Tongue and Lip Tie
What is a Tongue or Lip Tie?
It's called a frenum or frenulum, and practically everyone has one - it's that webbed piece of tissue under your tongue. Unfortunately, for some people, this piece of tissue can be restrictive and cause problems (also known as Tethered-Oral Tissues or medically called Ankyloglossia). Some people have an obvious "tie." For others, the restriction appears non-existent and difficult to detect. This is due to the fact that the area of restriction is deep within the mucosa under the tongue (commonly called a posterior tongue-tie). Appearance, function, compensation factors, and symptoms should all be assessed before a final diagnosis be made. Sticking the tongue out or looking under the tongue is not a thorough assessment. Lip and cheek frenums can also be tethered and cause problems. If a lip or cheek tie are restrictive, the frenum under the tongue will often be restricted as well. Ankyloglossia tends to be genetic, so if one family member has been found to have tethered-oral tissues, other family members should also be assessed.
What are the Symptoms?
I think I have a tethered-oral tissue. Now what?
Dr. Baxter, DMD, MS, author of the book entitled, Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More , explains "If it's not broke, don't fix it." If you are concerned you might have a restricted oral frenulum/frenum, yet you don't have any symptoms or a limitation of function, it is probably not necessary to pursue further action.
If you do have several symptoms of an oral restriction, it is recommended that a thorough assessment be performed. Not all medical and dental professionals have been trained on the proper assessment of restrictions, particularly if the restriction is less obvious. If in doubt, consult or have an assessment performed by an orofacial myofunctional therapist.
International Association of Orofacial Myology - Members Directory - to find an orofacial myofunctional therapist near you.
Sometimes, when there is a suspected "tongue-tie," starting myofunctional therapy is recommended. If the muscles are strengthened and can achieve proper function, there will be no need to perform surgery. There are always risks associated with any kind of surgery, so it is important to weigh carefully the risks versus the benefits.
Depending on the limitation of function and presence of symptoms, a release of the restricted tissue may be recommended (often called a frenectomy). There are a variety of methods and professionals available to perform the procedure, with varying results. Consultation with an orofacial myofunctional therapist on which method is best for you is recommended. In addition, reattachment of the tissue can begin to occur shortly after the release to several weeks (sometimes months) following the procedure. It is recommended that you meet with an orofacial myofunctional therapist for pre- and post-release appointments, to ensure exercises and stretches are being performed properly to minimize reattachment, decrease scar tissue, limit compensation issues, and gain full function and proper habits/patterns in the mouth and face. Referrals to various health professionals will be recommended as needed.