What is a tongue tie?

June 8, 2020

A tongue tie is a congenital attachment that connects the underside of the tongue to the floor of the mouth. 

Ankyloglossia is the medical term for tongue tie.  Other terms sometimes used are restrictive frenum and tethered oral tissues (TOT).  In any case, the tongue has less range of motion due to excess tissue holding it down.  Depending on the tie and the age of the patient symptoms can be more or less obvious. 

Tongue ties do not just compromise our mouths. We all have fascia running throughout our bodies like little spider webs to hold things in place.  The fascia that connects under our tongue goes all the way to our feet.  Therefore, you can experience pain or limitations in numerous parts of our bodies with a tongue tie (face, neck, back, pelvis, etc.).

Is a tongue tie a bad thing?

Tongue ties can affect speaking, eating, swallowing, breathing, face and neck pain, sleeping, and digesting (which can lead to acid reflux, GERD, and constipation). 

Some signs there may be a tongue tie:

·        Picky eaters (they may be compensating because eating certain foods is challenging for them)

·        Fast or incredibly slow eaters (they may not be chewing completely so they just quickly swallow, or they take a lot longer to properly chew)

·        Stores food in the pockets of their cheeks (seems cute but this is a red flag)

·        Drinks a lot while eating or swishes and swallows (to clear the food from their mouth)

·        Dental concerns – leaves lots of plaque on their teeth and can have cavities (because they cannot move their tongue all around to clear the food from their teeth)

·        History of poor nursing and prolonged eating of puree baby food

Much of the information in this blog comes from Tongue Tied by Richard Baxter, DMD, MS.  It is a great book that breaks down signs and symptoms of a tongue tie for both health care professionals and parents.  This Blog is in no way a complete summary of the book, but it does highlight some key points to help you become more aware of things that often go missed. 

Tongue ties often go undiagnosed unless there is an obvious speech delay, but they can unknowingly cause pain and restrictions in so many parts of our body.

-We have fascia throughout the body (like spider webs connecting different structures). The fascia under our tongue extends all the way to our feet which can explain a lot of aches and pains.

Eating and digesting:

Eating is more then just eating.  Of course, what we eat is widely talked about, but what about how we eat?

Eating can be a lifelong compensation.  Messy eating, slow eating, smacking, choking, gagging, grazing, and packing food inside the cheeks are all signs of concern in children and adults.  Additionally, drinking a lot during eating in order to swallow all the food is a classic sign the tongue may not be able to push the food to the throat on its own; therefore, one has to drink more to clear the mouth of the food.

But that is just the first part of digestion.  I remember my doctor telling me I had GERD in my twenties because he saw air in my stomach on an x-ray.  I thought he was crazy!  I was in the best shape of my life and did not have any concerns with digestion, but I did suffer from frequent stomach aches.  Turns out I have lived most of my life with a reverse swallow that had a negative (reverse) air flow every time I swallowed.  This was forcing a bubble of air into my digestive system hundreds of times a day.  Again, this is a compensation.  If someone has a restriction with their tongue and/or lips they cannot swallow properly.  It can also lead to protruding teeth and/or relapse after orthodontics.  I have had a form of braces three different times in my life and even with a glued in retainer on my top and bottom teeth they have manage to move again because of my reverse swallow (often called a tongue thrust).  Look for a future blog on tongue thrust.

** One easy way to see if you may have a dysfunctional swallow (usually caused by a tongue tie) is to try to swallow while smiling with your lips apart and your tongue holding steady on the roof of your mouth.  If your tongue moves forward or hits the back of your teeth this is called a thrust.  If you make a funny face, bob your head, or must use your lips to swallow this is a compensation (you may be compensating for a restricted tongue).  These are signs the muscles of your tongue and mouth may not be functioning correctly (which often indicates a tongue tie).  But not all ties need surgery.  Sometimes it just takes proper muscle toning to utilize your body the way it was meant to be used.

What if my doctor or dentist says there is no tongue tie, but I have these symptoms?

If you are told that you or your child does not have a tongue tie, that does not mean that they do not have a restriction.  Not everyone is professionally trained to look for tongue ties because diagnosing them is not taught in medical or dental school.  Same goes for surgeons that remove tongue ties (in what is often called a frenectomy).  They are not all trained the same way, nor do they all do the surgical process in the same way.  Additionally, many only do removal of anterior tongue ties (visible restrictions under the front part of the tongue), when in fact, the patient may have less obvious ties further towards the back that also need to be released.  I will talk more about frenectomies in another blog.

Regardless, tongue ties are linked to so many other health concerns and should be properly.  The hope is that myofunctional therapy exercises can help overcome the restriction and increase the muscle movement and tone of the tongue.  But, one must also realize that sometimes surgery is still needed. 

Look for my future blog on lip ties that discuss other forms of restrictions in the mouth.

Please feel free to contact me for more discussion on tongue ties or any other concerns you may have. 

I have always said the mouth is the gateway to our entire health.  But until recently I did not value the full scope of this sentence.  Now, I indisputably believe myofunctional therapy is the puzzle piece that connects dentistry to medicine.  It connects our mouths to our entire body. 

I would love to have the opportunity to talk to you more along with answer any questions you have.  Please contact me for a free assessment!