaches and neck tension has also been reported to improve when the tongue restriction is released.
For this reason, it is imperative to bring children as young as 2 months in for an assessment to correct any issues and ensure healthy development.
We believe that the tongue is to live in the roof of the mouth if proper growth of the top jaw is to happen due to the 2000 times we swallow a day. With tongue tie we may also find more tongue thrust on swallowing and a open bite in the front teeth as a result. Alternatively, the restricted tongue does not apply pressure on the spot on the roof of the mouth and stimulate proper forward and sideways growth of the upper jaw that is needed to fit all our teeth into the bone.
How is tongue tie treated?
Assessing tongue mobilityNormal tongue movements help to spread out the roof of the mouth and widen the jaw, allowing for adequate room for teeth. When this spreading of the palate doesn’t happen the way, it should it can lead to a lot of problems with a child’s teeth. We assess the mobility of the tongue and may prescribe tongue exercise in order to stretch the tongue tie but in some cases surgical intervention may be required in conjunction to tongue exercises. The exercises are important in the healing process after the surgery in order to limit the scarring and further limiting of the tongue movement after healing
We can identify tongue tie by assessing whether the following conditions exist.
- The tongue can’t poke out past the lips
- The tongue tip can’t touch the roof of the mouth and be sucked into the roof of the mouth entirely
- The tongue can’t be moved sideways to the corners of the mouth
- The tongue tip may look notched or heart-shaped
Tongue tie symptoms
Traditionally the only criteria used was to assess if a child can suckle and if speech problems exists but we looks at more than this including the following:
- Feeding difficulty: Breastfeeding, bottle feeding as well as solids
- Poor chewing and swallowing
- Food gulped down with drinks or water
- Food debris is often left around the mouth and easily aspirated resulting in coughing – often causing respiratory problems in babies, kids and adults
- Apparenthyper-salivation or dribbling – as a result of ineffective swallowing
- Regurgitation/gastrointestinal refluxcausing heartburn
- Oral hygiene, dental health and dentition can be affected
- Tongue thrust causing an open bite
- Speech impairment
- Lowered tongue position causing developing of the mandible and underdevelopment of the maxilla due to the wrong swallowing pattern
- Mandibular or bony growths the lower jaw on the tongue side are also frequently found in patients with the tongue tie, pushing the tongue even further back affecting the airways
- Self-esteem and self-image issues due frustration of tongue tie with behavioural problems: messy table manners, slow eating habits, over sensitivity to texture of foods, and splashing when talking.
Tongue tie pictures
What is lip tie?
Lip tie restricts the lip movement and can have an effect on speech however the biggest effect is the pushing apart of the upper teeth creating a gap.
Lip tie treatment
We all have this band that connects the lip to the bone but some are over pronounced and these sometimes need to be released with surgery.
We teach the exercise to stretch the tongue and in some cases, this can be achieved sufficiently. If surgery is needed we still do the exercises before the surgery and then do the surgery in house under local anaesthetic but can refer out for a general anaesthetic. The procedure is relatively straight forward and with few complications.
The recovery can take 2-10 days with minor discomfort – relieved by painkillers. It is recommended to have tongue exercises or speech therapy immediately post surgery to heal with more midget scar tissue.