Tongue-tie

What is tongue-tie?
Ankyloglossia or tongue-tie is the condition where the tongue is tethered to the floor of the mouth by the frenulum (small fold of tissue under the tongue). This usually results in reduced mobility of the tongue. It is commonly observed that a person with tongue-tie cannot protrude the tongue tip beyond the edge of the lower teeth or touch the area behind the upper front teeth. Sometimes when a person with tongue-tie attempts to stick out the tongue it forms a characteristic “W” shape.

What are the potential effects of tongue-tie?

Speech development: It is important to note that tongue-tie does not necessarily impair speech. Many individuals compensate well and have normal sounding speech. Some individuals may have articulation problems especially when talking very fast.

Dental health: Cavities can occur due to food debris not being removed by the tongue’s action of sweeping the teeth and spreading saliva.

Periodontic disease: Gingivitis (gum disease) can develop for the same reasons stated above.

Oral hygiene: Halitosis (bad breath) may be present due to food debris stuck in the teeth.

Eating and digestion: Some infants with tongue-tie have an extraordinarily difficult time breast feeding. Older children may be messy eaters due to a restricted ability to tidy up inside and outside of their mouths while they are having a meal. Some are unable to circle their lips with their tongues in order to fully lick their lips. In extreme cases poor oral hygiene can lead to digestive complaints.

Oral play: Children in particular may not be able to participate in play routines involving tongue movements and gestures.

Self esteem: It has been noted that older children are often self conscious, embarrassed or resentful about their tongue-tie. The tongue can be unduly obvious or unusual looking in some individuals.

Sexual function: Restricted tongue movements may affect sexual expression.

When should I go see the doctor?
In the newborn period where tongue-tie can limit breast feeding, the problem should be addressed immediately. Your primary care physician will most likely refer you to a pediatric ENT surgeon to have the problem fixed surgically. This procedure is called a frenuloplasty and is usually performed in the operating room under a very short general anesthetic. In older children there is less urgency and it often helps to have a full evaluation by a speech and language pathologist before considering surgery.

Will my child need surgery?
Not every child with tongue-tie needs surgery. It is true that tongue-tie can impact feeding and speech production, however, these problems are usually observed in the more severe cases. Thus, it is important that each child receives a thorough individual assessment and evaluation in order for the most appropriate management strategies to be selected. Many children would benefit from consultation with a pediatric speech and language pathologist. This can help parents make a decision about whether to proceed with surgery. These professionals can also offer important post operative exercises to help improve tongue movement and awareness.