Lip and Tongue Tied

   

We’ve all heard of the term “tongue tied,” but what does that really mean?  It is actually a common congenital anomaly, known as “Ankyloglossia.” It is characterized by partial fusion, or in rare cases, total fusion of the tongue to floor of the mouth due to an abnormality of the lingual frenulum. It is usually detected soon after birth, and depending on it’s severity, can have some pretty significant consequences.

           Normal Lingual Frenulum                       Frenulum with Anterior attachment                                     

An impaired and limited range of motion of the tongue due to Ankyloglossia can cause some of the the following functional effects:

  • Feeding problems in infants and toddlers. Difficulty with latching or sucking. For breastfed babies, this can potentially cause lower milk production from mother; difficulty moving a bolus and clearing food in the oral cavity in older children.
  • Oral hygiene and dentition deficiencies. Inability to remove food debris on the teeth, possibly contributing to dental caries; poor swallowing and a risk of anterior open bite; mouth breathing and a propensity to allergies; open mouthed posture associated with an imbalance in skeletal structure; restricted (dental) arch development and facial development.
  • Speech difficulties. While the tongue is remarkably able to compensate and many children have no speech impediments due to tongue-tie, others may. Around the age of three, speech problems, especially articulation of the sounds – l, r, t, d, n, th, sh, and z may be noticeable.

How to spot ankylglossia

  • V-shaped notch at the tip of the tongue
  • Inability to stick out the tongue past the upper gums
  • Inability to touch the roof of the mouth
  • Difficulty moving the tongue from side to side

As a simple test, caregivers or parents might ask themselves if the child can lick an ice cream cone or lollipop without much difficulty. If the answer is no,

then it may be time to consult a physician.

  

Treatment of ankyloglossia

Once Ankyloglossia has been diagnosed and intervention is determined, then what? A simple procedure, called a “Frenectomy” can be done with a reasonably short in office appointment. This procedure releases the tension between the tongue and the floor of the mouth by dividing the frenulum with electrocautery. This procedure has relatively minimal complications and minimal healing time.  After the structural problem has been successfully corrected, it is reasonable to expect improved function, and to be able to treat secondary problems successfully. Parents should consider that this surgery often yields more benefit than is obvious by restoring function, ease of speech and self-esteem in older children.

  

Lip tie

Much like a tongue tie, a lip tie or “maxillary tie” has similar symptoms and concerns.  With a lip tie, the labial frenum, located between the upper jaw and the inside of the upper lip, can vary in thickness, length, and connection point. Typically, a lip tie can be cause for concern mainly when it interferes with breastfeeding in infants. After evaluation by a doctor, a frenectomy may be indicative depending on the severity of the lip tie and the obstructions it may cause.

  

  

   

Lip ties themselves do not cause dental decay, but if the lip is difficult to reflect back to access the teeth so they can be brushed, the risk for plaque buildup can be increased. Speech does not seem to be majorly affected with lip ties, unlike with tongue ties.

  

  


     

For teen and adult patients who have gone through orthodontic treatment to close a gap between the front teeth, also known as a “diastema,” a frenectomy could possibly  prevent a relapse after braces. Evaluation by a doctor is necessary to determine the necessity of this procedure.

 

    

     

If you think you or your child may potentially benefit from a frenectomy, call our office for a consultation at 916-773-6565.

References:

https://tonguetie.net/consequences/

https://www.entnet.org/content/tongue-tie-ankyloglossia

https://leader.pubs.asha.org/article.aspx?articleid=2278327