Tongue and Lip Ties

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What is a tongue tie?

A tongue tie, medically referred to as ankyloglossia, is a condition present at birth where a short, tight band of tissue (the lingual frenulum) tethers the bottom of the tongue to the floor of the mouth. This can restrict the tongue’s range of motion and adversely affect various functions, including breastfeeding, speech development, and oral development, as well as leading to difficulties with eating and swallowing. Additionally, a lip tie can coexist with a tongue tie, complicating the situation further. These conditions can impact individuals at any age, presenting different symptoms. If left untreated, a tongue tie can inhibit proper oral and facial development, tongue posture, and even airway health, ultimately affecting overall breathing mechanics. A frenectomy, a surgical procedure to release the frenulum, may be necessary to alleviate these issues.

Why does it matter?

Diagram showing the importance of tongue posture for proper palate development and airway openness.

Tongue posture and airway development go hand in hand

The tongue plays a crucial role in shaping the palate and jaw during early oral development. Ideally, the tongue should rest against the roof of the mouth. However, when a tongue tie is present, this restriction hinders the tongue from reaching the optimal position, resulting in a high, narrow palate that compromises airway health and reduces the space available for nasal breathing. Additionally, poor jaw structure development due to issues like a lip tie can lead to a crowded oral cavity and airway.

Close-up of a baby's nose and mouth with soft skin details.

Mouth Breathing and Sleep Apnea

A tongue-tie can significantly impact airway health in various ways, particularly regarding oral development, tongue posture, and overall breathing mechanics. Here’s how the two are connected:

Obstructive Sleep Apnea (OSA): This condition involves repeated episodes where breathing stops during sleep due to upper airway obstruction. A tongue-tie can contribute to this by reducing tongue mobility, which may lead to airway collapse during sleep.

Snoring: The inability to properly position the tongue, often due to a tongue tie or even a lip tie, can result in vibrations in the throat during sleep, causing snoring. In some cases, a frenectomy may be recommended to improve tongue mobility and enhance airway health.

Close-up of a child's open mouth showing a missing front tooth.

Impact on Jaw and Facial Development

Underdeveloped jaws can impact airway health, as restricted tongue movement may prevent the lower jaw from growing forward properly. This can lead to a retruded mandible, positioning the lower jaw backward and further narrowing the airway. Additionally, malocclusion, or bite issues caused by misalignment of the teeth and jaws, can exacerbate breathing problems. Addressing these issues through interventions like a frenectomy can promote better oral development and alleviate conditions such as tongue tie or lip tie.

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Oral Function and Breathing Efficiency

Dysfunctional swallowing can occur due to a tongue tie, leading to an abnormal swallowing pattern where the tongue fails to properly seal the airway. This situation may result in tongue thrusting, which can further distort the palate and negatively impact airway health. In more severe cases, improper tongue function associated with a tongue tie can lead to compensatory movements that affect the throat and airway, straining the muscles involved in breathing, ultimately impacting oral development. A frenectomy may be necessary to correct these issues, especially if there is also a lip tie present.

Close-up of an open mouth showing the throat and tongue.

Tonsil and Adenoid Hypertrophy

Children with tongue tie are more likely to become chronic mouth breathers, which can negatively impact their airway health. This condition may lead to enlarged tonsils and adenoids, further obstructing the airway and contributing to issues like sleep-disordered breathing. Addressing tongue tie and considering a frenectomy can be crucial for proper oral development and overall health.

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Sleep and Behavioral Concerns

In children, restricted airway health due to tongue tie can lead to poor-quality sleep. This condition is often linked to fatigue during the day, behavioral issues resembling ADHD symptoms, and difficulties with attention and learning in school. Addressing tongue tie through procedures like frenectomy can significantly improve oral development and overall well-being.

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What are the symptoms to be aware of in infants?

Some of the symptoms related to airway health include difficulty nursing, which can be quite painful for mom, poor weight gain, an increased need to nurse constantly, blisters on the lip, or signs of colic and fussiness. Additionally, issues like tongue tie or lip tie may contribute to these symptoms, making a thorough evaluation necessary to assess oral development and determine if a frenectomy is needed.

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What are the symptoms to be aware of in children/adults?

Symptoms often include challenges with speech, swallowing issues such as gagging, choking, or vomiting, mouth breathing both day and night, tonsil enlargement or chronic sore throat, and recurrent infections in the upper respiratory system. These issues may also indicate problems with airway health and can be linked to restrictions in jaw growth and oral development. Additional symptoms include maligned teeth, a narrow arch, a high palate, bedwetting, thumb sucking or prolonged pacifier use, snoring, and obstructive sleep apnea. Children may experience restless sleep with frequent awakenings, excessive daytime tiredness, teeth grinding, and behavioral problems or an inability to focus. In some cases, a frenectomy may be necessary to address conditions like tongue tie or lip tie that can impact overall health.

Close-up of a child's mouth with dental gloves lifting the upper lip, showing teeth and frenulum.

When should something be done?

Early intervention is key for promoting airway health. Surgical intervention, such as a frenectomy, is most beneficial when performed at a young age to prevent a range of developmental issues related to lip tie and tongue tie. Completing a frenectomy during the infant stage helps prevent the child and adult symptoms associated with these conditions.

Intervention includes myofunctional therapy, also known as physical therapy for the tongue, both before and after the release. For infants, we recommend bodywork to support oral development, such as craniosacral therapy, chiropractic care, myofascial therapy, or massage. Children and adults also need myofunctional therapy before and after the release to ensure optimal airway health.

How do we treat it?

Illustration showing a dental tool used inside the mouth and throat.

All diagnoses are made after a thorough exam and consultation. If a tongue tie (and lip tie) release is recommended, treatment options may include a simple surgical procedure called a frenectomy, which involves releasing the frenulum to improve airway health and allow for better oral development. In addition to the frenectomy, myofunctional therapy is crucial to the success of the release.

We use a state-of-the-art Light Scalpel CO₂ laser, specifically designed for this procedure. The CO₂ laser is considered an excellent tool for tongue tie releases for several key reasons:

1. Precision: The CO₂ laser offers precise releases, allowing the doctor to target only the restricted lingual frenulum without damaging surrounding tissues. This precision minimizes the risk of complications and promotes a more effective release of the tongue tie.

2. Minimal Bleeding: The laser cauterizes blood vessels as it cuts, leading to significantly less bleeding compared to traditional methods using scissors or a scalpel. This is especially beneficial for infants, as they have smaller, more delicate tissues.

3. Reduced Pain: Because the CO₂ laser seals nerve endings and blood vessels as it works, there is often less post-operative pain compared to conventional surgical methods. This can result in a more comfortable experience for the patient, particularly for babies and young children.

4. Faster Healing: Laser procedures typically lead to quicker healing times. The laser’s ability to promote coagulation and minimize tissue trauma helps reduce swelling and inflammation, which speeds up the recovery process.

5. Lower Risk of Infection: The CO₂ laser sterilizes the area as it works, reducing the risk of post-operative infection. This is an important advantage in procedures performed in the mouth, where bacteria are abundant.

6. No Need for Sutures: In many cases, the CO₂ laser doesn't require sutures because the laser closes small blood vessels and tissues as it cuts. This means fewer follow-up procedures and less discomfort during healing.

Overall, the CO₂ laser offers a safe, effective, and relatively pain-free method for tongue tie release, with advantages in terms of precision, reduced complications, and faster recovery, all contributing positively to overall oral development.