Tongue Ties – What’s The Deal?
The phrase “tongue tie” is becoming more common as new evidence of the connections between tongue tie, tongue position, head posture, fascia, clenching/grinding, snoring, GERD, mouth breathing, TMJ issues, head and neck pain, crowded teeth, dental problems, food texture issues, gag issues, and more all become more understood.
So what’s the deal here?
Nasal Breathing- It’s important!
In healthy infants, children and adults, we expect nasal breathing at all times expect heavy exercise. This means snoring or noisy breathing isn’t healthy and mouth breathing isn’t healthy or normal. Nasal breathing allows for filtering of the air, humidification and warming of the air, increased flow to arteries, increased brain and lung function, and more oxygen retained in the bloodstream.
What problems pop up with mouth breathing, snoring, and noisy breathing?
We see problems ranging from enlarged tonsils, inflammation in the mouth and throat, dry mouth leading to high cavity risk, tonsil stone formation and bad breath. We see forward head posture problems, head and neck pain, trigger points in the neck and back, frequent headaches, TMJ pain or issues, grinding of teeth, clenching of teeth. All of these often lead to poor sleep, daytime sleepiness, snoring, drooling at night, severe gag reflex, and food texture issues. This can in turn lead to soft diet and poor skeletal development, tooth wear, GERD, high blood pressure and more. The one thing we haven’t mentioned here is the tongue tie! The tongue tie- anterior or posterior- can also lead to mouth breathing, which we know is a problem.
Many of the signs and symptoms listed above are often end point problems of mouth breathing, and many times, the initial triggering factor is the tongue tie!
How does the timeline of these problems typically progress?
Often, babies with tongue ties have early warning signs: poor latch, poor weight gain, reflux, fussy, prolonged feed time, painful nursing, falling asleep while nursing, and more. Typically these babies will show a tongue tie that can easily be reversed.
Unchecked, these babies often end up being bottle fed and switched to soft diets early on. They tend to develop sleep habits like tossing, turning, sleeping on their face, snoring at night and teeth grinding that can be heard by parents or siblings.
Many physicians will recommend that children will “just grow out of it.” However, we often see that these children go on to have attentions/focus issues, problems waking up, waking up at night frequently, and more. They will typically develop cavities in childhood that need to be filled, usually acid reflux develops, and their tonsils enlarge and inflame. They also tend to choke easily eating and drinking.
In the teen years we will often see tooth crowding and the need for orthodontics and possibly tooth extractions. Usually at this milestone we will start to see tooth wear and flattening of the canine teeth, tonsil stones and occasional bad breath, bleeding gums even for really good brushers/flossers, and early TMJ / TMD signs.
As these people age into adulthood, often snoring worsens, GERD worsens, dental conditions like cavities / inflammation / gum issues / and tooth wear worsen. With these problems we usually see full blown TMJ / TMD issues or pain, and things like high blood pressure and feeling tired frequently become common as do full blown sleep apnea cases.
As time goes, on, we often see tooth loss from uneven forces, wear, and bone loss; as well as further systemic health issues.
See my other blogs to read more about overall health issues seen orally:
https://www.latdentistry.com/blog/oral-health-overall-health
https://www.latdentistry.com/blog/the-secrets-teeth-tell
How is tongue tie often the root cause here?
Tongue ties are the flap of tissue under the tongue that when unusually tight, restrict the range of motion of the tongue. The promote the tongue sitting down in the bottom of the mouth rather than up in the roof of the mouth. The tongue needs to sit in the roof of the mouth to keep the airway open, and it allows for nasal breathing. It also allows for proper skeletal development in infants and children. When the tongue is “tied” the front or back of the tongue cannot move enough into the roof of the mouth, leading to mouth breathing and the list of problems we covered above.
How do I know if I have a tongue tie or if my child has one?
The easiest way would be to let me or a trained professional evaluate. I have an extensive team of providers who work together in these cases from infants to adults. You can also watch the 2 youtube videos I posted below to learn how to assess as well. Severe anterior tongue ties are often easy to self-diagnose, but posterior tongue ties require more background understanding to diagnose.
Examples of anterior (left) and posterior (right) tongue ties
Functional classification of ankyloglossia based on tongue range of motion ratio (TRMR)
What do I do to correct my tongue tie?
We start off all patients with myofunctional therapy- ie: tongue exercises! You tongue needs to naturally assume the proper position once we release it from its restricted position, and the only way to train a muscle is through exercise! After therapy, we will do a quick and easy release- typically with a laser and minimal or no numbing agents. Then you will perform follow up therapy to allow everything to heal into position properly.
Where can I learn more?
Dr. Wendy Brown - Inner Sun Chiropractic in Roanoke, VA
Richard Baxter, DMD - The Alabama Tongue Tie Center
https://tonguetieal.com/the-facts/#infants
Carmen Woodland – Myofunctional Therapist
https://www.myofunctionaltherapy4u.com/
Dr. Zaghi, MD – ENT, Sleep surgery, and Airway specialist
