It seems to be the newest trend in dentistry. Social media platforms are blowing up with videos, questions, and opinions on it. Members of neighborhood chat pages are starting to post: “Whose dentist can release my tongue-tie?” “Looking for an airway dentist.” “In search of a functional dentist.”
Most providers realize that airway dentistry and releasing a tongue restriction is not something new. Tongue-ties have been noted in historical documents, and even said to be mentioned in the Bible. Midwives would use a fingernail to release a tongue restriction in the 1600s when the frenotomy was widely unknown. Nevertheless, we know the condition of ankyloglossia has been around for thousands of years, but our patients do not. Not only do they want to know if they have a tongue-tie, but they want to know what it is and how it affects their health. Could their tongue-tie be the missing piece to the puzzle they have spent thousands of dollars in health-care bills on looking for a resolution?
Many mothers tell me they have heard about a tongue-tie in the breastfeeding community and how it can cause problems for women who are nursing. As an infant, a tongue-tie can create trouble with the baby’s oral development, affecting how the baby eats, sleeps, and swallows. An infant tongue-tie can contribute to poor latch when nursing, reflux symptoms, a fussy baby, and many other concerns. A question I typically am asked is why a tongue-tie should concern a toddler or child who is no longer nursing. This is when I run late into my next patient’s prophy time.
The importance of educating patients about airway health and orofacial myofunctional disorders in addition to hygiene gets me excited! Our patients should be lucky enough to have a dentist who points out a possible tongue restriction. It’s way more serious than just the inability to stick out the tongue and lick an ice cream cone. Here’s six reasons why you shouldn’t ignore a tongue-tie.
No. 1: Crowded teeth and insufficient airways
The tongue helps to push the teeth out into the correct alignment. When the tongue is restricted, it no longer can help spread the teeth out. I tell my patients to look at it as not having room for all the seats in their stadium. The teeth will become crowded when there isn’t enough room for them to erupt. The tongue plays a crucial role in craniofacial development. If the jaw and palate are not growing, neither are the throat and breathing passageways. The nose can become narrower, and open mouth posture could lead to a long face.
No. 2: Incorrect tongue posture
The tongue can be the mouth’s natural expander when it’s placed on the roof of the mouth in correct resting posture. If a restriction is holding the tongue down in the floor of the mouth, the palate can start to form with more of a V-shape instead of a nice U-shape. Having correct tongue posture also allows for vagal nerve stimulation. The vagus nerve is largely involved with the parasympathetic nervous system. Stimulating the vagal nerve helps with digestion, regulated breathing, and relaxation. Have you ever wondered why children like to suck on their thumb? They are stimulating that sweet spot, located near the incisive papilla behind the maxillary front teeth.
No. 3: Choking and swallowing concerns
The tongue helps manipulate and move the food during chewing. If the tongue cannot move properly to create a bolus with our food, choking becomes a problem. Food can pass to the stomach and intestines in chunks and only be partially digested, leading to constipation. Having a tongue-tie may lead to acid reflux, gas, bloating, belching, hiccupping, and stomachaches.
No. 4: Difficulty nasal breathing
Many children with tongue-ties are mouth breathers, which leads to open mouth posture and affects the way the face grows. When the tongue is properly placed in the roof of the mouth, it forces you to breathe through the nose. Suction your tongue to the roof of your mouth and try to breathe through the mouth. It’s not possible! Oxygen is the most critical nutrient that our body needs. Mouth breathing can cause oxygen deprivation. I explain to my patients that the mouth is made for eating and the nose is meant for breathing. Do you have a child who constantly has a runny nose? Mouth breathing leads to the vicious cycle of congestion.
Dr. Richard Baxter notes in his book, Tongue Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More, how allergies and asthma worsen in response to chronic mouth breathing.1 Mouth breathing during the day and night has also been linked to childhood eczema, or atopic dermatitis.2
No. 5: Speech issues
A tongue-tie is a permanent structural issue that may affect the quality of a child’s speech.3 A tied tongue will have trouble moving from other oral structures to produce certain sounds. A few speech-related symptoms that children may experience include trouble with vowel sounds, frustration with communicating to others, avoiding speaking in public or avoiding certain words, and stuttering. Correct tongue placement is essential when learning to speak correctly.
No. 6: Sleep-disordered breathing and ADHD
A tongue-tie restricts the tongue to the floor of the mouth. When a child is snoring, this could be from the tongue falling down and back into the throat, cutting off their airway. The child may experience many ear infections, enlarged tonsils, or even sleep apnea. Disturbances in sleep and snoring are sleep-disordered patterns. Changes in craniofacial development can also contribute to sleep-disordered breathing (SDB). SDB can either worsen existing ADHD symptoms or play a role in the development of similar symptoms. When a child’s mouth drops open while sleeping and they begin to mouth breathe, it can lead to hypoxia, oxidative stress, sleep fragmentation, and ultimately altered cognitive functions presenting as inattention.4
What happens next when you suspect a patient has a tongue restriction?
Once a tongue-tie is identified, a referral should be made to a knowledgeable, tongue-tie-savvy provider. A great place to start is with an orofacial myofunctional therapist who can guide the patient through the process. Myofunctional therapy is essential to the success of a release, or frenectomy, and should be incorporated into the postoperative care plan to maintain a full release and retrain the tongue to functionally correct rest postures and muscle patterns. The absence of appropriate wound care and myofunctional therapy immediately following surgery often results in a fibrotic reattachment of the released tissues.3 The tool used for a frenectomy is less important than the provider’s ability to achieve a full functional release during the frenectomy.
The provider performing the frenectomy can be a general or pediatric dentist, periodontist, oral surgeon, otolaryngologist, neonatologist, physician, or other health-care provider with adequate training and licensing to perform the procedure. The provider should also be knowledgeable about both anterior and mid-restriction (once referred to as “posterior” tongue-ties), lip- and buccal-ties, be aware of the consequences of an untreated tie throughout the lifespan of the patient, and know the before- and after-care protocols involved with treatment. Successful outcomes may also include a speech language pathologist, chiropractor, craniosacral therapist, physical therapist, and orthodontist.
It is important that we come together as health-care providers from both the dental and medical fields to educate patients on the mouth/airway/sleep-wellness connections. It is our time as dental professionals to look at more than teeth, gums, and smiles. The mouth is the gateway to the body and a crucial place to ensure overall wellness. Together we can work toward whole-health integration and confidently provide our patients with better health and root-cause resolutions.
Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.
References
- Izuhara Y, Matsumoto H, Nagasaki T, et al. Mouth breathing, another risk factor for asthma: the Nagahama study. Allergy. 2016;71(7):1031-1036. doi:10.1111/all.12885
- Yamaguchi H, Tada S, Nakanishi Y, et al. Association between mouth breathing and atopic dermatitis in Japanese children 2-6 years old: a population-based cross-sectional study. PLoS One. 2015;10(4):e0125916. doi:10.1371/journal.pone.0125916
- Baxter R. Tongue Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More. Alabama Tongue-Tie Center; 2018.
- Ivanov I, Miraglia B, Prodanova D, Newcorn JH. Sleep disordered breathing and risk for ADHD: review of supportive evidence and proposed underlying mechanisms. J Atten Disord. 2024;28(5):686-698. doi:10.1177/10870547241232313
