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Tongue-Tie: Definition, Symptoms, Risks, and Treatment

Tongue-tie, or ankyloglossia, is a condition where the tissue that connects the bottom of the tongue to the floor of the mouth (the lingual frenulum) is shorter or thicker than usual. A tongue-tie limits movement of the tongue, causing problems in both children and adults.

Tongue-tie is present from birth. In fact, most tongue-ties are identified in babies, particularly babies who breastfeed. However, less severe cases of tongue-tie can be present in adults, where they can cause issues like sleep apnea.

How are tongue ties classified?

There are several ways to classify tongue ties, including the Coryllos I–IV classification system, the Hazelbaker assessment tool for lingual frenulum function (HATLFF) system, or a simple anterior/posterior nomenclature.

The former two classification methods also take the severity of the tongue-tie into consideration. In the most severe cases, the lingual frenulum extends all the way to the tip of the tongue, severely restricting its movement. In mild cases, the tip of the tongue has a freer range of motion.

Tongue-ties are often classified according to how much of the tip of the tongue is unattached. Many dentists and other oral healthcare practitioners will measure the length of the tongue that’s not connected to the frenulum and use that measurement to classify the tongue-tie.

What is the most common type of tongue-tie? The most common type of tongue-tie is an anterior tongue tie, located under the front of the tongue. These tongue-ties are also the easiest to diagnose.

What causes a tongue tie?

Tongue-ties form as babies develop in utero, and they’re present from birth. As the tongue develops embryonically, it’s attached to the inside of the mouth. In most people, these attachments disappear, but they remain in people who have tongue-ties.

Most scientists believe that genetics determine whether a baby has tongue-tie, although research into tongue-tie causes is still ongoing. Tongue-tie may be linked to genes on the X chromosome, which is why it may run in some families.

There’s also some evidence that the fetal environment may affect the development of tongue-ties. For example, babies whose mothers used cocaine during pregnancy were more likely to have tongue-ties than babies whose mothers did not.

Symptoms Of Tongue-Tie

There are several symptoms of tongue-tie, which can vary according to the severity of the tongue-tie and the patient’s age. Symptoms tend to be more disruptive in younger children but can still be serious in some adults.

In Children

Tongue-tie symptoms found in infants include:

  • Difficulty latching and trouble breastfeeding (in babies)
  • Poor weight gain in newborns, particularly breastfed newborns
  • Nipple pain, milk supply issues, and mastitis in breastfeeding mothers

Many feeding problems in babies, including breastfeeding difficulties, are caused by tongue-tie. Breastfeeding problems don’t automatically mean that your child has a tongue-tie. Many other conditions can cause feeding problems in babies, including lip-tie.

Symptoms of an untreated tongue-tie in older children are similar to the symptoms of tongue-tie in adults.

In Adults

What are the symptoms of tongue-tie? The symptoms of tongue-tie in adults are:

  • Trouble swallowing and eating
  • Trouble sticking out the tongue
  • Difficulty touching the tip of the tongue to the outer surfaces of the front teeth
  • Speech issues requiring speech therapy
  • Tooth decay (usually caused because the tongue-tie makes proper oral hygiene difficult)
  • Obstructive sleep apnea

Sleep Apnea And Tongue-Ties

Sleep apnea is one of the biggest problems tongue-ties cause. In fact, many adults with tongue-ties are diagnosed as they’re being treated for sleep apnea.

Tongue-tie can change the anatomy or shape of your airway, making it narrower than it should be. When you sleep, it’s easier for the airway to become blocked, causing obstructive sleep apnea.

Patients with sleep apnea stop breathing for short periods as they sleep, leaving the body and brain without oxygen. That’s why sleep apnea can create a whole host of nasty side effects, including heart disease, poor oral health, cognitive impairment, and more.

Sleep apnea is incredibly dangerous, which is why it’s essential to get a quick diagnosis. In addition to diagnosing you, your dentist or doctor can also help discover why you have sleep apnea, including whether a tongue-tie is the root cause.

Other Complications From Tongue-Ties

Tongue-ties can actually be quite harmful if left without treatment.

The most significant complications from untreated tongue-ties include:

  • Breastfeeding problems
  • Speech difficulties
  • Problems eating and drinking
  • Malocclusions of the teeth

Breastfeeding Problems

Babies with a tongue-tie have trouble breastfeeding because the baby’s tongue can’t extend to create a proper connection to the nipple. Instead, these babies usually use their jaws to latch, leading to a lot of pain for mom and usually a transition to bottle feeding.

Speech Difficulties

People with tongue-ties often have difficulty speaking because the tongue doesn’t have the range of motion it needs for speech. Speech therapists may recommend surgery in some cases if the tongue-tie is severe enough to drastically impact speech.

Problems Eating and Drinking

Tongue-ties may interfere with normal eating and drinking movements. For example, many people with a tongue-tie struggle to lick ice cream off an ice cream cone because they can’t stick their tongue out far enough.

Malocclusions of the Teeth

Some case studies have shown that tongue-tie can change the development and shape of the mouth and jaw, resulting in malocclusion (a poor bite). Malocclusion, in turn, can cause a large host of problems, including dental issues, trouble eating, jaw pain, and sleep apnea.

Diagnosis

Tongue-tie is often caught by lactation consultants, pediatricians, and speech-language pathologists because they are the medical professionals in the best position to notice the symptoms.

For example, it’s easier to notice a tongue-tie on a baby who is struggling to gain weight because they can’t eat properly.

When a lactation consultant or speech-language pathologist believes a patient may have a tongue-tie, they will recommend the patient see their pediatrician, primary care provider, or an otolaryngologist (ENT). These doctors can make a formal diagnosis and make a treatment plan.

Some cases of tongue-tie aren’t as severe and are diagnosed in adulthood. In these cases, the tongue-tie diagnosis usually comes with another diagnosis, like sleep apnea or bite problems. Many of these diagnoses are made by dentists catching what pediatricians missed.

Tongue-Tie Treatment

The primary tongue-tie treatment, a frenotomy, is a relatively simple procedure because the lingual frenulum doesn’t have many nerves or blood vessels. The doctor (typically a dentist, pediatrician, or otolaryngologist) will use sterile scissors to snip the frenulum.

Sometimes a dentist or other healthcare professional will use a laser to cut the frenulum in a frenectomy procedure. The laser cauterizes any blood vessels and nerves in the lingual frenulum, further reducing the risk of pain and bleeding.

Some doctors prefer to use a wait-and-see approach, particularly if the tongue-tie isn’t causing severe symptoms. The lingual frenulum can stretch and lengthen over time, so a frenotomy may not even be necessary in mild-to-moderate cases.

A surgical procedure called frenuloplasty may be necessary in more severe cases. Unlike frenotomies, frenuloplasty is done under general anesthesia. The incisions into the frenulum are closed with sutures that dissolve as the mouth heals.

Tongue exercises are a non-surgical way to treat some tongue-ties. These exercises help lengthen and stretch the lingual frenulum. Over time, you may not even need a frenotomy to treat the tongue-tie.

How do you fix a tongue-tie? You fix a tongue-tie by loosening the lingual frenulum under the tongue, either by cutting it or letting it loosen naturally over time or using special exercises in mild cases.

Statistics On Tongue Ties

Tongue-ties are surprisingly common, and they have a deep impact on the lives of the people who have them.

Here are the statistics on tongue-ties:

  • Tongue-ties affect approximately 4-10% of all children.
  • Males are between 1.5 and 4 times as likely to have a tongue-tie than females, depending on the country studied.
  • Uncorrected tongue-tie affects adults: it causes problems with tongue movement in 57% of study subjects and speech issues in 50% of participants.
  • Mothers of babies with tongue-tie are more likely to have difficulty breastfeeding than mothers of babies without  a tongue-tie, coming in at 25% vs. 3%.

If you have a tongue-tie or think you might have one, you’re not alone! Many people have tongue-ties, and it’s not uncommon for adults to have an undiagnosed tongue-tie. It’s also straightforward to correct most tongue-ties if yours has been affecting you.

We treat tongue ties and mouth breathing.

Although tongue-ties are often diagnosed in children, it’s possible for adults to have them, too. If you have a tongue-tie that’s affecting your oral health or overall health, we can help.

Our team of dental experts will use their decades of experience to diagnose and treat your tongue-tie. They’ll also address any additional problems that may have been caused by the tongue-tie, like sleep apnea, malocclusion, or even mouth breathing.

We can screen you for tongue-tie and get to the root cause of any symptoms you’re currently experiencing. Click here to schedule an appointment at our Manhattan or East Hampton offices and get your tongue-tie treated today.

Sources

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  2. Suter, V. G., & Bornstein, M. M. (2009). Ankyloglossia: facts and myths in diagnosis and treatment. Journal of Periodontology, 80(8), 1204–1219. https://doi.org/10.1902/jop.2009.090086
  3. Kezirian, E. J., Simmons, M., Schwab, R. J., Cistulli, P., Li, K. K., Weaver, E. M., Goldberg, A. N., & Malhotra, A. (2020). Making Sense of the Noise: Toward Rational Treatment for Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 202(11), 1503–1508. https://doi.org/10.1164/rccm.202005-1939PP
  4. Segal, L. M., Stephenson, R., Dawes, M., & Feldman, P. (2007). Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Canadian Family Physician Medecin de Famille Canadien, 53(6), 1027–1033. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949218/
  5. Ballard, J. L., Auer, C. E., & Khoury, J. C. (2002). Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics, 110(5), e63. https://doi.org/10.1542/peds.110.5.e63
  6. Yoon, A. J., Zaghi, S., Ha, S., Law, C. S., Guilleminault, C., & Liu, S. Y. (2017). Ankyloglossia as a risk factor for maxillary hypoplasia and soft palate elongation: A functional – morphological study. Orthodontics & Craniofacial Research, 20(4), 237–244. https://doi.org/10.1111/ocr.12206
  7. Messner, A. H., & Lalakea, M. L. (2000). Ankyloglossia: controversies in management. International Journal of Pediatric Otorhinolaryngology, 54(2-3), 123–131. https://doi.org/10.1016/s0165-5876(00)00359-1
  8. Lalakea, M. L., & Messner, A. H. (2003). Ankyloglossia: the adolescent and adult perspective. Otolaryngology–Head and Neck Surgery, 128(5), 746–752. https://doi.org/10.1016/s0194-5998(03)00258-4
  9. Messner, A. H., Lalakea, M. L., Aby, J., Macmahon, J., & Bair, E. (2000). Ankyloglossia: incidence and associated feeding difficulties. Archives of Otolaryngology–Head & Neck Surgery, 126(1), 36–39. https://doi.org/10.1001/archotol.126.1.36

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