A tongue-tie can reduce the range of motion of a person's tongue tip and cause mild or severe symptoms, including problems with speaking, swallowing and chewing. Our dentists in Ottawa can treat tongue-tie with laser surgery.
What is Tongue-Tie?
A tongue-tie (ankyloglossia) is a congenital oral anomaly that can decrease the mobility of a person's tongue tip. The condition is caused by an unusually short, thick lingual frenum — a membrane connecting the underside of the tongue to the floor of the mouth.
While some cases of tongue-tie conditions will be mild, others will be severe in that the tongue will be tethered to the floor of the mouth. These more severe cases can impact speaking, chewing, swallowing and thrust, along with oral hygiene.
They can also lead to open bite deformities. As the child grows, there may also be mechanical and social impacts that reduce quality of life.
For the skull, jaws, and nasal airway to develop properly, the tongue must be properly positioned in the oral cavity and have a normal range of function.
How Does Tongue-Tie Affect Speech?
People with tongue-tie have a distorted sense of the geography of the mouth, due to the tongue's limited range of lingual movements. This causes under-developed oral kinaesthesia, or oral motor development.
As a result, speech problems develop and will be difficult to correct with conventional methods since these individuals cannot memorize the correct movements of speech, or achieve them.
To adapt, adults will develop speech methods to mask these difficulties with sounds. However, they will rarely be successful since these methods are often inefficient or conspicuous.
Speech Challenges & Limitations
Both children and adults with tongue-tie often try to speak with a small oral aperture, so that they can make the lingual contacts required for pronouncing consonants; others speak slowly, softly or loudly.
Nearly all patients past toddler stage are aware of the movements their tongue cannot make. Clarity in rapid speech is almost always impossible for a tongue-tied person to achieve.
Though individual cases vary, some movements will always be difficult or impossible to achieve because of how tightly the lingual frenum is pulled on the floor of the mouth and on the tongue. Other movements can only be achieved by speaking slowly and carefully, concentrating intensely, or with long-term speech therapy.
Types of Tongue-Tie
There are a few different types of tongue-tie. Here is more information about each.
- Tongue-Tie in Babies or Infants
Some babies with tongue-tie have a mild case and are rarely affected. If the condition is severe, the tongue is almost completely attached to the floor of the mouth.
Doctors do not always agree on how to identify tongue-tie, especially if it is mild. Because of this, it is difficult to say how common it is. Some studies have shown that about four percent of babies have tongue-tie. Others found it to be much more common, affecting about 11 percent.
Sometimes the doctor identifies tongue-tie during your baby’s first routine check-up at birth. Your midwife may put her finger in your baby’s mouth to check the roof of his mouth and his tongue. But a tongue-tie is not always easy to spot. It may not be found until later, for example, if your baby has feeding difficulties.
If you and your baby are finding breastfeeding difficult, you can ask your midwife, nurse or doctor to check for tongue-tie.
Breastfeeding is not always easy. So difficulties may have nothing to do with tongue-tie, in which case your midwife, family doctor or lactation consultant should still be able to help you and your baby with feeding.
Many babies with tongue-tie may not have any feeding problems at all. But because the tongue can’t move freely, other babies may:
- Have trouble latching on
- Slip off the breast while feeding
- Not gain weight as expected
- If your baby is struggling to feed because of tongue-tie, this may leave you with painful nipples and a feeling of frustration.
These are common problems early on in breastfeeding, but for most mothers and babies they improve over time. If these troubles last longer than six weeks, it may be a sign that your baby has tongue-tie. Of course, breastfeeding difficulties may not be because of tongue-tie at all.
Difficulties can also be experienced when attempting to introduce solids. The tongue-tied baby will quickly develop strong habits of oromuscular movement, all influenced by his inability to move his tongue correctly.
Thus, accepting the solid food by opening the mouth widely enough to receive the spoon can be affected by a habit of inadequate mouth opening (see breastfeeding), the tongue may not protrude over the gum ridge, instead it will hump at the back of the mouth and push the food out rather than draw it in.
Pureed or solid food must be transferred to the middle, then to the back of the mouth prior to swallowing. The food has to be collected by the tongue into a more compact mass (bolus) so that it all goes down into the oesophagus and is not allowed to be diverted into air passages and cause choking.
A tied tongue may have difficulty in performing the movements needed for dealing with solid food; thus, lateral (sideways) movements of the tongue are often difficult or impossible, tongue protrusion and elevation for accepting food or licking may also be affected.
Time and practice will be needed to learn the movements for dealing with solids, which are different from those used in sucking both on breast and bottle unless the frenum is revised.
When the baby progresses to firmer food requiring chewing, and the bolus of food needs to be moved from side to side, to assist mastication by the jaws, many children with tongue tie will reject food that is difficult to chew, or move it around their mouths with their fingers. Dealing with a variety of solids of different textures may also prove difficult. Habitual gagging, coughing, choking or vomiting is frequently caused by inadequate tongue mobility and coordination while eating.
Such children often continue to be slow picky eaters or fast untidy eaters who chew inadequately, prefer soft foods or suffer the results of aerophagia – swallowing air while they eat. An inability to clear food off the teeth and lips with the tongue is common, and even adults with tongue tie may continue to be unable to chew meat, or masticate bulky mouthfuls.
Adults, though rarely undernourished, are thus often significantly limited in their range of acceptable foods, which can be a social handicap.
- Tongue-Tie in Children
The consequences of an untreated tongue-tie can be many and varied, depending largely on the age of the subject and the severity of the condition. The demands made on us increase as we grow older, and our environment becomes less forgiving of mistakes. Delay in treatment, therefore, can have very negative consequences.
Children with a tongue-tie have to contend with difficulties which may only be discovered as they grow older.
- These difficulties can include:
- Inability to chew age appropriate solid foods
- Gagging, choking or vomiting foods
- Persisting food fads
- Difficulties related to dental hygiene
- Persistence of dribbling
- Delayed development of speech
- Deterioration in speech
- Behaviour problems
- Dental problems starting to appear
- Loss of self confidence because they feel and sound different
- Strong, incorrect habits of compensation being acquired
- Tongue-Tie in Adults
What adults have to contend with is very much the result of old habits of compensation for inadequate tongue mobility. The areas of difficulty spread to include social and domestic situations, self-esteem, the work environment, and dental health. Thus it is seen that the consequences of unrepaired tongue tie do not reduce with time – instead, more difficulties are experienced as time passes.
- Specific challenges include:
- Inability to open the mouth widely affects speech and eating habits.
- Always having to watch their speech
- Inability to speak clearly when talking fast/loud/soft
- Difficulty talking after even moderate amounts of alcohol
- Clicking the jaws
- Pain in the jaws
- Protrusion of the lower jaws, inferior prognathism.
- Multiple effects in work situations.
- Effects on social situations, eating out, kissing, relationships
- Dental health, a tendency to have inflamed gums, and increased need for fillings and extractions
- Sensitivity about personal appearance
- Emotional factors resulting in rising levels of stress
- Tongue tie in the elderly often makes it difficult to keep a denture in place.
Tongue-Tie & Frenectomy FAQs
Here are some of the most frequently asked questions our dentists at Chapman Mills Dental have received from patients about tongue-tie in children and adults.
- What is a frenum or frenulum?
A frenum/frenulum is a fold of tissue in the mouth. Frenua are found between the upper two front teeth, under the tongue, and on the sides of the gums. A frenectomy is a procedure to remove or release one of these folds of tissue.
- What is a frenum used for?
A frenum has no significant purpose aside from securing or restricting the movement of a mobile organ in the body. A frenectomy procedure is performed when a frenum is diagnosed as being too tight or short, too thick, in the wrong place, or otherwise causes problems. In most cases, an oral and maxillofacial surgeon or a specialized dentist performs the surgery.
Some people have a tight frenum under the tongue. This may prevent the tongue from moving freely. The condition is called tongue-tie or ankyloglossia. Tongue-tie may interfere with feeding in infants. Later, it can cause problems as a child learns to talk.
Sometimes a frenum is attached between the upper front teeth (incisors). This may cause problems when a child’s permanent teeth come in around age 6 or 7. The teeth may not be able to come in, or there may be a gap between them.
Less often, a frenum inside the lower lip may pull the gum away from the lower front teeth (incisors). This may result in gum problems such as recession.
A frenum also can interfere with the fit of a denture. This may occur anywhere in the mouth. However, it is seen more often on the sides of either the top or bottom jaw.
- How is tongue-tie treated?
At Chapman Mills Dental, we treat tongue-tie with laser surgery. This method is more precise, safer and less invasive than the traditional method of using scissors.
- Is a frenectomy painful?
While an individual may feel some pain or discomfort following a frenectomy with laser surgery, there will be less pain with this method than with conventional treatment methods.