Tongue tie (ankyloglossia) is a condition present at birth in which the small band of tissue that connects the tongue to the floor of the mouth (lingual frenum) is unusually short, thick or tight. When the frenum restricts normal resting posture or range of motion of the tongue, a variety of problems or symptoms can develop that interfere with normal growth and oral function.
It is important to note that not all ties cause problems and require correction. Tongue tie is a diagnosis based upon function, so what the tongue looks like can sometimes be less important than how it can move. A simple test of sticking out the tongue is not adequate to rule out a tongue tie. Most oral functions involve fine motor movements of the tongue inside the mouth, so each case needs to be assessed on an individual basis by an educated and trained practitioner.
A lip tie exists when the membrane attaching the lip to the gums (labial frenum) creates excessive tension during function. Lip ties can affect an infant’s ability to latch during nursing and may cause oral hygiene and orthodontic challenges in children and adults.
Why Early Intervention is Important
A tongue with ideal function aids in effective eating, drinking and speaking, but it also applies necessary pressure to upper jaw to help it grow to its proper size. This will allow enough room to support properly aligned teeth and create an optimally sized nasal airway. Addressing tongue restrictions early in life can not only improve a child’s wellbeing, but it also allows us to capture a critical window of time where growth of the jaw can be influenced to correct any deficiencies. If we miss this window, any resulting structural issues are more challenging and costly to correct.
When a tongue restriction is present, there is an increased chance that patients will suffer from airway obstruction during sleep due to low tongue posture. For this reason, many of the symptoms of tongue ties and sleep disordered breathing often overlap.
Babies
Symptoms:
Nursing Mom
- Nipple pain or damage
- Prolonged feedings
- Poor breast drainage
- Decreased milk supply
Baby (breast or bottle fed)
- Noisy suckling or clicking
- Popping on and off nipple
- Leaking on the sides of the mouth
- Poor weight gain
- Coughing or gagging
- Lip blisters
- Excess gas pain
- Reflux or colic symptoms
- Noisy breathing/snoring
Infant Laser Frenectomy
The release procedure, called a Frenectomy, involves removal of the tight tissue under the tongue or lip to allow for better mobility and to reduce excess tension that may be contributing to feeding and digestive difficulties.
Dr. Kuntz uses the LightScapel, a state-of-the-art CO2 laser to perform her releases efficiently and safely while minimizing pain and discomfort both during and after the procedure.
Children & Adults
Symptoms:
- Poor sleep, daytime fatigue
- Snoring, UARS, sleep apnea
- Mouth breathing; chronically enlarged tonsils & adenoids
- Messy or picky eating; chokes or gags easily
- Speech difficulties
- Narrow jaws, crowded teeth, cross-bites, recessed chin
- Anxiety, impulsive behavior, ADHD symptoms
- TMJ dysfunction; jaw or facial pain
- Chronic neck and shoulder tension, poor posture
Functional Frenuloplasty
The tongue tie release procedure we use in older children and adults differs slightly from that used on infants and toddlers. Tongue ties that have been present for many years often result in learned patterns of dysfunction. These patients often have weak or imbalanced orofacial muscles and improper tongue resting posture. The release procedure improves tongue mobility, but if the memorized patterns of dysfunction aren’t addressed this will hinder symptom resolution. Functional frenuloplasty utilizes a targeted physical therapy program (called myofunctional therapy) alongside the lingual release to achieve optimal treatment outcomes.
After the tongue tie is released, dissolvable sutures are placed at the site to guide healing, minimize scarring and reduce the chance of reattachment.
LightScalpel CO2 Laser
Dr. Kuntz uses a state-of-the-art CO2 laser, called the LightScalpel, to perform her releases efficiently and safely. While a frenectomy can also be accomplished using scissors or a diode laser, the CO2 laser is a preferred method because it provides less discomfort, minimal bleeding, precision removal of tissue, bactericidal effects, and faster healing.
Dr. Kuntz is certified in Laser Dentistry, Laser Surgery & Laser Safety Studies through the Laser Institute of America and The American Laser Study Club.
Collaborative Care
We work closely with other healthcare professionals to provide our patients the opportunity for optimal healing. Our functional and comprehensive approach supports improved outcomes for the conditions we treat.
- An Orofacial Myofunctional Therapist (OMT) helps patients before tongue tie release to strengthen the tongue for safe positioning during surgery and to address any muscular dysfunctions or compensations the patient may have adopted due to their restriction. After surgery they help guide the healing process to minimize scarring and ensure the newly freed tongue has optimal posture and function.
- An International Board-Certified Consultant (IBCLC) can help the mother-baby dyad with lactation and nursing. They are an invaluable resource both pre and post release.
- A speech therapist, SLP or feeding therapist can help navigate oral motor dysfunctions or sensitivities to achieve more optimal speech and eating.
- A Craniosacral Therapist (CST), massage therapist or chiropractor can address increased tension patterns in the body which is often present in patients with restricted lingual frenula.
