Tongue Tie Q & A

Melanie L. Throne, DDS, PA - General Family Dentist located in Fort Worth, Texas

Tongue tie and lip tie are common conditions that can make it difficult to move your tongue or mouth. Sometimes identified shortly after birth, tongue lip and cheek ties can make breastfeeding hard for newborn babies. However, people of all ages can have oral tissue ties, and these conditions can be corrected at any age. Melanie L. Throne, DDS, PA, has extensive training in Tethered Oral Tissue (TOTs) release. Find the best care for all ages at Dr. Throne’s practice located in Fort Worth, Texas, make an appointment for an initial consult by phone today to learn more. 817-735-4700


What is tongue tie?

Tongue tie, or ankyloglossia, is a condition that restricts the movement of your tongue. A string of tissue, called the lingual frenulum, connects the bottom of your tongue to the floor of your mouth. If you have a tongue tie, the lingual frenulum is shorter, thicker, or tighter than normal. Recently, it was realized that the tongue can have a posterior and deeper component of restriction that hinders the elevation of the posterior part of the tongue to the roof of the mouth. There now exists four different classifications of tongue and lip ties.  Any provider rendering an opinion on the presence of oral tethers should be able to describe these classifications as well as listing the names of pioneers in this field hopefully whom they have trained with or shadowed while doing procedures.  

It is now widely accepted that the ability to stick the tongue out of the mouth is not a predictable indicator of tongue tie or proper tongue function. Research is evolving in this area currently which will drastically raise the occurrence rate of tongue tie in the population.  Current but dated research supports up to 11% of babies are born with tongue tie, but that number could rise to 75% or more with new definitions and ongoing research. The exact cause is unknown, but it can run in families suggesting a genetic component, and it seems to be more common in boys than in girls. Since tongue tie is a midline fusion problem, current research has been focused on a mutation in the MTHFR gene group as the possible cause.  This abbreviation is for methylenetetrahydrofolate reductase, and it controls all midline fusion reactions in the body as well as most all digestive and detoxification processes within may organ systems like your kidneys, liver, and gut. Problems with this gene can lead to several manifestations like Stork Bite, cleft lip and palate, urinary tract developmental issues, thyroid function issues, sacral dimpling, hair swirls, Spina Bifida, and food sensitivities like gluten and dairy.  As an extension of the detoxification processes being altered with MTHFR gene mutations, all persons with identified tethered oral tissues should be especially cautious with vaccinations and anesthetics It is strongly advised that parents of a tongue tied infant research MTHFR  mutations and read the book Dirty Genes by Dr. Ben Lynch when making decisions about vaccinations and medical procedures involving anesthetics.

Early symptoms of tongue tie can often appear soon after birth, when a baby exhibits problems breastfeeding, struggles to gain weight, or mom experiences pain with latch. Unfortunately, medical personnel are often times inadequately trained or are not knowledgeable on tethers or on breastfeeding so many struggling babies and moms do not receive treatment.  Many moms are even blamed or ridiculed for questioning or struggling with the process which leads to them abandoning their breastfeeding goals opting instead for the inferior option of feeding formulas with bottles.  Bottle and pacifier use leads to lifelong incorrect swallow patterns, low tongue postures, and compensations in the musculature involved in feeding, speaking and swallowing.  It is recommended that restrictive oral tethers be addressed in infancy, although the condition can be treated in patients of all ages since most of these conditions are currently overlooked or misdiagnosed.  It is critical that infant/mother dyads be thoroughly evaluated by highly trained personnel for issues that can contribute to breastfeeding difficulties like cranial nerve dysfunction, body issues like torticollis, etc. prior to release procedures to insure need and success.  This involves lactation consultants (IBCLCs) and body workers like occupational therapists, chiropractors, and craniosacral massage therapists to name a few.

What are lip & buccal ties?

Lip or buccal ties occur when a frenulum, or band of tissue along the midline inside the upper or lower lip or at the sides of the cheeks, is too thick or too tight. A lip or buccal tie keeps your lips and cheeks from moving freely and can make speaking and brushing and clearing of food debris difficult. It can make it hard for babies to feed and gain weight as they should. In all ages these ties can put tensions on the tissues causing all sorts of face, head, and neck pain issues, sinus and ear drainage issues, migraines, scoliosis, and cranial strains, just to name a few symptoms.

What are the symptoms of restricted tethered oral tissues (TOTs)?

Milk Tongue

Stork Bite

Most people first notice tongue, lip, or buccal ties in newborn babies or in children as they begin to speak.  Tethers may present in older children and adults being noticed in conjunction with crooked teeth, speech issues, or body aches and pains.  Tongue or lip tie can impact your ability to speak clearly or eat comfortably. In older children, speech and language pathologists may identify restrictive or tethered oral tissues. In some cases, tongue or lip ties may not have any symptoms, at least not symptoms that the parent or patient or medical physician can readily connect to reduced function.  Physicians get one hour of lecture on tethers and feeding in medical school, and so most are not familiar with any of these issues and unfortunately often dismiss patient's and parent's concerns when voiced.


Common symptoms of tongue tie and lip tie include:

Infant

Shallow or poor  latch
High or bubble palate
Torticollis
Colic/gassy/gulping air
Lip nursing blister/thin whitish lips
Reflux
Slow weight gain
Milk tongue/Thrush misdiagnosis
Biting or chewing at the breast to feed
Clicking sounds/popping off the breast
Arching when nursing
Recessed lower jaw/ jaw quiver
Falls asleep while nursing/fists closed & baby seems tense
Feeds all the time/never satisfied
Refuses nipple, bottle, or pacifier
Dislikes carseat/"scoot crawling"
Long nursing sessions with short breaks
Spitting up/gagging
Sleep issues/Snoring/ Sleep apnea

Mother

Pain, often extreme,  with nursing
Lipstick shaped nipple
Mastitis
Bleeding/cracked nipples
Over or Under supply
Thrush diagnosis
Plugged or clogged duct
Flat crushed nipple
Vasospasm
Blanched nipples
Incomplete drainage
Depression/Anxiety
Bruised nipples and breast







Child

Speech difficulties delay or lisp
Dark circles under eyes/allergy shiners
Picky eater food & texture aversions
Mouth breathing/drooling/Chapped lips
Bed wetting
ADHD/ADD/ODD/OCD
Gagging, choking, vomiting food but especially liquids
Migraines/headaches
Food falls out, washes bite down instead of swallowing/pockets food
Crooked or touching baby teeth/decay
High palate
Allergy or sinus issues
Enlarged tonsils and adenoids
Snoring, sleep apnea, night terrors
Clumsiness or posture issues
Digestive issues/IBS/Sensitivities
Anxiety/Depression/Melt downs

Adult

Forward head posture/Dowager's hump
Migraines/headaches
Neck, back, face pain/Scoliosis
TMJ pain/clicking/popping/locking
Crooked teeth/recessed jaws
Chapped lips/premature wrinkles
Cavities/decay/gum disease
Facial & ear asymmetry
High palate/food trapping
Bladder issues especially at night
Gummy smile/narrow arches
Grinding/Bruxism/Can't open wide
Snoring/Sleep apnea/Anxiety
Reflux/ IBS/ Digestive sensitivities
Long face syndrome/narrow
Picky eater
Gagging if brushing or drinking liquids
Difficulty with dental x-rays
Speech issues when talking fast, tired
Open bite/underbite/overbite


How are tethered oral tissues (TOTs) related to body posture and tension?

Deep Front Plane

Our bodies are intricately and perfectly designed connected by a fascial web beneath our skin and throughout all our organ systems.  Our body has the ability to reinforce itself with this webbing by recruiting more of it to help to stabilize and reinforce compromised areas.  If one area, like the tongue, is tethered and its function is restricted, our body still has to swallow and breathe, etc., so other muscles and tissues are recruited to help assist for survival despite not being designed for this additional function.  More fascia will be recruited and used to reinforce these additional functional loads.  There are standard fascial planes that run throughout the body in all different directions, but no two people are exactly alike.  A very well known plane involving the tongue is called the Deep Front Plane. It runs from the tongue base down through the neck and chest attaching to the diaphragm and then continues all the way through the abdomen and legs to the toes.  When a tongue tie is released, it would therefore, stand to reason that there would be tension changes on the entire length of this fascial plane that would require body work and manipulation to break it all free.  This is often where we implement the popular TummyTime Method for babies.  It is common for adults during a TOTs release procedure to feel tingling or relaxation in the shoulders, neck, face, sinuses, chest, breathing, hands and even feet.  It is for these reasons that body work and myofunctional therapy before and after the procedure are critical for success long term.  This ensures that the surrounding soft tissues are as loose as they can be, and that the surrounding musculature is as strong as it can be prior to surgery.  Dr. Throne and her team also assess for any Cranial Nerve Dysfunction that would be critical to address prior to release of tethered tissues.  The team wants a patient as strong as they can be and functioning at their best possible ability prior to surgery. This minimizes the extent of the surgery focusing strictly on those structures that are truly tethered and restrictive and not simply tangled together. This ensures the least invasive procedure possible combined with the quickest most uneventful recovery and most successful long term outcome.

How are restricted oral tissues treated?

Dr. Throne uses laser technology for soft tissue release of all restrictive tethers in the oral cavity on all ages.  Dr. Throne is laser certified by the Academy of Laser Surgery (ALD) and adheres to the strictest and most current laser safety protocols. Since she has devoted years to studying different techniques, she is well-versed and experienced treating and releasing all ages. She has established multiple Facebook support pages for patients and parents and has a team of well over 50 specialty professionals to ensure the most successful outcomes.  As an Ambassador with The Breathe Institute training under Dr. Soroush Zaghi, Dr. Throne approaches each and every release using the Functional Frenuloplasty Technique no matter the patient's age. The procedure takes only a few minutes and is virtually painless. After the procedure, the tethered tissues are freed immediately. It is critical before and after the procedure to follow all stretching and exercise guidelines given by Dr. Throne and her treating team to experience a great, predictable, and stable outcome ensuring long term success. 

If you or a loved one has tongue tie or lip tie, Dr. Throne and her team can help. To get started, request your first appointment online today or call the office at 817-735-4700.

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