“Tongue tie”, also known as Ankyloglossia, is a common condition developed in vitro in which the cord of tissue (lingual frenulum) that connects the bottom of the tongue to the floor of the mouth is unusually short. This restricts the mobility of the tongue and affects speech development, eating habits, and even social skills of children. Tongue tie is often genetic, and it is advised to get your newborn checked, as it is not always fully apparent until they are a little older.
Thanks to advanced treatments, being “tongue tied” can easily be fixed as soon as the condition is noticed. Depending on the method used, tongue-tie can be treated and healed within 24 hours. If surgery is performed on infants for tongue tie, speech issues may be prevented during the child’s speech development.
Based on an interview with Dr. Phu-My Gep from Woodbridge Kids Dentistry, a pediatric dental office in Vaughan, Ontario, we learned a little more about tongue tie, what the symptoms are, why it should be treated, and how it can be treated.
The Different Types of Tongue-Tied
Anterior tongue-tied: With anterior tongue tie, the underside, tip of the tongue is connected to the floor of the mouth being connected by the lingual frenulum membrane. This type of tongue tie causes decreased mobility of the tongue tip. This type of tie is the most easily recognizable. This can interfere with nursing causing maternal discomfort, speech delay, and articulation and can cause pulling on gingival tissue causing dental and periodontal defects of teeth.
Posterior tongue-tied: With posterior tongue tie, the tongue tie is beneath the mucus lining of the mouth. Because it is hidden under the lining, this type of tongue tie is not easily visible, but it can be felt if you run a finger from side to side underneath the tongue. If the child has posterior tongue tie, you will find that their tongue is anchored to the floor of their mouth; this prevents the tip from moving freely.
Maxillary lip tied: This type of tie affects the maxillary frenulum, which is the tissue that attaches the infant’s gums to the middle upper lip. Maxillary lip tie can interfere with normal mobility and reduce the function of the upper lip. In newborns and infants, it may affect the ability to latch for nursing. It may also cause a gap in the front teeth.
Symptoms of Tongue-Tie
Symptoms of tongue tie include the following:
- Impaired tongue mobility
- Pain
- Trouble moving the tongue from side to side
- Trouble swallowing
- Difficulty sticking tongue out past the lower front teeth
- Inability to self-cleanse (teeth)
- Vomiting
- Low weight
- Tongue cannot touch the roof of the mouth
- Difficulty licking lips
- Excessive drooling
- Trouble breastfeeding
Why Tongue Tie Needs to be Treated
Not all lip and tongue ties need to be corrected. It is individually based. Lip ties sometimes self-correct as permanent incisors erupt. Tongue ties tend not to self-correct and surgical correction is only indicated if there are symptoms related to the tie. If you suspect your child or anyone in your family has a tongue or lip tie, it is best to have a consultation to determine if surgical intervention is necessary. One issue that can occur is the appearance and structure of the teeth and face will be affected, which will alter their oral function; this can in turn, affect the child’s speech development (their ability to talk). It also affects their ability to breastfeed, eat, digest food, kiss, and can even affect their social skills. If they have issues bottle or breastfeeding and eating, it will lower their weight drastically.
In terms of dental health, the inability to move the tongue and self-cleanse may result in messy eating habits, and food particles get stuck in the teeth. This can result in cavities and tooth decay. Leaving a tongue tie can alter the child’s self-esteem due to difficulty speaking or excessive drooling.
Treatment Options
Tongue tie is treated by surgery; there are a few different surgery options for treating tongue tie, which includes snipping, revision of the frenum, and soft tissue laser surgery.
Snipping: Snipping was originally the only method of treating tongue tie as far back as the 1600s. The tie was divided by sterilized scissors to free it. This allowed the infant to feed easier. With the introduction of laser surgeries, which are much less painful for the child, and promotes faster healing and reduces post-operative pain. Soft tissue lasers also allow for a more complete release of the tie.
Revision of the frenum: This surgery is often performed in hospitals, and like snipping, it frees separates the tie by cutting only with surgical tools rather than scissors. The surgery can be performed as early as 6 months, though often if the infant is that young a general anesthetic is used. If the child is older and will cooperate with the surgeon, anaesthetic is not necessary. This treatment is used if the tongue tie is more complex, and there is a risk of cutting important blood vessels in the mouth. A disadvantage with this treatment is it prolongs the timeframe in which the infant heals and can begin feeding again. Once the child heals, they will have no trouble moving their tongue, feeding, or developing proper speech.
Soft tissue laser surgery: Soft tissue laser surgery cuts the tongue or lip tie with a laser, similar to snipping, but it is often painless, takes only a few minutes to perform, and often the child heals in a few hours but complete healing takes 1 to 2 weeks. The laser can instantly correct the tongue tie; the child will be able to bottle or breastfeed after an hour, and is able to eat solid food within 24 hours. This surgery can be done without the need for general anesthetic and sometimes without the need for local anesthetic (freezing) especially in newborns and infants. An older child over 6 months may require sedation or general anesthetic depending on their level of cooperation. You may notice a small amount of bleeding from the cut at first, but it should stop within 24 hours of the operation, as the tissue is very thin.
Soft tissue laser surgery is the most advanced treatment for tongue tie. Compared to other tongue tie treatments, the soft tissue laser procedure is safe and minimally invasive surgery with the fastest recovery time, and mild or no pain or major side effects. This operation is often performed at dental clinics. Drs. Phu-My Gep, Charlene Walker and Monica Gawlik at Woodbridge Kids Dentistry are trained in using the soft tissue laser, and are all experienced to perform this surgery.
Are tongue tied procedures covered by OHIP?
Ontario Health Insurance Plan (OHIP) does not cover tongue tie procedures done in a dental clinic. Often personal dental insurance will cover a portion, if not all of it. If you want to find out if your can get the procedure covered by your insurance, you can either contact your dental insurance provider or call and ask our financial coordinator. If you are concerned about your child’s tongue or lip tie, we highly recommend that you make an appointment to get it assessed with our pediatric dental specialists.