As a laser dentist who sees a lot of babies, I get asked about posterior tongue ties every day. I thought explaining what this is would answer a lot of questions. Here I go…
We all have seven frenums in our mouths. Our tongue only has one frenum, and it is the midline under the tongue. When a person is “tongue-tied” it means that tissue is restricting their function. We gather a thorough health history and ask a lot of questions, not just evaluating the child’s weight gain. So, to determine if a frenulectomy is recommended, we discuss symptoms and physical findings. For babies, I evaluate what they are doing with their tongue by having them suck on my gloved finger and watching their mouth and tongue move. For children and adults, I ask they to go through some range of motion exercises.
An anterior tongue tie is tethered tissue that can be more readily seen. Oftentimes, the frenum creates a fence-like barrier to prevent a finger from sweeping the floor of the mouth from one side to the other. Many people can see the tight tie when the baby is crying. These restrictions often insert towards the tip of the tongue and may create a “cute” little heart-shaped tongue. Anterior tongue ties can be very thin like a guitar string or very thick like a Twizzler stick. Many of these ties prevent the tip of the tongue from normal movement up, to the sides and out of the mouth. All anterior ties have a posterior component. Even if the front part of the tongue is “clipped” and the tongue tip is free, the deeper (or further in) part remains. The significance of this is that a deeper frenum attachment restricts the upward movement of the mid and back portion of the tongue. A posterior tie is problematic by interfering with normal suck, swallow and breathing functions. Often times it leads to gagging, gulping of milk, spitting up, symptoms similar to reflux, excessive gas, nasal congestion upon waking, chomping on the breast and a tongue thrust motion. There are many other complications including but not limited to improper rest position of tongue, which leads to a narrow maxillary arch, which leads to poor facial growth. A future consequence is often malocclusion, mouth breathing and sleep disturbances.
Many people who have problematic tongue ties don’t have an attachment in the front (anterior part). Unfortunately, they are often much more difficult to see. As a trained laser dentist who releases posterior tongue ties, I examine the baby from the 12 o’clock position with the baby laying flat. My pointer fingers go under the left and right sides of the tongue and the tongue is elevated. My finger tips are nearly touching. Examining this way allows me to see if a posterior tie exists. I take a photo and also feel for a restriction by sweeping across the floor of the mouth. That area should feel soft, without a hard cord of tissue in the midline. After practicing dentistry for 15 years (seeing thousands upon thousands of people) and going through continuing education on restricted oral tissues, I am able to give an accurate diagnosis of a tethered oral tissues. I am a general dentist, which means I treat all ages.
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Many health care providers are not trained in what to ask of parents regarding the symptoms that may be caused by a problematic frenulum attachment. Often a tongue depressor is quickly used while the parent holds the baby upright or is in a car seat. An absent or poor examination combined with myths regarding tongue-ties (that is passed down through educational system) leads to people hearing that oral tethered tissues do not affect suck, swallow, breathing for infants. Personally, I remember being taught in dental school that if they have a tongue tie, a surgeon needs to sedate the person and do an extensive procedure called a z-plasty. Also, I was told that a thick or low labial frenum, will eventually trip and tear it when the child falls on their face. Really? Thankfully lasers can easily treat these problems without sedation, without sutures and a long healing time. I am amazed that we were taught to tell parents that a potential trauma will solve an anatomic and functional problem. My blood pressure is raising as I continue to write. I am upset with the lack of knowledge in general for health care practitioners and moms being told it’s a problem with a lazy baby, too heavy of a let down, or that the child just needs to “get it eventually.” I also hear that a tongue tie is “a little tight” but will probably be ok if the child is gaining. Breast feeding success is so much more than just a measure of weight gain. I know what you are going through if you are a nursing mother reading this, because I have been there. The problems are not in your imagination.