Tongue Tie

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Tongue Tie

What is Tongue Tie?

The cord that stretches from under the tongue to the floor of mouth is called lingual frenulum. When this cord is short, it can restrict the movement of the tongue. Most people will know this as ‘Tongue tie’. The proper medical term is ‘Ankyloglossia’ – meaning fixed tongue.

A normal frenulum should be elastic and does not affect or restrict the movement of the tongue. However when the frenulum is short, broad or tight, it can have an adverse effect on oromuscular function (the muscular function of the mouth) – affecting feeding, swallowing and speech.

Estimation of incidence of tongue tie varies from 0.4 to 10%. This wide difference stems from disagreement in the diagnosis criteria. Also not all tongue ties look alike, making it difficult to spot them. A baby with a tongue tie looks different from an older child with the condition.

Up until around 1940’s, tongue ties were routinely cut to help with infant feeding. However this has changed in recent years, mainly due to a reduction of breastfeeding, plus a fear of excessive / unnecessary surgery from the medical profession. Over the years, it has become a belief that tongue tie is not a real medical problem. However there has been evidence that tongue tie can bring various consequences:

For infants, having a tongue tie can cause latching problems and inability to breastfeed successfully. Mothers that manage to persevere in the presence of tongue tie might suffer painful or damaged nipples, with severe pain associated with latching.

In children, tongue tie can cause an inability to chew age appropriate food, gagging or choking symptoms. There can be speech consequences where they are unable to form tongue-tip sounds, resulting in loss of self-confidence as they feel and sound different. Tongue tie can also bring dental problems and difficulty with dental hygiene.

The effects of tongue tie in adults normally stems from long term habit of compensating for inadequate tongue mobility. Their inability to open their wide mouth wide enough might have formed some eating and speaking characteristics. A patient told me he had been unable to move food easily towards the back of his mouth for swallowing, so he always have to cut food up into very small pieces. Some find it difficult to speak clearly when they are talking fast, when they have to give a speech, or when moderate alcohol has been consumed. A clicky or painful jaw has also been noted. There is also the effect during social situations, such as going out, kissing, relationships etc. Dental hygiene issues continue to be a problem, with some having difficulties with denture wearing when they get older.

Obviously not all tongue ties give the same problems. It does seem that these little side effects can and do occur, contributing to a reduced quality of life in some patients. Having a tongue tie divided is a relatively brief and uncomplicated affair. It can be done under local anaesthetic injection in adults. In infants, a quick snip is all it takes.

The photos below demonstrated an immediate improvement in tongue mobility after division of this patient’s tongue tie: