Tongue-tie is also known as ankyloglossia. This condition comes from a genetic mutation, and it develops when a child is still in the womb. The gene mutation that causes tongue-tie makes the child have a frenulum that is either too short or too thick.
A frenulum is that flexible tissue that connects the sublingual region of the mouth to the tongue. It should be long and flexible enough to allow the tongue to move freely to perform various functions. An overly short frenulum reduces the tongue’s reach, while thickness reduces the tongue’s flexibility and reach.
Since it is a genetic condition, tongue-tie runs in families; thus, parents should be extra vigilant with their newborn babies if there have been such cases in their family in the past. It is also noteworthy that while any child can get this condition, it affects more boys than girls.
The following are some of the notable effects of the tongue-tie.
- Difficulties in breastfeeding: babies use the tongue to press on the breast and express breast milk. They need to place the tongue over the lower gum or teeth. When a child has a tongue-tie, it doesn’t extend long enough to get over the gum. This means that the child will be chewing on the nipple instead of sucking.
The chewing will cause the mother pain, and it may inflame the nipple to make it impossible for her to breastfeed. This chewing may also cause the mother to contract mastitis and other infections on the breast.
The difficulties in breastfeeding also manifest in the child’s attitude during breastfeeding. The child becomes fussy due to frustration; they also make a clicking sound as they take long periods suckling with short breaks in between.
Chewing doesn’t effectively express the milk. A child with tongue-tie doesn’t breastfeed properly, and they may be malnourished, especially if breastfeeding is their sole source of nutrition. They appear hungry all the time because they are often unable to lick their lips.
- Difficulties in Maintaining Oral Hygiene: The lack of tongue flexibility caused by tongue-tie makes it difficult to remove food particles from the tongue. The best time to clean the tongue is when it is stretched. A flaccid tongue makes it difficult for the toothbrush to move effectively. Poor oral hygiene leads to mouth odor, gingivitis, and tooth decay. These conditions can significantly reduce a person’s quality of life.
- Difficulties in Speaking: A person with this condition will find it difficult to make sounds that require certain tongue positions that the tongue-tie makes impossible to achieve. Some of these sounds include; ‘d,’ ‘l,’ ‘r,’ ‘s,’ ‘t,’ ‘th,’ and ‘z.’
- Deformities and Other Oral Challenges: sometimes, this condition causes a gap between the two lower teeth. It also makes it hard for a person to engage in otherwise simple activities that require them to move the tongue, such as licking one’s lips, rolling the tongue, playing a wind instrument, kissing, licking ice cream, etc.
The difficulties above experienced by a person with the condition form a large part of the symptoms. There are other possible symptoms as below.
- The tongue moves only a little from side to side, and they can’t stick it out of their mouths.
- The patient can’t touch the upper gum or cleave the tongue to the top of the mouth at will.
- The tongue may have a V-shape when they try to stick it out. The short or thick frenulum holds it backward, causing the tongue to stretch inwards, thus the V-shape.
A clinician will want to know how a child with tongue-tie is feeding and ask them to stick out their tongue for diagnosis. The doctor may also use a tongue depressor to help them examine the range of motion, especially when the patient is too young to follow instructions when required to stretch the tongue. Older children may be requested to make some sounds whose pronunciation is usually negatively affected by tongue-tie.
Treatment for tongue-tie often occurs when the patient is still a child. This is the best time as it helps the baby breastfeed and thus avoid the adverse consequences of lack of proper nutrition. Early treatment also helps the child avoid the social stigma associated with the inability to pronounce certain words properly later in life. There are two treatment options for this condition:
This is a minor surgical procedure that often occurs right in a tongue tie doctors’ office. All the doctor needs is a pair of sterile scissors with which they clip the offending frenulum. This procedure typically doesn’t need numbing because the frenulum has a minimal number of nerves and blood vessels.
As a result, the clipping doesn’t cause much pain or blood loss. The treatment doesn’t cause any significant disruptions in the patient’s life. A child can proceed to breastfeed as soon as the frenotomy is conducted. It is recommended that that do so as it helps to calm the baby. Frenotomy is ideal when the frenulum isn’t too thick.
This is the treatment method to use when the frenulum is too thick for a simple snip. The doctor might use scissors or a laser to cut the frenulum. This procedure will require the child to be anesthetized to protect them from the pain.
Stitches aren’t necessary when the doctor uses a laser to cut the frenulum, but they will use a few stitches on the area when the doctor has used scissors. These stitches usually dissolve by themselves after a while, and the child’s growth is typical afterward.
This treatment usually has no complications except for the rare case of bleeding and infection. There have been some reported cases of damaged sublingual salivary glands, but these are extremely rare. It would take a doctor to rapture the glands mistakenly, and this is highly unlikely.
Besides treatment options, there is a variance of opinions between doctors on whether treatment is necessary and when it should be done. Some experts argue that tongue-tie often resolves itself as children grow, and it isn’t essential to treat it. They say that parents should at least wait to see whether the tongue will loosen on its own.