A Lingual frenum is a naturally occurring fold of skin that connects the bottom of the tongue to the floor of the mouth. “Tongue tie” is an abnormally short, thick or tight band of skin that restricts the tongue’s range of motion as the tip of the tongue can be bound down to the floor of the mouth. This may cause a whole range of undesirable effects lasting a lifetime, however the most critical is when a newborn is unable to latch on to breastfeed or bottle feed adequately. This can be a devastating and urgent situation necessitating immediate correction as the infant can quickly become malnourished. In order to breastfeed correctly, the baby’s tongue must be positioned over the lower gum while sucking. If the baby cannot protrude the tongue to this extent, then it is impossible to make a proper seal to draw the milk out of the milk ducts which can lead to inadequate nutrition and failure to thrive. If this occurs to a lesser extent, the baby may get just enough milk, however the baby may chew on the nipple causing pain, nipple injury, blocked milk ducts, and even mastitis (infection of the breast). The baby may have low weight, insufficient weight gain, vomiting, and gagging.
A Labial frenum is normally seen between the front teeth (either upper or lower). It connects the inner aspect of the lip with the gum. Baby’s upper lip must roll outward so that the inner lining (mucosa) can form an adequate seal around the breast areola. If the lip is restricted, the baby may not be able to latch well enough to adequately cause sufficient negative pressure to draw the milk out of the ducts. Effective breastfeeding occurs when the baby can widely open the mouth – the upper lip flanges outward and the tongue protrudes over the lower gum. If the upper lip is restricted, the baby is forced to adopt a more shallow position on the breast which again leads to numerous problems whether breast or bottle feeding.
Effects of untreated tongue and lip tie for infants and mothers:
Tongue and lip ties are not just a concern exclusive for infants as they can affect the way children eat, speak and swallow . If these tethered tissues are not diagnosed and corrected, various ill effects can influence and last a lifetime. Tongue tie can inhibit proper jaw development, cause long-term orthodontic problems, and sometimes lead to sleep apnea. Children with airway constriction or compromise, can have sleep disordered breathing. These toddlers and children are chronically exhausted and can conversely appear “hyper” or “wound up”. This can result in negative behavior issues at home and in school and can result in a child being labeled as “hyperactive”, “trouble maker”, “problem getting along” etc. These children are simply exhausted! How many children are given labels of ADD/ADHD and medicated when in reality they are exhausted because they cannot sleep adequately? We see toddlers who cannot chew properly, children who cannot lick an ice cream cone, children who are disadvantaged by their poor speech, children who are exhausted and “cranky” with dark circles around their eyes, children who have trouble with bedwetting – all because of constricted airways and disordered sleep. Tethered oral tissues and enlarged tonsils are easily treatable today!
Effects of untreated tongue and lip ties in children:
Following a lifetime of limitation brought on by untreated tethered oral tissues, the adult has accumulated a group of old habits compensating for limited tongue and lip mobility. These habits can then adversely impact social situations, self esteem, work performance and relationships, dental health, nutrition and overall well being. Adults can limit their range of healthy food choices causing a nutritional and social disadvantage. Alterations in speech can cause stress, lack of self confidence and affect performance in school and work which can negatively impact social and financial comfort. A lack of attached gingiva, in conjunction with a high (closer to the biting surface) frenum attachment, which exaggerates the pull on the gum margin, can result in gum recession. Additionally, an excessively large frenum can prevent the teeth from coming together resulting in a gap between the front teeth. If pulling is seen or the frenum is too large to allow the teeth to come together, the frenum is surgically released from the gum with a frenectomy. When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a gingival graft, can increase stability and improve success of the final orthodontic result.
Effects of untreated tongue and lip tie in adults:
A frenectomy is simply the surgical removal of a frenum and is quickly and easily done with a laser at any age. The unfortunate end result of untreated tethered oral tissues is a reduction in the quality of life for the patient, and this can be on multiple levels – physical, emotional, psychological, social, etc. Once a frenum has been suspected or diagnosed as being abnormal, early intervention is the ideal form of management as these do not improve or “get better” with time, in fact quite the opposite is true. The frenectomy procedure with a laser is quick, simple and virtually free of complications!
