This is a topic that seems to relate primarily to newly nursing babies or possibly shy people in social situations. We have neither of those here so why do I bring it up? Because 3 out of the 4 of us have a tongue tie! And all 3 will hopefully have this remedied in 2012.
But first let me back up. What is a tongue tie and why does it matter? Classic tongue tie (like in the photo above) is when the frenum, that is the piece of tissue under the tongue that attaches it to the floor of the mouth, extends too far toward the tip and prevents it from moving as freely as it should. In utero the tongue starts out fused to the floor of the mouth but should separate fully long before birth. One very simple test to see if you have a tongue tie is to open your mouth as far as you can and try to touch the roof of your mouth with your tongue. You should be able to touch the roof of your mouth without raising your jaw even a little. If you do this in front of a mirror you will see that it is attached further forward in the center than on the edges. This is normal. Tongue tie happens when that attachment goes too far forward. If you have a classic tongue tie you won’t be able to touch the roof of your mouth with your jaw fully open and it will be obvious that the attachment in the center is holding it back. This sort of tongue tie is the easiest to see and correct. It can vary in degree but you could very well have a severe one and have no idea. My husband of 10 years is almost completely tongue tied with a classic tongue tie. That is his frenum comes nearly to the tip of his tongue. Neither of us had any idea until I started looking into this a couple of months ago. No one ever mentioned a thing to him, not even his dentist and he just assumed his tongue was normal and people who could extend their tongue far out of their mouths were freaks. This kind of tie is also easy to see in a crying baby. When they cry they try to lift their tongue and the tether can be clearly seen.
Also when they stick it out it the tip of the tongue looks flat or like the top of a heart. It pulls in, in the center. My younger daughter had a tongue that looked like that at birth. You can see that the tongue is pulled in right in the center in the top photo.
Here we can see Einstein demonstrating that he does not have a tongue tie. A normal tongue should have a pointy tip like his does.
Another kind of tongue tie is called a posterior tongue tie. This is when you have a thick tissue on either side of the tongue under it that impedes it’s ability to move easily and correctly. This is very easy to overlook. You can’t easily see it and it can be very difficult to feel for some. It can be thin like a filament or very thick. It has been called a speed bump, fence or ridge in the bottom of the mouth. If you feel in the mouth with a finger it should feel smooth. If you feel that bump that is a posterior tongue tie. My experience is that it takes several tries to know if you are feeling correctly if you are wanting to educate yourself on this subject. It may or may not make it impossible to touch the roof of your mouth or stick your tongue out. In general the impairment can be harder to demonstrate and evaluate.
Lastly there is what is called a lip tie. This is where the piece of tissue that connects the lip to the center of the gums extends down too far. This can actually come down so far that it grows between the two front teeth. It obviously makes it difficult to move your lip up and away from your gums. A lip tie makes nursing very difficult for a baby since being unable to move their lip makes it difficult or impossible to get the proper seal on the breast. It also can pull the teeth out of alignment quite dramatically. We think of bone as being fixed, but a steady pull on it by muscle or tissue will always win.
Some of the consequences of a tongue tie are (this is not an exhaustive list)
- Inability to breastfeed successfully
- The baby failing to thrive
- Sleep deprivation for the infant and/or nursing mother because of more frequent nursing
- Pain for the nursing mother including nipple damage, bleeding, blanching or distortion of the nipples
- Mastitis, nipple thrush or blocked ducts
- Problems with introducing solids
- Inability to chew age appropriate solid foods
- Gagging, choking or vomiting foods
- Persisting food fads
- Difficulties related to dental hygiene
- Persistence of dribbling/messy eating
- Delayed/impaired development of speech
- Deterioration in speech
- Behavior problems
- Dental problems/cavities because of inability to clean teeth with the tongue
- Loss of self confidence because they feel and sound ‘different’
- Strong, incorrect habits of compensation being acquired
- Improper palate formation because the tongue isn’t able to rest against it and encourage it to expand
- Compromised sinuses because of the high palate.
- Need for braces
- Inability to open the mouth widely affects speech and eating habits.
- Always having to watch their speech
- Inability to speak clearly when talking fast/loud/soft
- Clicky jaws
- Pain in the jaws
- Protrusion of the lower jaw, inferior prognathism
- Effects on social situations, eating out, kissing, relationships
- Dental health, a tendency to have inflamed gums, and increased need for fillings and extractions
My older daughter was checked for a tongue tie at birth since she was having some nursing issues and I was assured that she didn’t have one. She always nursed often and for long sessions but I just assumed this was her personality since physically she was pronounced perfect by a lactation consultant. She had a tendency to click while she nursed which is a dead give away to a poor latch but since it looked good I was told it didn’t mean anything. She spoke very clearly from the time she started talking at 9 months old. Her baby teeth were straight and well spaced and her adult teeth are now coming in generally straight but a bit crowded. She hasn’t ever had a cavity. She does have reflux and some digestive issues. She also has a slight lisp (that I never noticed before I started looking) and some behavioral problems that have improved greatly with GAPS
. When I began checking my kids mouths I was surprised to discover that she has a posterior tongue tie. This was confirmed in an appointment with Dr Grawey
who has taken it upon herself to become a local expert in evaluating tongue tie. We aren’t absolutely certain that her posterior tongue tie is contributing to these issues but since she has a lisp and a narrow palate and it is a very simple procedure, we are going to get it corrected and hope that it will have multiple benefits for her.
My younger daughter had an mild classic tongue tie at birth with a slightly heart shaped tongue, but since she seemed to be nursing well I didn’t think I needed to do anything about it. Her pattern of frequent extended nursing seemed normal to me after my experience with her sister. Both girls gained very slowly but since they started out very large (9.9 and 11.1 respectively) I was told that this can be normal for big babies. After a few months she no longer had a heart shaped tongue and I assumed her tongue tie had resolved itself. Little J still talks like a toddler at nearly 4. She can’t make l or r or most blends and while this may be within normal for kids her age it points to improper use of her tongue that may or may not improve on it’s own with time. I did baby led weaning with my older daughter and tried it with J but she would get tired of feeding herself long before she was full and would then be cranky because she was hungry. Chewing was very tiring for her and she happily ate baby food off of a spoon I offered for a long time. She is now nearly 4 years old and will still request that we feed her almost every day for at least part of a meal. I always assumed it was because she has some low tone issues but since her low tone symptoms are largely related to eating I’m not so sure anymore. She had lots of digestive issues including motility issues, gagging and vomiting regularly when she was younger. Also persistent reflux and food sensitivities. GAPS has helped these issues a lot but they aren’t gone. Also her top center teeth are tilted in at the center and her bottom center two teeth have a significant separation between them. She currently has both a posterior tongue tie and a lip tie (her classic tongue tie has stretched enough that we think it isn’t an issue any longer) and while we can’t know for certain that it is contributing to all of her issues it certainly is effecting her tooth alignment and needs to be fixed soon before her adult teeth come in. I have high hopes that it will benefit far more than her appearance.
My husband has relatively clear speech, when he isn’t trying to talk quickly. (I do regularly accuse him of speed mumbling). He has only one cavity that he got recently (despite a WAPF/GAPS diet and straight teeth that never needed braces. He even still has 3 of his wisdom teeth! However, he has an extremely high narrow palate that most likely contributes significantly to the chronic sinus issues he has dealt with his whole life. Correcting his tongue tie can’t fix that now (but probably would have if it had been done when he was a young child). In fact it may be that correcting it now won’t fix much of anything. His tongue has been trained over the course of his life to act in a certain way to compensate for it’s impaired range of motion. The Dr who examined him commented on how big and thick his tongue is to make up for it’s impaired range of motion. This is one reason why the earlier the better for correcting a tongue tie, even a mild one. It has very low risk of harm and it gives the body the ability to develop a normal wide palate and proper tongue movement and speech patterns. It could be that Big J will naturally be able to take advantage of that new tongue freedom and be able to speak clearly at the speed of light, just like he has always wanted to. Or he may need therapy to teach his tongue how to move correctly before he will see improvement in his speech or other tongue related issues. I have often said that he is the luckiest person I have ever met, so if anyone will naturally improve from this procedure it will be him
So, now that we know, what can we do about it? Newborn babies often have their tongue tie corrected with a pair of scissors while being held immobile. Painful but quick and an important solution for a significant problem. Past the newborn stage that is impossible. The procedure itself doesn’t take long and isn’t complicated but you can’t have a flailing infant with scissors in her mouth. She has to wait till at least 6 months old to be old enough for general anesthesia. Infants generally recover very quickly from surgery but for an older child or adult recovery from a conventionally done tongue tie surgery take a week to 10 days and is painful plus the recovery from general anesthesia and the risks of it make many reluctant to revise any but the most severe tongue ties past infancy. Now, however, thanks to modern breakthroughs, the surgery can be done with a laser, painlessly without general anesthesia and with almost no recovery time. Just a topical anesthetic is used. Not even an injection of Novocaine is required in most situations. The procedure itself takes under 5 minutes, even for a complicated case. Many laser dentists are able to do this procedure right in their office. The Dr that we saw is in the process of getting a laser for herself but currently refers out most older children and adults. We have found a local laser dentist, Dr James Maxwel , with experience correcting tongue ties. He has a water laser that contains a topical anesthetic right in the water that is part of the laser. No shots, no trauma and very quick. Our dental insurance even covers the procedure out of network at 80%! It is considered a basic procedure. Of course check with your insurance for your own coverage. My husband is going to go first and get his tongue tie corrected and then we will see about scheduling the girls for their procedures. Depending on who does it, it may be covered by dental insurance or medical insurance.
This procedure is also done by ENT’s, Family Doctors, Pediatricians, and the like. Different Dr’s with all different bents decide to learn about this and help people with this little known but very real problem. Some estimate that as many as 10% of all people have the problem to one degree or another but most put it between 4-6%. If your Dr isn’t very informed ask if they know someone who is. You could also contact your local La Leche League leader and ask her if there is a local Dr or dentist who is able to diagnose and treat tongue tie.
It is not known what causes a tongue tie. It does tend to run in families. One theory is that it is a midline defect (your tongue is in the middle of the body after all). Midline defects include some very serious life threatening problems but may also be quite minor. It has to do with the very earliest development of the baby in utero. Midline defects can be caused by low folate in the mother. They happen very early in the pregnancy so the woman needs to have enough folate in her body before she gets pregnant or it is too late. This is why many processed foods are fortified with folic acid and women of childbearing age are encouraged to take prenatal vitamins even when they aren’t pregnant. Unfortunately folic acid supplementation isn’t very helpful for the estimated 40% of Americans with MTHFR mutations who can’t convert the folic acid found in supplements and fortified foods into the active form that their body needs. Testing for MTFR is a simple blood test and is usually covered by insurance. I hope to write a blog post about that soon as well. MTHFR has far more implications than just tongue tie and needs it’s own post.
Here are some links for you to do your own research
TongueTie – Home
I hope you have found this post helpful and that it might help prevent or resolve issues for some of my readers. I never would have guessed that this was an issue for my family until this fall and I wish I could go back in time to correct this for my children at birth. Who knows what that simple procedure might have prevented in them. (and how much more sleep I would have gotten.)
I am adding a link here to my first post on MTHFR.
My husbands tongue tie is now fixed. My post about that is here. Tongue Tie #1 is Fixed