Tongue tie occurs when a tight band of tissue restricts the tongue's movement. Here's a detailed explanation of how this condition functions:
Understanding Tongue Tie
Tongue tie, also known as ankyloglossia, is a condition present from birth where the lingual frenulum, a small piece of tissue connecting the underside of the tongue to the floor of the mouth, is abnormally short or tight. This restriction hinders the normal range of motion of the tongue, preventing it from moving freely.
Normal Tongue Movement vs. Restricted Movement
| Tongue Function | Normal | Restricted by Tongue Tie |
|---|---|---|
| Extension | The tongue can extend past the lower lip. | The tongue cannot extend past the lower lip, often appearing notched or heart-shaped at the tip. |
| Elevation | The tongue can reach the hard palate (roof of the mouth) and the upper teeth. | The tongue struggles to reach the hard palate or upper teeth. |
| Lateral Movement | The tongue can move easily from side to side. | Side-to-side movement may be limited, impacting speech articulation. |
| Functional Movements | The tongue can perform the complex movements required for speech, feeding, and swallowing without difficulty. | Difficulty with feeding (especially breastfeeding), speech issues, and other orofacial functions may occur. |
Why Restricted Movement Matters
The limited movement caused by tongue tie can impact various functions:
- Feeding:
- In infants, it can cause difficulty with latching and sucking, making breastfeeding challenging. This often results in poor weight gain for the baby and pain for the nursing parent.
- In older children and adults, it might make eating certain foods difficult.
- Speech:
- Restricted tongue movement can affect the articulation of specific sounds, particularly 't', 'd', 'l', 's', 'z', 'th', and 'r'.
- Oral Hygiene:
- Difficulty cleaning the mouth may increase the risk of cavities and gingivitis.
- Other:
- In some cases, it can lead to jaw pain or difficulty with musical instruments.
How the Tissue Restriction Works
The lingual frenulum’s job is to anchor the tongue, however in tongue tie cases, the tissue is either too short, too tight, or attaches too far forward. This causes:
- Reduced mobility: The tight frenulum essentially acts as a tether, limiting the tongue's range of motion.
- Strain: Attempting to move the tongue past this restriction can cause strain on the frenulum.
- Impact on muscle function: Over time the muscles responsible for tongue movement may have difficulty reaching their full potential leading to problems with speech, eating and swallowing.
Examples
For example, a child with tongue tie may have difficulty licking an ice cream cone or sticking their tongue out. An infant might struggle to latch onto the breast, leading to inadequate milk intake and discomfort for the parent.
Solutions
- Frenotomy (or Frenectomy): The most common treatment involves a simple procedure where the frenulum is either snipped with scissors or laser surgery. This releases the restriction, enabling a full range of motion. This can be done in the office by a trained provider such as a dentist or doctor.
- Speech Therapy: Following a frenotomy or frenectomy, speech therapy might be necessary to improve speech articulation and correct any muscle imbalances.
In summary, tongue tie works by physically restricting the tongue’s movements, impacting key functions like eating, speech, and oral hygiene. The tissue’s tightness and location determine the severity of the restriction.
