Tongue Ties – Everything you need to know – Symptoms and treatment

Introduction

A Tongue tie is a condition where the band of tissue connecting the underside of the tongue to the floor of the mouth is unusually tight or short. This can restrict tongue movement and lead to various issues, especially in infants and young children. Common problems include difficulty breastfeeding, speech delays, dental concerns, and challenges with oral hygiene. Early detection and intervention are crucial for preventing long-term complications and improving quality of life for those affected.

What is a tongue tie?

Tongue tie is the improper development of the frenulum (tissue anchoring the tongue to the mouth) which impacts proper tongue movement. The frenulum can be too short, thin or tight to allow for proper movement. In the photo on the right, when the mouth is closed, the tongue is unable to rest on the top of the mouth and back of the front teeth. Tongue ties can have a major impact on breastfeeding and speech.

Other types of Tongue ties

  • Lip Tie: A Lip tie is very similar to a tongue tie in that it is an extension of the frenulum between the lip and upper gums. It too has a significant impact on breastfeeding and speech. Although it is less common than a tongue tie, if a lip tie is present, you are almost guaranteed to find a tongue tie as well.
  • Buccal Tie: Cheek ties occur when there is an abnormally tight frenum in the cheeks. You can have it on one or both sides. This drastically impacts a baby’s ability to latch properly causing bub to take in excessive air. A baby with buccal ties will commonly present with reflux-like symptoms.

What do we check for

  • The Tongue should be resting at the roof of the mouth, filling the entire palate. Those with tongue ties may not be able to reach the top of their mouth due to restriction.
  • Changes in palate shape: smaller/narrower
  • Crooked teeth growth or recessed lower mandible
  • Airway restriction
  • Poor tongue mobility

Your tongue should fill up the entire roof of your mouth and is part of the internal support structure for the upper jaw. When your tongue is in the correct position, your teeth will grow straighter and face will develop properly.

Infant Tongue Tie Signs/Symptoms  

  • Poor or shallow latch (also called nipple feeding)
  • Slides off the nipple after latching
  • Gumming or chewing of your nipples when nursing
  • Clicking when feeding
  • Gags easily
  • Reflux symptoms
  • Vomiting
  • Colic symptoms or excess gas
  • Extended nursing episodes
  • Falls asleep while nursing
  • Short sleep episodes
  • Unable to hold dummy in mouth
  • Green poo
  • Pulls body off the breast during feed
  • Congested breathing/snoring
  • Challenges with solid food
  • Dribbles or messy eater
  • Poor weight gain
  • Prolonged drooling

Mother Tongue Tie signs/symptoms

  • Creased or flattened nipples during/after nursing
  • Cracked or blistered nipples
  • Bruised or bleeding nipples
  • Blanched (whitened) nipples during or after feeding
  • Pain during latching/feeding
  • Use of nipple shield
  • Poor or incomplete breast drainage
  • Infected nipples/breast/mastitis
  • Nipple thrush
  • Low milk supply
  • Feeling anxious/stressed

Kids Tongue Tie signs/symptoms

  • Speech difficulties, issues eating/textures avoidance, inability to stick tongue beyond upper lip

Adults Tongue Tie signs/symptoms

  • Speech issues, mouth breathing, jaw pain/clenching/grinding, headaches, head/neck/shoulder tension, forward head posture, snoring/sleep apnea/sleep disordered breathing, increased risk of cavities/gum disease, slower orthodontic treatment/relapse

How is A Tongue Tie diagnosed

There is no agreed upon criteria, more so a combination of clinical findings, assessment and impact on function.

What we look for: heart-shaped tongue, ‘eiffel tower’ frenum, unusually thick frenum, difficulty raising tongue/moving sideways/protracting tongue

Hazelbaker Tongue Tie Assessment Tool

Type 1: 100% tie – 2mm from tip

  • Attached to alveolar ridge

Type 2: 75% tie- 2-5mm from tip

  • Attached to alveolar ridge or base of ridge/mouth floor

Type 3: 50% tie- 6-10mm from tip

  • Attached to alveolar ridge/mouth floor

Type 4: 11-15mm from tip

  • Posterior tongue tie
  • Attached to mouth floor/base of alveolar ridge or on alveolar ridge

Type 5: Over 15mm from tip

  • Submucosal tongue tie
  • Attached to mouth floor or base of alveolar ridge

Kotlow Tongue Tie Assessment Tool

  • Measured by the distance of the tie to the tip of the tongue
  • Posterior ties are diagnosed by touch as they are located under the mucous membrane at the bottom of the mouth.

Class 1: Mild – 12-15mm

Class 2: Moderate – 8-11mm

Class 3: Severe 3-7mm

Class 4: Complete: less then 3mm

Risk Factors

  • MTHFR gene
  • Increased prevalence in boys

Issues arising from tongue ties

BREASTFEEDING PROBLEMS

  • Baby’s tongue is unable to make a ‘vacuum’ on the breast because it is unable to reach the lower gum, resulting in issues with latching.
  • Parents often resort to bottle feeding, deal with painful breastfeeding or a drop in supply and failure to thrive.
  • Often the baby is able to accommodate these structural changes and is able to feed and gain weight appropriately. However, often this can result in difficulties for the mother including blocked ducts/mastitis and reduced milk supply (due to an ineffective latch and stimulation for letdown).
 

SPEECH DIFFICULTIES

  • Most common sounds struggled with are ‘r’ and ‘l’
  • Older kids who undergo frenectomy late will often require speech therapy to correct habitual speech difficulties

IMPROPER JAW/FACIAL GROWTH

  • According to multiple studies, untreated tongue tie leads to issues with orofacial growth

SLEEP DISORDERS

  • Short frenulum increases the likelihood of open mouth breathing. This can lead to an abnormally small palate or constricted airways in the first years of life and can contribute to an array of sleep conditions such a sleep apnea, snoring etc..
  • Disrupted sleep can also manifest in behavioural issues such as an ADHD presentation. Kids may not have noticeable ‘wakeful’ or disrupted sleep and still have symptoms development

TMJ PAIN

  • Increased pressure on jaw muscles causing pain which can cause headaches and migraines.

ORTHODONTIC ISSUES

  • Delayed response to orthodontic treatment
  • Increased chance of relapse with tongue tie causing movement of teeth away from their corrected position.
  • Poor oral hygiene due to inability to move tongue when brushing teeth and increase bacteria being caught in tongue frenulum.

POOR DIGESTION

  • Inability to chew properly can impact digestion which in turn can lead to food sensitivities, leaky gut and nutritional deficiencies.

Treatments

  1. Craniosacral therapy: Chiropractic care to improve cranial function as much as possible and help strengthen muscles and prepare the joints and muscles for changes to mechanics and increased range of motion.
  2. Frenectomy: Short, low-risk procedure, usually completed by a paediatric dentist, ENT or GP alongside a lactation consultant. The procedure can be done using laser, scissors or scalpel. We work closely with three providers.
  3. Wound care: Tongue and wound stretches are integral in ensuring the ties do not reattach.
  4. Post-op exercises: It is important to book in with your chiropractor within 48 hours of the procedure. Tongue and oral muscles will need to be strengthened and retrained following the procedure. Remember, the tongue hasn’t previously learnt to move and rest properly. These exercises should be done for 4-6 weeks after the frenectomy.

If you suspect that a tongue tie may be affecting you or your child, it’s important to address the issue as early as possible. The team at Health Spot Randwick is here to help you navigate the path to better health. Our qualified chiropractors are experienced in identifying and treating conditions like tongue ties that can impact oral function and overall well-being. We take a holistic approach, assessing not just the tongue tie itself, but how it may be affecting posture, movement, and overall comfort.

Want to know where to start? Begin by booking an appointment with one of our qualified chiropractors at Health Spot Randwick. We’ll work with you to understand the problem and provide effective solutions tailored to your needs. Whether it’s for a child struggling with feeding or an adult facing speech or posture concerns, we would love to help you find relief and improve your quality of life.

Want to know where to start? Begin by booking in with one of the qualified chiropractors at Health Spot Randwick. We would love to help!

Let’s chat! If you have any further questions do not hesitate to get in touch at chiropractorruby@hotmail.com or book an appointment at https://healthspotrandwick.com.au/booking/ or (02) 8866 3696.

 

Looking forward to hearing from you. Ruby x

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