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Let's Talk About Tongue -Tie | Dr. Mark Breiner

December, 2018

What does it mean to be tongue-tied?

The more scientific name is ankyloglossia, and it refers to the tongue being tied or tethered to the floor of your mouth by a band of tissue called a frenum. The frenum may attach midway to the tongue or in extreme cases attach all the way forward to the tip. The significance of being tongue-tied is the resulting lack of mobility. Depending on how taut the frenum is and where it attaches onto the tongue determines the severity. The tongue begins to form in the embryonic stage at weeks 4 to 5. By about week 9 the tongue is supposed to start separating from the floor of the mouth. When there is an incomplete separation of tissue from the mouth floor ankyloglossia occurs.

Should I be concerned about myself or my child being tongue-tied?

This should definitely be a concern, especially if you are a parent or plan on becoming one. It is essential to be aware if a newborn has this problem for many reasons. Improper feeding may be an early consequence. Often babies with tongue-tie cannot properly latch onto a mother’s nipple. This results in a number of potential problems. If the baby is not gaining weight or the mother’s nipples are sore or cracked, or mastitis is present, make sure to check if the baby is tongue-tied. Have a lactation specialist perform the exam because they are often better than a pediatrician for evaluating this problem. Some other signs of potential tongue-tie problems for the baby are bloating, burping, hiccups, reflux, and milk leakage, as well as an unhappy baby.

If this issue is not addressed at the outset, besides feeding problems, a “snowball” starts rolling. The normal position of the tongue, when at rest, is just touching the roof of the mouth (palate). The tip of the tongue should be resting on the tissue just behind the upper front teeth. When the tongue lacks the mobility to do this, it lies on the floor the mouth. The significant ramifications of this are critical. The tongue is a great orthodontic instrument. When it touches the palate, it helps the palate to develop a proper shape in both width and height. When the tongue sits on the floor of the mouth, the palate becomes constricted in width development, and the arch becomes very high. Constriction of the upper jaw affects the lower jaw development, and orthodontic treatment is on the horizon. Also, with the constricted tongue space, the tongue is often forced backward thus reducing the airway space. Remember, the roof of the mouth is the floor of the sinus and the nose. Sinus problems and a deviated septum can be a result of insufficient development of the upper jaw.

When the face develops harmoniously, it is divided into equal parts, an upper third, a middle third, and a lower third. If the tongue improperly lays on the floor of the mouth and pushes on the lower front teeth, this may result in abnormal growth of the lower jaw resulting in the bottom third section of the face becoming larger. More often what happens is the mid-face does not fully develop, the cheekbones won't be as prominent, the upper lip area will be flatter, and the nose won't attain its full growth potential, with the nares being constricted. Often dark circles form under the eyes due to venous congestion. Breathing through the mouth rather than through the nose takes place. Breathing through the nose has certain advantages; the air is warmed and moisturized as it passes through the nasal passages. Also, nitric oxide is produced in the nasal passages helping to kill bacteria, viruses, and mold. Breathing through the mouth often causes the tonsils to enlarge.

Weak facial structures and reduced oral cavity size can cause the tongue to reduce the airway size leading to sleep breathing disorders which are being recognized as a problem for a lot of adults and children (see Sleep Breathing Disorders).

Abnormal swallow patterns develop which cause imbalances in the oral-facial muscles and can even contribute to neck aches. The tongue is a large organ and connects to various muscle groups; thus, the tongue can have an impact beyond the floor of the mouth. One adult patient noted after having the tongue released that he could stand up straighter because now his head could go back into a more proper position. Ankyloglossia can also cause problems with the enunciation of words.

After having a tongue tie released, it is essential during the healing stage to do tongue exercises, so reattachment does not occur. Training for proper swallowing, breathing and tongue position will help prevent relapse of orthodontic treatment.

As you can see, many poor outcomes can be attributed to ankyloglossia. Optimally, the problem is best addressed at the time of birth or shortly thereafter. By age four, 60% of the adult face is formed.

The release of the frenum is not a huge procedure, especially in an infant. Some nurses have told me that they will use a sharp fingernail to release the tongue in the newborn! Some practitioners use scissors, scalpel, electrosurgery or a laser to release the frenum. With the laser there is minimal bleeding, less chance of scarring and pain is minimal.

I hope this brief discussion will have made you aware of how important it is to address the issue of ankyloglossia at an early age.

© 2018, Mark A. Breiner, DDS 

The information presented is for educational purposes only. Please consult a qualified dentist or health practitioner for diagnosis and treatment.