Tongue Ties: They Hold You Back
How tongue ties wreak havoc in many areas of daily function
We’ve all heard the idiom about feeling “tongue-tied” and you may have felt the sensation yourself when trying to speak while feeling shy or nervous. It doesn’t take much reflection on how this sensation was coined; it can really feel like your tongue is tied in a knot when you have difficulty verbally expressing yourself. For many children and adults, however, a tongue tie is a literal, physical restriction that can impact speech– as well as a number of other important functions.
Tongue-tie, also referred to as ankyloglossia, is a condition in which the lingual frenulum– the band of tissue that tethers the tongue to the floor of the mouth– is notably short, thick and/or tight, thus limiting the tongue’s range of movement. An official definition from the International Affiliation of Tongue-Tie Professionals (IATP) states that a tongue-tie is “an embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement.”
While everyone has a frenulum (also called a frenum) on the underside of the tongue, it does not always cause limitations in the tongue’s range of motion and thus does not result in negative consequences to a person’s well-being. In order to meet the criteria for a tongue-tie, there must be both anatomical evidence as well as presence of a functional limitation. Let’s examine the functional limitations that can result from ankyloglossia…
A newborn baby’s difficulty with nursing is typically the earliest indication that a tongue tie may be the root of the problem. Some signs include:
- Difficulties with latching
- Acting particularly fussy during feedings
- Exhibiting a clicking sound while feeding
- Extended feedings that do not seem to satiate baby
- Poor weight gain
Early identification is ideal for a myriad of reasons, the most important being that the earlier the tongue tie is corrected, the greater the chance that the breastfeeding relationship between mother and baby can be salvaged.
There are various professionals who can identify and correct a baby’s tongue tie, and it’s important to research the most appropriate practitioner that will suit your baby’s needs and your family’s budget. Consider requesting to follow the Illinois Tongue and Lip Tie Support Group on Facebook in order to connect with other concerned parents who can provide advice and support (but don’t let it replace professional advice and recommendations!)
In an ideal world, problematic tongue and/or lip ties would be identified in all babies shortly after birth. In actuality, many fly under the radar, often due to lack of nursing difficulties (since even babies with tongue ties that eventually become problematic can manage to nurse efficiently through compensations) or because babies with tongue ties may be bottle-fed (and drinking from a bottle is generally “easier” than breastfeeding, from an oral motor standpoint). When babies with tongue-ties go unidentified, they often become problematic eaters in childhood.
Feeding difficulties that may indicate a tongue tie include:
- Inability to chew age-appropriate foods
- Gagging, choking, and/or vomiting foods
- “Picky” eating/food refusals
- Pocketing foods (i.e., leaving pieces of food in crevices of the mouth for extended periods)
- Dental hygiene concerns
- Speech difficulties/decreased intelligibility (see next section)
Parents who are concerned about their child’s feeding difficulties are advised to seek an evaluation from an experienced speech-language pathologist, who can perform a comprehensive feeding evaluation and determine if an assessment by a pediatric dentist or ENT to rule out a tongue tie is warranted.
Remember the sensation of feeling “tongue-tied” referred to earlier, when speaking becomes difficult? For those who experience this during nerve-wracking events, this challenge is temporary and situational. For those with tongue ties in the diagnostic sense, talking can be a chronic challenge, due to physical limitations of the tongue when producing various sounds in connected speech. For instance, it may be difficult for someone with a tongue tie to elevate the tip of their tongue or retract their tongue in order to produce sounds such as: /t, d, z, s, l, r, th/. If these sounds alone are difficult for someone with a tongue tie to produce, imagine how challenging speech must be at the conversational level!
Again, the recommendation here is to seek a skilled speech-language pathologist, who will assess speech sound production as well as any physiological limitations that may be impacting an individual’s ability to produce speech sounds.
In typical craniofacial development, our tongue is aligned correctly in our mouths when it is resting in the roof of our mouth, without pushing against the back of our teeth. When a tongue is restricted by a short and tight frenulum, it cannot elevate to the roof of the mouth easily or comfortably. When this happens, the tongue will inevitably rest in a downward position, and may even push forward when swallowing (instead of up, in the roof of the mouth). These two occurrences will typically result in the following, in terms of dentition and jaw development: a narrow upper arch in dentition (teeth), an overjet of the front teeth, and an underdeveloped lower jaw. Tongue ties can and do change the shape of a person’s face during the course of their craniofacial development, which is why many people often learn the negative effects of a tongue tie when seeking cosmetic solutions to undesirable facial and/or dental features. This can include those who noticed a relapse in the alignment of their teeth/jaw following orthodontic treatment.
More important than cosmetics, detriments to jaw and dental development that result from tongue ties can include the following adverse symptoms:
- Clicking jaw
- TMJ pain
- Difficulties biting into/chewing various foods
- Poor self-esteem