This is a very common appearance of tongue tie in a child. This patient cannot have full movement of the tongue,

This is a very common appearance of tongue tie in a child. This patient cannot have full movement of the tongue.

Tongue-tie (ankyloglossia) is a condition present at birth that restricts the tongue’s range of motion. With tongue-tie, an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth. A person who has tongue-tie might have difficulty sticking out his or her tongue. Tongue-tie can also affect the way a child eats, speaks and swallows, as well as interfere with breast-feeding. Here are four reasons to correct tongue ties and lip ties:

1-Breastfeeding, Bottle Feeding, and Eating Solid Food!

‘Failure to thrive’ is the term used to describe babies who have poor weight gain and are difficult to settle. A baby who does not feed well is likely to fall into this category, and breastfeeding can be complicated by a tongue or lip tie. If the tongue and lips don’t have adequate mobility, the breast won’t be properly stimulated to produce milk, creating a poor supply for the baby. This leads to an ineffective feeding and sleeping cycle for mother and baby, leading to frustration and inevitable shift towards bottle feeding (either breast milk or formula). Formula deprives the baby of sharing maternal immunity from infections in early life. Problems experienced at this time can also cause a weakening in the bonding process when the baby becomes frustrated by unsatisfying attempts to feed, and the mother becomes depressed by what she feels to be a failing on her part.

The need to resort to bottle feeding may have other significant negative consequences, as none of the wide range of bottles and teats available and promoted as being “as good as the breast” fulfils their promise. Also, the sucking patterns required for breastfeeding are different from those used when bottle feeding and can have an undesirable effect on the skeletal structure of the palate. Bottle feeding requires strong piston-like up and down movements of the tongue to compress the nipple. This can cause a high, narrow, arched hard palate, and sometimes encourage a tongue thrust swallow, if the baby uses the tongue as a ‘stop’ to cut down the flow of milk from a nipple with a larger hole. Breastfeeding has the advantage of allowing the soft and hard palates to be moulded into a gentle curve, because the breast istributes pressure over the whole of the palatal region.

Difficulties can also be experienced when attempting to introduce solid foods. The tongue-tied baby will quickly develop poor habits of facial movement, all caused by the inability to move the 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, 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. This entire process creates poor habitual eating, a process which can be very difficult to correct and retrain in later years. Such children often continue to be slow and picky eaters or fast and sloppy eaters who chew poorly, prefer soft foods, or suffer the results of swallowing air while they eat and chewing with their mouths open. Poor tongue mobility can prevent clearing of food off the teeth or lips, and adults with tongue tie may continue to be unable to chew meat or bulky mouthfuls.

2-Cosmetic Appearance

Low lip tie in a newborn just prior to laser correction.

Low lip tie in a newborn just prior to laser correction.

On first seeing a baby with tongue tie, the cosmetic appearance of the tongue and the tie will stand out. The tongue may look small, rounded and indented in the midline with a heart-shaped look. If the frenum does not reach the tip of the tongue this typical heart shape may not be apparent, although function of the tongue may still be significantly impaired.

As the child grows older, the appearance changes and the tongue may look square, split, or thickened and too large for the mouth, so that it curls up at the sides. The tie itself can vary from a thin elastic membrane to a thickened, white non-elastic tissue. The tie or frenum may extend to the tip of the tongue causing notching, or spread along the floor of the mouth in a fan shape reaching towards the incisors and causing discomfort or actual pain on movement.

Excess saliva due to inadequate coordination of swallowing during speech can be seen and heard. Habits of mouth breathing, air-swallowing, and forward tongue position become entrenched, and are easily noticed and less excused in the teenager or adult person. The appearance of both the tie and the tongue generally becomes more conspicuous and even ugly, as the child grows older.

3-Oral Hygiene and Dental Health

Poor oral and dental hygiene because of limitations in tongue mobility or habitual incorrect tongue posture usually accompany messy eating habits, with food debris remaining on teeth and lips, and causing cavities. Commonly, excess saliva is dealt with by the patient in different ways. Whereas the younger child may drool profusely, older patients will mal-adapt, keeping the mouth opening small during speech, reducing the length of speech or slurping loudly during speech or at rest. Involuntary spray of saliva during speech occurs frequently and embarrassingly.

Orthodontic treatment is needed for malocclusions caused by pressure of the tongue on the front teeth during a tongue thrust swallow, or pressure on the lateral teeth because of an unusually wide tongue. In fact, if the tongue tie is not corrected, or the chewing and speech patterns remain poor, any orthodontic correction will most likely fail over time as the poor oral rest and function posture of the tongue continues.

Lip tie occurs most commonly at the middle of the upper or lower lip, but can also happen at the sides of the lip near the premolar teeth. These attachments can prevent proper breastfeeding and facial muscle movements, as well as improper development of the jaws. In addition, lip ties can cause spaces between the teeth and can pull gum tissue away from the tooth surface, risking gum disease, tooth sensitivity, and poor appearance of the teeth as the roots become exposed.

4-Speech

Speech problems occur which are difficult to correct by conventional means because they cannot memorize the correct movements of speech, or be sure of always achieving them. Adults develop methods of speech which mask their difficulties with sounds. Both adults and children often try to speak with a small mouth opening, so that they can make the tongue 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. Being understood while speaking quickly is almost always impossible for a tongue-tied person to achieve. Thus it is seen that many with tongue tie learn to compensate for their limited tongue mobility by adopting changed patterns of movement. Prolonged speech therapy may be minimally helpful at best unless the tongue tie is released.

So, what can be done?

The good news is that correction of tongue and lip ties are easier than ever before with the use of lasers. Naturally, the earlier these are corrected the better, and it ismost efficient to evaluate and correct tongue and lip ties in newborn infants. In most cases, this can be completed in minutes in a dentist’s office with a strong topical anesthetic; the mother in encouraged to nurse the baby immediately after treatment, and to continue to stretch and move the treated area repeatedly over the next two weeks to ensure excellent healing. The discomfort to the baby after treatment is minimal, and Tylenol can be given if desired.

In many cases, especially when breastfeeding is not attempted, tongue and lip ties may only become noticed as the children get older, or even only in adult years.  The same laser correction techniques are used with routine dental anesthetic, a series of stretching exercises are recommended, and the area will feel like a deep burn from hot pizza for a few days. Depending on the age of the patient treated and the location of the “tie”, Myofunctional Therapy may be recommended to teach proper oral rest and function posture, increase tongue mobility and strength, and correct faulty swallow and speech patterns that may have developed over time. Most often, Myofunctional Therapy can be taught by a dentist, dental hygienist, or speech therapist over several months as required.

Dr. Andrea Stevens is a cosmetic and family dentist in practice in Kanata, Ontario. If you have dental questions, you can call her at 613-271-7091 or visit her at drandreastevens.com Please also feel free to leave comments or questions below, and Dr. Stevens will be happy to answer.