Tongue-Tie

Tongue-tie, or ankyloglossia, is a condition that some babies are born with, affecting their tongue movements. Normally, your tongue should have full flexibility to reach all corners of your mouth, allowing you to produce various sounds when you talk and aiding in swallowing and cleaning your mouth from food particles.

In individuals with tongue-tie, there’s an abnormality in the lingual frenulum, a small strip of tissue connecting the underside of the tongue to the base of the mouth. This tissue may be too short, tight, or attached near the tip of the tongue. In mild cases, only a small fold of tissue may restrict tongue movement, while in severe cases, the entire underside of the tongue is tethered to the floor of the mouth.

About 10% of newborns experience ankyloglossia.

How to identify tongue-tie

Identifying ankyloglossia in your baby involves observing the shape of their tongue, particularly when they cry or lift it. The tip may resemble a heart shape, and you might notice that your baby’s tongue:

• Struggles to move sideways adequately.
• Cannot reach the upper gums or roof of the mouth.
• Fails to extend beyond the gums.
• Is unable to curl towards the nose or lick the lips.

Additionally, examining the frenulum when your baby cries or yawns can reveal whether it is tight or short, further indicating tongue-tie.

Tongue-Tie Causes and Risk Factors

1. During fetal development, the lingual frenulum initially adheres to the tongue but typically separates before birth to allow unrestricted tongue movement.
2. In some cases, this separation does not occur, leading to tongue-tie. The exact reason for this failure of separation is unknown.
3. There may be a genetic predisposition to ankyloglossia, as it can run in families.
4. Studies indicate that male infants are approximately twice as likely to be affected by ankyloglossia compared to female infants.
5. Tongue-tie is more commonly observed in first-born babies.
6. Race or ethnicity does not appear to be a significant factor in the occurrence of tongue ties.

Symptoms tongue-tie

Tongue-tie is often identified due to challenges encountered during breastfeeding. If your newborn has a tongue tie, you might observe the following symptoms:

1. Difficulty latching onto the breast properly.
2. Tendency to chew more than suck during feeding.
3. Inadequate weight gain.
4. Extended feeding sessions are interrupted by short breaks, followed by further lengthy feeding.
5. Fussiness during feeding.
6. Clicking sounds while nursing.
7. Constant hunger cues.

In addition to your baby’s symptoms, you might experience:

1. Pain during and after breastfeeding.
2. Sore or cracked nipples.
3. Mastitis, which is inflammation or infection of the breast,.
4. Low milk supply.

However, it’s important to note that breastfeeding difficulties can stem from various causes, so it’s advisable to discuss any concerns with your doctor.

For children, signs to watch out for include:

1. Difficulty pronouncing certain sounds like “t,” “th,” “d,” “r,” “l,” and “s.”
2. Challenges with swallowing or moving the tongue sideways.
3. Difficulty licking an ice cream cone or playing a wind instrument.

While ankyloglossia doesn’t typically delay speech development, it may lead to difficulty pronouncing specific letters. However, it’s essential to recognize that ankyloglossia might not be the sole cause of speech issues. Some research suggests that there is “no difference” in speech development between children treated for ankyloglossia and those who aren’t.

Diagnosis

Diagnosing tongue-tie usually involves a physical examination by a healthcare professional. During the examination, the doctor will:

1. Inquire about breastfeeding experiences.
2. Examine your child’s tongue, mouth, and teeth.
3. Use a tongue depressor to assess the underside of the tongue and evaluate its range of motion.
4. For older children, the doctor may request that they move their tongue and produce certain sounds for further assessment.

Treatments

Treatment approaches for ankyloglossia vary among healthcare providers. Some may opt for immediate intervention, while others may prefer a wait-and-see strategy. In certain instances, the frenulum may naturally loosen over time without causing significant long-term issues. Before considering surgery, doctors may recommend consulting a speech therapist or lactation consultant to address speech or breastfeeding challenges.

Tongue-tie surgery, if deemed necessary, can be performed in different ways:

1. Frenotomy: This simple procedure is typically done in a doctor’s office without the need for anesthesia. Using sanitized scissors, the doctor clips the frenulum, which contains few nerves or blood vessels, resulting in minimal pain or bleeding. Babies can breastfeed immediately after, which can be comforting and aid in healing.
2. Frenectomy: Similar to frenotomy, this procedure involves the complete removal of the frenulum.
3. Frenuloplasty: If the frenulum is too thick for a simple snip or if additional repair is required, this option may be chosen.

Surgery procedure for tongue tie removal

During surgery, the doctor may administer anesthesia to ensure the child’s comfort, then use specialized instruments to cut the frenulum and apply dissolvable stitches to aid in wound healing. Some hospitals may use lasers instead of traditional surgical tools, eliminating the need for stitches.

Additionally, doctors may recommend tongue exercises for babies to prevent reattachment of the frenulum and improve tongue movement, although this is typically not necessary for older children.

The prevalence of tongue-tie surgery has increased over the past two decades due to heightened parental awareness and demand. While some healthcare providers believe that surgery is often unnecessary, evidence from clinical trials suggests that frenotomy can lead to improvements in breastfeeding. However, further research is needed to fully understand the impacts of surgery on breastfeeding and other related factors.

Risks associated with tongue-tie surgery

Treatment for ankyloglossia through surgical procedures is generally considered highly successful, with a rare occurrence of complications. However, like any medical intervention, there are potential risks associated with these procedures, including:

1. Bleeding.
2. Damage to the tongue or salivary glands.
3. Infection.
4. Scarring from frenuloplasty, which may affect tongue movement.
5. Adverse reactions to anesthesia.
6. Possibility of the surgery not fully resolving the issue.

Complications of ankyloglossia

Untreated ankyloglossia can lead to complications as the child grows older, including:

1. Dental problems such as tooth decay, gum inflammation, and gaps between the lower front teeth due to limited tongue movement for removing food debris.
2. Excessive drooling and mouth discomfort.
3. Difficulty swallowing or choking on solid foods.
4. Challenges with everyday activities like licking an ice cream cone or kissing.
5. Speech difficulties, particularly with certain sounds like rolling an “r,”

Discussing the best course of action with your doctor is essential to determining the most suitable treatment approach for you and your baby.

Points to note:

• Surgical intervention can effectively address tongue-tie in babies but may not always resolve breastfeeding or speech issues entirely. Consulting with a doctor is crucial to assessing the necessity of surgery.
• Tongue-tie doesn’t always require correction, as it may not significantly impact a baby’s life in some cases.
• The ideal age for an ankyloglossia procedure is typically between 6 months and 6 years, although some healthcare professionals advocate for early intervention, even as early as 2–6 weeks. However, adults can also undergo a fenectomy. It’s advisable to consult with your doctor to determine the appropriate timing for the procedure.
• If left untreated, the consequences of ankyloglossia vary depending on the child. While some may experience no significant issues, others may encounter difficulties with breastfeeding, speech development, eating certain foods, and maintaining dental hygiene later in life.

Sources

1. Children’s Hospital Association: “How to tell if your baby is tongue-tied.”
2. International Journal of Pediatric Otorhinolaryngology: “Speech production in young children with tongue-tie.”
3. Smile Wonders: “When is the best time to get my baby treated for a lip and/or tongue tie?”
4. StatPearls: “Ankyloglossia (Tongue-Tie).”
5. Cleveland Clinic: “Tongue Tie (Ankyloglossia).”
6. Mayo Clinic: “Tongue-Tie (Ankyloglossia).”
7. Children’s Hospital of Philadelphia: “Ankyloglossia (Tongue-Tie).”
8. National Health Service: “Tongue-Tie,” “Tongue-Tie: Advice for Parents and Carers.”
9. Nemours Kids Health: “Tongue Tie (Ankyloglossia).”
10. Otolaryngology: “Clinical Consensus Statement: Ankyloglossia in Children.”
11. CMAJ: “Ankyloglossia (tongue-tie).”