What is tongue tie?
Ankyloglossia, or ‘tongue-tie,’ as it’s commonly called, is a congenital defect that hinders the movement of the tongue. The underside of the tongue will be tethered to the floor of the mouth by the frenulum, although the extent varies by case. As many as 11% of all babies are born with this condition, meaning that it’s considered a common occurrence. Even so, many new parents are unaware of this abnormality where the frenulum ‘ties’ the tongue to the floor of the mouth. The symptoms of tongue-tie may even be mistakenly confused with symptoms of colic.
Tongue-tie is more common in boys, and can present a wide range of problems if the condition is severe enough. Newborns with tongue-tie are much more likely to have problems breastfeeding, which can result in problems of its own.
In more severe cases, even the tip of the tongue can be tied to the floor of the mouth by the lingual frenulum. This limited lingual mobility may present a wide range of issues for infants. Tongue-tie is usually diagnosed and treated because of issues with eating, drinking, speech, and dental issues, among other symptoms.
What are the symptoms of tongue tie?
The symptoms vary based on the severity of the condition. It can cause problems in children of all ages, but especially in newborns and infants. Many mothers of tongue-tie babies find it difficult to breastfeed, because babies with the condition often have a hard time latching on during feeding times. In fact, the condition may even be diagnosed by the mother’s symptoms!
Common symptoms in mothers of infants with tongue-tie include:
- Painful breastfeeding
- Poor latching when breastfeeding
- Sore, cracked or bleeding nipples
- Nipple pain
- Mastitis
- Inflammation of the breast
- Low breastmilk supply
- ‘Spilling’ milk while breastfeeding
- Other infant feeding problems
Up to 1 in 4 mothers of tongue-tie babies report difficulties breastfeeding, which is why the condition is sometimes diagnosed by a lactation consultant.
In infants and children, the symptoms may vary based on severity and the child’s age.
Common symptoms in babies with tongue-tie include:
- Lack of weight gain, or remaining underweight for the child’s age
- Limited tongue movement
- Speech impediments or speech difficulties in older children, due to the placement of the tongue
- Gaps between lower and upper front teeth
- Gagging or choking
- Excess saliva
- Dental problems like tooth decay, or cavities despite good oral hygiene, because of the tongue’s inability to reach leftover food particles
- Silent reflux
- Colic (frequent episodes of crying)
- A visibly tight or short frenulum
How is tongue tie diagnosed, and who diagnoses it?
How tongue-tie is diagnosed (and who diagnoses it) varies.
In newborn babies and infants, the condition is usually discovered when the mother has prolonged issues breastfeeding, or if the infant’s weight gain is less than normal for his or her age.
Tongue-tie limits the range of motion of the tongue, which includes suckling. The baby may have trouble latching onto the breast, or might ‘premasticulate’ (start chewing) in an attempt to get more milk. This is stressful for both mom and baby — the baby will be frustrated because of the lack of milk, and the mother has a painful breastfeeding experience.
Because of this, tongue-tie may be diagnosed by a lactation consultant, or breastfeeding specialist, after a physical examination when the mother raises concerns about the breastfeeding pain. However, the baby may also be diagnosed by his or her pediatrician if they are underweight, or not getting enough nutrients.
In toddlers and children, tongue-tie can present itself differently. For instance, a 6-year-old may have a hard time making an ‘r’ or ‘l’ sound, and it may seem like a speech problem. In this case, a speech pathologist may be the professional who diagnoses the condition.
On the other hand, if the 6-year-old has a gap between the baby teeth on the bottom or top front teeth, excess saliva, or even tooth decay and/or cavities, a pediatric dentist may find the root cause of the issue after an oral exam. If the tongue-tie resolves itself on its own, the gaps between lower and upper front teeth can be fixed with orthodontic treatment, and a general dentist can help young adults with diligent oral care to prevent tooth decay.
Can tongue tie be treated, and if so, how?
There are many treatment options for tongue-tie. The condition is easily treatable with a simple procedure called ‘lingual frenectomy,’ also sometimes referred to as a ‘frenotomy procedure’ or even ‘tongue tie surgery.’
However, don’t be fooled — this surgical treatment is quick and nearly painless, since there aren’t many nerves in the frenulum. To perform a frenectomy, a board certified general or pediatric dentist or a pediatrician will use sterile surgical tools to cut the frenulum that ties the tongue to the floor of the mouth. This will result in freedom and increased motion of the tongue. Depending on the severity of the tongue-tie, a topical anesthetic may or may not be necessary. Occasionally, the doctor will recommend a laser frenectomy instead of a traditional one.
The healing process is very quick as well — infants that undergo a frenectomy procedure will be able to latch and breastfeed successfully almost immediately following the procedure.
There are other options on how to treat tongue-tie, depending on the severity of the case. There are nonsurgical tongue-tie treatments available for milder cases. A lactation consultant may be able recommend different breastfeeding positions, and speech therapy may resolve any speech disorders because of the limited lingual mobility. For more severe cases, though, surgical treatment may be necessary.
When should I consider a surgical procedure, like a lingual frenectomy or frenotomy procedure?
Like all surgical procedures, be sure to consult with a healthcare professional to find out if a surgical correction like frenectomy is best for you or your child.
If you have questions about whether your child has the tongue-tie condition, or if you should consider frenectomy, make an appointment with your pediatric dentist today for additional information.
