Tongue Tie Clinic
Tongue tied can have serious negative affect on facial development and general health. We use Laser to treat tongue tied


Tongue-tie, professionally known as ‘Ankyloglossia’, is a congenital condition in which the lingual (tongue) and/or labial (lip) frenum (sometimes called frenulum) is too tight, causing restrictions in movement of these parts. This in turn can cause significant difficulty with key functions of this area of the mouth including speech, swallowing, eating and breathing. For infants, the key function of the mouth region is to breast-feed so restrictions of the motion of tongue and position of lips can have a significant impact on successful breastfeeding.

 

In providing some preliminary information about tongue tie, it is important to note that each mother/baby dyad is very unique and hence tongue/lip tie issues can present differently for everyone. Some common symptoms that may point to the infant being tongue/lip tie are included in the Sign and Symptoms section below.

Some mothers and infants manage to cope with some or all of these issues, either by compensating through postural, positional or other ways. For many, however, it impacts on successful breastfeeding, and compensations that may work in the initial phases of breastfeeding become less effective when milk supply is diminish.  Milk supply of the mother is driven by demand rather than by her hormones. 
There are lifelong implications for tongue and lip ties beyond breastfeeding, so it is important to establish early competence in the use and position of the tongue. Short term compensations frequently lead to establishment of long-term habits, which manifest in other issues across the lifespan. Merely ‘coping’ is neither favoured nor ideal for long term habits and functions. 

 

Tongue or lip ties present in many different shapes and forms. Classic tongue-ties are obvious with the end on the tip of the tongue or cause a heart-shaped tongue. However, tongue ties can be deceptively hidden in the underside of the base of the tongue, called sub-mucosal tie and cannot be easily visualised. This “sub-mucosal tie” is also called a posterior tongue tie. Proper assessment and evaluation from a clinician or health carer who is experienced with their identification is critical.

 

Signs and Symptoms of Tongue tie and lip tie in infant
• Difficulty latching 
• Slipping off the nipple
• Lethargy  during feeding 
• Sleepiness during feeding 
• Irritability during feeding 
• Poor weight gain 
• Clicking noise during feeding 
• Trickling of milk whilst breastfeeding or bottle-feeding  
• Digestive complications (e.g. increase in flatulence, reflux, nausea, heaving and vomiting ) 
• Nipple pain/injury for mother 
• Increase risk in nipple/breast infections 
• Diminished milk supply from mothers 

 

Tongue ties in Children:

- Children with tongue tied are almost always breathing through their mouth. This leads to major facial growth problems including:

Open bite (where the front teeth do not touch with each other when the child closes the mouth). This happens because during swallowing the tongue sits between the teeth in the front part, not allowing the jaws to come together.

Under develop and narrow upper jaw and thus causing crooked or crowded upper teeth due to lack of space for those teeth

The lower jaw being trapped inside the upper jaw, this prevented it to grow properly result in an in big over bite.


- It often impedes speech.  

Mouth breathing which is a breathing problem. 

 

Long term breathing problems are likely to lead to
 i. Snoring
ii. Sleep apnoea leading to tiredness and therefore ADHD
iii. ADHD
iv. Enlarge tonsil, which block the airway and in turn make the above problems worse
v. Multiple ear infections
vi. Bed wetting

 

Adults
Long term compensations for dysfunction can lead to many symptoms as below:.
-chronic head and neck pain from chronic subluxation of the head and neck
-severe sleep apnoea from severely underdeveloped jaws and airway
-chronic states of stress from chronic poor sleep and chronic pain
 

Treament: Laser Frenectomy
A frenectomy is the surgical elimination of the fold of mucosal skin under the tongue or the mucosal attachment of the lip (frenum).
Lasers are known to have advantaged over conventional scissors and scalpels. 
The advantages include: 
• More precise 
• Less damage to surrounding tissues 
• Bactericidal reducing risk of infection 
• Less discomfort and soreness during and after the procedure 
• Less swelling and inflammation post-treatment 
• Less bleeding 
• Better healing due to light energy encouraging cellular healing 
 
 At Best Western Dental Centre, we use laser which remove tissue and cauterizes it, stopping bleeding immediately. The healing and recovery is faster due to the advantages listed above.  

 

Understanding tongue tie as an oral restrictions
It is important to understand that every tongue restriction begins under the skin of the mouth (called mucosa) so it is most accurate to refer to it as sub-mucosal (under the mucous membrane).  Some tongue restrictions have an extension outside of the mucosa toward the middle or toward the tip of the tongue, which make it more visibly obvious. 
In the case of tongue restrictions, there may or may not be a visible portion of the tie extend towards the front of the underside of the tongue. Regardless of where the tongue tie is, it is vitally important to note that the classification, appearance or point of attachment does not indicate the severity or impact of a tongue or lip tie. What determines the severity and impact of an oral restriction is the degree to which it contributions to functional issues and symptoms.  It is more a focus on how things work not merely how things look.
As such, it is not correct to refer to a tie as mild or severe on the basis of appearance (classification) alone. For example, a type 3 or 4 tie may appear deceptively as a normal functioning tongue, but can in fact result in severe nipple pain and damage, where as a type I attachment that goes all the way to the tip of the tongue, may result in less severe functional issues, despite having a far more obvious presentation.
The bottom line is, if a child or mother are experiencing several of the symptoms listed above consistently, it is prudent to explore for a tongue and/or tie and these should be checked by a practitioner experienced in diagnosing and treating ties.
Understanding of ties is still fairly limited for most medical and dental practitioners due to the lack of education on ties in basic and specialist medical and dental degrees. Therefore, it is advisable to check the level of experience and education a practitioner has had in tongue ties when choosing who to visit. Dr Le has further his knowledge, and trained with the Tongue Tie Institute, a leader in tongue tie training.

 

Please read these Frequent Ask Questions, for Infant Tongue tie and tongue tie appointment.

 

Click here for Tongue Tie appoinment for children and adults

 

Click here for Tongue Tie useful resources

 

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