When people call our dental practice, and want to have an evaluation for a tongue tie for a 4 through 99 year old, they will actually receive what we call an “airway exam”. The tongue functioning properly is imperative for optimal airway growth, therefore Dr. Geisler will take into consideration the whole person, and not just look under the tongue. For children, we ask that parents complete a sleep inventory questionnaire, which is emailed specifically to you prior to the appointment. Before we even walk you back to the clinical space, a thorough health, sleep and dental history is discussed in the consultation room. After our first conversation, photos of the face, the upper and lower arches, the tongue, the back of the throat and the full body posture are taken. We measure your end tidal CO2 and breathing in our office with a capnometer, which is easy and painless. Measurements of maximum opening of the mouth, tongue up to the palate and also making a suction are taken, along with a measurement of the length of the lower face and widths of the upper arch. The tonsils, back of throat, entire dentition and nares are examined. We very frequently recommend sleep screening, that is easy to do at home. A good airway and good sleep go hand in hand. Often, people who have a tongue-tie have many compensations and a collapsible or narrow airway. An assessment named the fatigue severity scale (FSS) is a helpful tool we use to get a baseline of fatigue and it’s day to day effect on activities of daily living. We often will look at films taken in the past, or we may request new films be taken. For example, we often request a panorex, a cephalometric film, or a cone beam CT (CBCT). Dr. Geisler will feel many muscles of the head and neck for tenderness and check the range of motion of your jaw. Oftentimes, we watch the person eat a piece of food and drink water. The next steps are varied, but often result in referrals to other healthcare professionals, such as (but not limited to) an ENT, a sleep doctor, a chiropractor, an orthodontist, a physical therapist, and a myofunctional therapist who is also a speech language pathologist (known as a COM). Just as every person is unique, the next steps Dr. Geisler recommends are not a the same for every person.
When a tongue-tie is diagnosed, we talk about when that should be released with a frenectomy. The specific procedure that is performed at Life Smiles for adolescents and adults is coined a “functional frenuloplasty.” This procedure involves sutures. On the other hand, children are treated with a CO2 laser and the laser site is left open. If you are fascinated with lasers, check out the website for the LightScalpel laser. Life Smiles will release patients who have successfully gone through oral myofunctional therapy. For others who have a tongue tie, the tongue-tie release may be recommended mid-way through a series of steps. As the public knowledge of tongue-ties increases, there are some people who are convinced that a simple “snip” will resolve their health concerns and seek just the procedure. Dr. Geisler has seen that poor results can be expected if therapy isn’t done before and after the procedure.
In our dental practice, we have two different types of sleep screening tools that are recommended and are worn at home. Both are not worn at the same time, and they are both easy to use, really! If you have never seen a photo of a person wired up for a sleep study in a lab, just do a web search, and you appreciate the simplicity of our screening. The device that is approved for age 6 months of age and up is made by a company named Sleep Image and is a single lead EKG called a Cardiopulonary Coupler. The second device is called a high resolution pulse oximeter (HRPO) and can be used for both children and adults. The reports from our devices are not a true or medically official sleep study. A software report is generated after a few nights sleep and works as a tool to get a balance objective measure of sleep quality and helps us decide who needs to see a sleep physician. Because the screening devices are easy to use, while you sleep in your own bed, it is reasonable to follow-up in 6-12 months after any therapy, to objectively compare data to assure we are truly improving sleep quality. Dr. Geisler uses the first mentioned device for very young children and for others who are very sensitive to their sleeping environment.
Sleep Disordered Breathing (SDB) is what we are trying to either find, or rule out. SDB is a spectrum, and has numerous presentations. Some symptoms that are related to sleep disordered breathing are:
Difficulty falling asleep
Difficulty staying asleep
Gasping or choking
Pausing breathing (apnea)
Recurrent tonsillitis or history of tonsils and/or adenoid removal
Poor school or work performance
Tossing and turning
Feeling stressed out upon wakening
Not feeling rested after a good amount of hours of sleep
High resting pulse rate
Falling asleep on sitting
Falling asleep while driving
Dry mouth on waking
Neck and shoulder pain
Forward head posture
Low thyroid hormone
Difficulty losing weight
Depression and anxiety
Above is a long enough sampling list to convince almost anyone that ideal breathing while sleeping is crucial for optimal health!
Whenever I feel blue, I start breathing again. – L. Frank Baum
Learn more about tongue and lip tie releases at Release and Breathe Dentistry.