Tongue Tie and Lip Tie Treatment
What is Tongue Tie (Ankyloglossia)?
Tongue tie, medically known as ankyloglossia, is a condition where the lingual frenulum (the tissue connecting the tongue to the floor of the mouth) is short or tight, which may restrict tongue movement. This restriction can affect various oral functions including feeding in infants, speech development, and other oral activities.
Tongue tie occurs in approximately 4-11% of newborns, with varying levels of severity. Some cases may cause functional difficulties whilst others may not require treatment.
Why Early Assessment Matters
In some cases, tongue tie can affect:
- Infant nutrition and weight gain
- Speech development
- Jaw growth and dental alignment
- Breathing patterns
- Swallowing mechanics
- Overall quality of life
However, not all cases of tongue tie cause functional problems or require treatment. Assessment helps determine whether tongue tie is contributing to difficulties and whether treatment is appropriate.
Signs and Symptoms by Age Group
In Infants
- Poor latch during breastfeeding
- Inability to sustain a latch
- Extended nursing sessions
- Clicking sounds while feeding
- Milk leakage during nursing
- Falling asleep at the breast before satiation
- Colic and excessive gassiness
- Reflux symptoms
- Poor weight gain despite frequent feeding
Visible Signs
- Heart-shaped or notched tongue tip when extended
- Inability to move tongue sideways or extend beyond lips
- Flat or square tongue tip instead of pointed
- Restricted upper lip movement (in cases of lip tie)
- Gap between front teeth
Maternal Symptoms
- Pain during breastfeeding
- Decreased milk supply
- Nipple damage or mastitis
- Early weaning due to difficulties
In Children
Eating Challenges
- Difficulty chewing age-appropriate foods
- Gagging, choking, or vomiting during meals
- Persistent food selectivity or “picky eating”
- Messy eating habits
Speech Issues
- Delayed speech development
- Difficulty with specific sounds (T, D, L, R, S, Z)
- Unclear speech, especially when speaking quickly
- Frustration when trying to communicate
Other Manifestations
- Persistent drooling
- Dental problems (cavities, misalignment)
- Decreased self-confidence
- Mouth breathing and snoring
- Difficulties with oral hygiene
In Adolescents and Adults
Functional Limitations
- Restricted mouth opening
- Jaw pain or clicking (TMJ issues)
- Migraines and tension headaches
- Neck and shoulder pain related to compensatory postures
Social and Professional Impact
- Self-consciousness about speech or appearance
- Need to constantly monitor speech in professional settings
- Difficulty with clear articulation when tired or after minimal alcohol
- Impacts on relationships and social interactions
- Challenges with activities like playing wind instruments
Ongoing Health Concerns
- Gum inflammation and dental issues
- Sleep-disordered breathing
- Forward head posture and associated pain
- Difficulty wearing or retaining dentures (in elderly patients)
Assessment Process
Assessment for tongue tie includes:
- Comprehensive history: We gather information about feeding difficulties, speech concerns, dental history, and any functional challenges you or your child may be experiencing.
- Physical examination: We evaluate the structure and mobility of the frenulum and tongue, and assess impact on oral function.
- Functional assessment: We observe how any restriction affects feeding, speaking, or other oral activities depending on age.
- Collaborative approach: When appropriate, we may consult with lactation specialists, speech pathologists, or other healthcare providers.
Following assessment, we’ll discuss whether treatment is recommended based on the severity of restriction and its functional impact. Not all cases require treatment.
Treatment Options
Treatment recommendations depend on the severity of restriction and its functional impact. Treatment options include:
Frenectomy Procedures
- Laser Frenectomy: A procedure that uses laser technology to release the restricted tissue. This is one approach for performing a frenectomy.
- Scissor Frenectomy: A procedure using surgical scissors to release the restricted tissue. This approach may be preferred in specific clinical situations.
- Frenuloplasty: For thicker or more complex restrictions, this surgical procedure involves releasing and reconstructing the frenulum tissue with suturing. This approach is generally used for older children and adults.
Supportive Therapies
- Pre-Procedure Exercises: Techniques to prepare oral tissues before the procedure.
- Post-Procedure Stretching: Exercises performed after the procedure to help prevent reattachment. Compliance with these exercises is important for outcomes.
- Myofunctional Therapy: Exercises to retrain oral muscles and support function after release.
- Lactation Support: Expert guidance to optimise breastfeeding before and after treatment.Guidance for breastfeeding before and after treatment in infants.
- Speech Therapy: Intervention for speech sound production and articulation when needed.
Comprehensive Management
- Orthodontic: For patients with jaw development or dental alignment concerns, we may collaborate with orthodontists.
- Sleep Medicine: For patients with breathing-related symptoms, we may coordinate with sleep specialists.
- Follow-up Care: Regular follow-up monitoring is recommended after treatment to assess healing and address any concerns.
Risks and Considerations
As with any surgical procedure, frenectomy involves risks and potential complications that you should understand before proceeding:
Common risks include:
- Bleeding during or after the procedure
- Pain or discomfort following treatment
- Swelling and inflammation
- Infection at the surgical site
- Incomplete release requiring additional treatment
- Reattachment of tissue (particularly if post-procedure exercises not performed)
Potential complications may include:
- Damage to surrounding structures (salivary glands, nerves)
- Excessive scarring
- Changes in tongue or lip mobility
- Difficulty with feeding or speech immediately following procedure
- Anaesthetic-related risks
Important considerations:
- Not all tongue ties require treatment
- Treatment may not resolve all symptoms
- Post-procedure exercises are typically required to prevent reattachment
- Some symptoms may require additional therapies (speech therapy, feeding therapy)
- Success depends on patient compliance with post-procedure care
- Outcomes vary between individuals
For infants: While many infants can feed shortly after the procedure, individual experiences vary. Some infants may take time to adjust to new tongue mobility.
For children and adults: Recovery time varies. Discomfort, dietary restrictions, and speech changes may occur during healing.
Contact the practice immediately if you experience severe pain, excessive bleeding, signs of infection, or any concerning symptoms following treatment.
The Connection Between Tongue Tie and Overall Health
Some research suggests possible connections between tongue tie and:
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Dental development: Tongue positioning may affect palate development and dental alignment in some individuals. The relationship between tongue tie and dental issues varies, and these conditions can have multiple contributing factors.
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Breathing patterns: In some cases, tongue restriction may contribute to mouth breathing patterns. Mouth breathing can be associated with various factors affecting facial development and sleep quality.
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Sleep quality: Some research suggests tongue restriction may contribute to sleep-disordered breathing in some children and adults. However, sleep disorders have multiple potential causes, and not all individuals with tongue tie experience sleep issues.
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Posture and pain: Some individuals may develop compensatory head and neck positioning. This can be associated with pain patterns and postural changes, though the relationship varies between individuals.
