A tongue or lip tie is when the tongue or lip is connected to the bottom of the mouth by a piece of tissue (called frenum) that is shorter than optimal. It is a condition that forms 4 weeks in utero, so the child is born with it. Having a short frenum restricts the tongue’s range of motion. As an infant, it can cause painful and/or ineffective breastfeeding. The child can have symptoms such as colic, gas, not gaining weight, unable to latch and fussiness when nursing. Moms can have symptoms such as pain when nursing, cracked/bleeding nipple, lipstick shaped nipple and under/oversupply. Many pediatricians and hospital lactation consultants are not trained to detect a tongue or lip tie properly and many mom and baby duos struggle through the breastfeeding process. If the frenum is removed and it heals well, many of these symptoms resolve.

If this is not removed, it can affect other aspects of the child’s life. It can be associated with speech or swallowing difficulties during eating or drinking and a lip tie more specifically can be associated with a higher risk for decay on the front teeth because milk or food is more likely to be held in place rather than being cleansed away after a meal. We tend to see quite a few toddlers with cavities in the front teeth. These tend to occur mostly in those with an upper lip tie and those nursing throughout the night.

In adults, a variety of issues can be related to this restriction:

Structurally, an adult may present with atypical patterns such as a tongue thrust, abnormal (open) lip posture, or mouth-breathing habits resulting in enlarged tonsils, dry mouth or inflamed gums. Recession of the gums or exaggerated spacing between the front teeth can result from the tension created by the restriction. Other more “orthodontic” issues of the teeth can arise such as cross bite, anterior open bite, a tipping angle of the teeth toward the tongue, a high narrow palate (which can also correlate with a deviated nasal septum), and improper facial proportions.

With a tongue that is held down and not able to move freely, breathing issues are more likely to arise. These breathing issues can range from increased snoring to sleep disordered breathing such as sleep apnea. Respiratory illness and heart conditions such as high blood pressure become more prevalent in patients who are not breathing properly.

The difficulty breathing and the structural variations caused by these restrictions can increase the likelihood of clenching or grinding of the teeth, which can wear down the teeth and cause changes to the bite or cracking of the teeth. An increased gag reflex or a harder time at routine dental appointments may also be noted.

Oftentimes in adults, we learn to compensate with other muscles to make up for the restriction of the lip or tongue. By recruiting other muscles of our upper body to help us function as if there were no restriction, tension can be created in the head, neck and shoulders. Headaches, neck pain, shoulder pain or jaw joint dysfunction may present itself as a result of these compensations.

What needs to be done to treat a tongue or lip tie?

After evaluation by our dentist, a range of symptoms would be discussed. Treatment may not be indicated if there are no negative symptoms being experienced. However, if it seems that greater health and quality of life may be attainable by correcting this issue, therapy and surgery may be recommended. Infant surgery is done at our office. After care, the most important part, is done at home and followed up with other therapists. Therapy for adults and some children is done outside of our office with a specialist known as a myofunctional therapist who focuses on physical therapy rehabilitation of the oral facial region. Exercises are assigned and evaluated by this specialist to ensure better muscle tone prior to the surgery, and to ensure rehabilitation following the surgery. The surgery simply allows the tongue or lip a greater range of motion to better achieve the goals set in place by the myofunctional therapist. For infants, partnership with a lactation consultant is also critical to successful treatment outcomes. Surgery may be done with a laser, scalpel and/or scissors depending on the provider and the patient. It is also important to have bodywork done by a cranial sacral therapist or chiropractor. This seemingly small tissue can have a grand impact on the body and the right approach to correcting it is very important

  Read more about our tongue/lip tie procedure