Adult Tongue-Tie and Frenectomy

Ankyloglossia is commonly known as tongue-tie, which is a congenital condition where the tissue membrane connecting the tongue to the floor of the mouth is unusually short, thick, and/or tight. This often causes problems throughout development, first interfering with breastfeeding ability in infancy and continuing to affect feeding, swallowing, and speech in childhood, as well as palate formation and the placement of incoming permanent teeth.

Additionally, improper resting position of the tongue can restrict the airway and cause sleep apnea in children and adults, which in turn negatively affects sleep quality and attention & focus during the day. Moreover, sleep apnea is linked to a number of other health conditions across age groups, including obesity, hyperactivity, high blood sugar and type 2 diabetes, high LDL cholesterol, cardiac and liver problems, acid reflux, and cognitive symptoms such as memory loss, confusion, learning difficulties, and depression.

While the symptoms of ankyloglossia present differently over time as our bodies learn to compensate for the restricted muscles and tissues, tongue-ties are easily corrected by frenectomy: a simple procedure where the restrictive webbing under the tongue (or the lingual frenulum) is released, mobilizing the tongue and enabling it and the supporting musculature to function more optimally.

My Experience

I've been a massage therapist for 11 years, but it was only recently that I began learning about tethered oral tissues (i.e., tongue/lip/buccal ties) and their long-term effects. Many of the symptoms of tongue-tie in adults resonated with me, particularly jaw clenching, teeth grinding, neck & shoulder tension, and forward head posture. So, I decided to get a functional evaluation myself, at 37 years old. I'd always attributed my symptoms to the everyday stresses of life, a somewhat anxious personality, and the physical nature of my job. However, I was eager to see if there might also be a structural cause or contributing factor, as I'd had limited results from regular yoga practice, acupuncture, bodywork, aromatherapy, etc. for tension relief.

I met with Samantha, the Oral Myofunctional Therapist who is part of our team at the PA Tongue-Tie Center, for the evaluation. She guided me through a series of activities to test the functional limitations of my oral musculature, and found that my tongue was quite restricted. This was affecting my chewing, swallowing, and causing my jaw and other facial muscles to work especially hard to compensate. We also realized that my tongue was resting against my teeth instead of my palate, which explained part of my dental history where my occlusion (bite) had been adjusted from open to closed, but over time became open again. That is, my tongue was gradually pushing my front teeth forward so that the top and bottom teeth no longer touched.

Once Samantha determined that a tongue-tie was present and I would benefit from a frenectomy, we began the therapy process to strengthen my tongue in preparation for the procedure. Oral myofunctional therapy (OMT) before and after release is critical because the tongue and supporting muscles don't automatically know what to do once they have the proper range of motion; they must be retrained because they have been unable to move and function as they should.

Another important adjunctive therapy in treating ankyloglossia is bodywork, specifically craniosacral therapy (CST) and/or chiropractic care. These modalities target and correct abnormal strain patterns in the body that result from compensatory muscle actions caused by ties. As with OMT, it's often helpful to receive CST or chiropractic before frenectomy to loosen the tissues and facilitate a more complete release, as well as after the procedure.

After almost 3 months of weekly OMT, I reached the point where I couldn't progress any further without having my tongue released, so we scheduled the frenectomy with Dr. Cockley, who performs releases via laser. The entire procedure lasted only a few minutes, including time for the numbing agents to take effect. I felt minimal discomfort and no pain during the frenectomy, but the effects of the release were immediately noticeable.

My Results and Aftercare Plan

Aside from the sudden ability to fully elevate my tongue, the first thing I noticed just minutes after my release was that my neck & shoulder tension relaxed as my shoulders settled into a new resting position. It seemed to require less conscious effort for me to maintain good posture. That night during yoga, I was able to bend and fold further into the poses without the familiar stiffness or pain shooting from my neck down my spine, as though a cord of tension connecting my upper and lower body halves had been severed.

I am now one week post-op and I've noticed less tension in my body overall, which has reduced my general stress & anxiety levels. I'm able to chew and swallow certain foods more easily, so I don't feel the usual fatigue in the floor of my mouth while eating. My face and jaw feel more relaxed more of the time, particularly while driving and sleeping when I tend to clench my teeth. Doing the post-op tongue exercises and stretches 5 times a day as recommended has kept any soreness to a minimum, and I always feel better afterward.

For my aftercare plan, I am continuing weekly OMT with Samantha to gain optimal strength, mobility, and function of my tongue and supporting muscles. I received monthly CST treatments prior to my frenectomy and will receive a few more biweekly treatments, as recommended by my practitioner. Ultimately, I'm very happy that I decided to pursue this. My tongue-tie release has already made a tangible difference in my life, and it was well worth it!

Frequently Asked Questions

Does it really exist?
Tongue tie, also called Ankyloglossia (or crooked or looped tongue) is a real medical condition and has its own typical problems and presentation. Symptoms can be mild or severe, and where no difficulties are caused no intervention is needed. Where problems exist, it can be diagnosed, assessed, and successfully treated. It is not well known - although the expression  'tongue tied' is generally used to mean 'unable to speak'.
Can anything be done?

Much can be done to counter the problems caused by a tongue tie which is causing significant difficulties. Since it is caused by a structural anomaly, the structural defect must be physically corrected before other treatments for presenting problems will have a chance to succeed. Early intervention is recommended to avoid the formation of incorrect habits of using the tongue in feeding and speech.
 
Does it hurt?
Release of the frenum by snipping causes little pain, some babies sleep through the procedure. Surgery in hospital with a general anaesthetic will cause soreness until healing takes place in a week to 10 days. Revision by laser causes very little pain in most cases.

How is it caused?
The frenum is a remnant of tissue that was part of the facial structure of the infant during early pregnancy. Usually it disappears or reduces to a very slight membrane which is elastic and does not limit the tongue in its movements or disrupt function. Similar webs of tissue can also occur joining the cheeks or lips to the gums and these - like a tongue tie - also can be released surgically. When the lingual frenum does cause problems it is because tightness, thickness or width of the frenum  affects the function of the tongue in various ways. There is a very strong tendency for tongue tie to run in families, and it is more common in boys.
Who should diagnose it?

Tongue tie may be diagnosed by family doctors, dentists, lactation consultants, ENT (ear, nose and throat) doctors, surgeons, or speech-language pathologists.

Is it too late for adults?
No. it is never too late. Adults with problems report the following improvements: ability to chew better, not biting their tongues or cheeks when chewing, a sense of space in the mouth, improvements with speech, not having to think before they speak, relief of tight, clicky jaws, tension headaches and migraine, improved oral and dental health, and ability to control a lower denture! However, the strong oromuscular habits acquired while the tongue tie was present will be harder to get rid of in older persons. Speech therapy after surgical revision is strongly recommended.

To read this entire article, which provides some Tongue Tie FAQ's, please visit TongueTie.net

Dental Clinic East Berlin -  East Berlin Smiles 

Tel: 717-259-9596 

418 West King Street 

East Berlin, PA 17316 

USA

Background: What is Tongue Tie?

Terms
The ‘lingual frenum’ (or lingual frenulum) is the cord that stretches from under the tongue to the floor of the mouth.

‘Tongue tie’, ‘Ankyloglossia’ or ‘short frenum’ are the terms used when the lingual frenum is short and restricts the mobility of the tongue.

Introduction
Tongue tie can be defined as a structural abnormality of the lingual frenum. When the frenum is normal, it is elastic and does not interfere with the movements of the tongue in sucking, eating, clearing food off the teeth in preparation for swallowing and, of course, in speech. When it is short, thick, tight or broad it has an adverse effect on oromuscular function, feeding and speech. It can also cause problems when it extends from the margin of the tongue and across the floor of the mouth to finish at the base of the teeth.

Genesis
The frenum is tissue left over from the time the foetus was developing in the mother’s womb and which would normally reduce to insignificance before birth. In the first 3 months of life, the face becomes differentiated into its various parts, and the frenum is what is left of the tissues that should have disappeared as the oral areas are formed. Such vestigial structures are not uncommon, and ‘webbing’, as it is sometimes called, can occur between upper or lower lips and gums, cheeks and gums as well as in tongue tie.

To read this entire article, which provides background information on what a Tongue Tie is, please visit TongueTie.net

Dental Clinic East Berlin -  East Berlin Smiles

Tel: 717-259-9596

418 West King Street

East Berlin, PA 17316

USA

Breastfeeding Problems: A video from Fauquier ENT

This video from the Fauquier ENT YouTube channel explains 'why breastfeeding difficulties may occur due to infant factors, such as tongue tie and upper lip tie'.

The above video is found on Fauquier ENT YouTube Channel.

Dental Clinic East Berlin -  East Berlin Smiles

Tel: 717-259-9596

418 West King Street

East Berlin, PA 17316

USA

Dr.Kotlow's office visit for newborn infants having breastfeeding problems

Dr.Kotlow's office visit for newborn infants having breastfeeding problems.

The above video is found on Dr. Kotlow's YouTube Channel.

Dental Clinic East Berlin -  East Berlin Smiles

Tel: 717-259-9596

418 West King Street

East Berlin, PA 17316

USA

Dr. Kotlow Shows How to Examine for TOTS (Tethered Oral Tissues) in Infants

Watch a video where Dr. Kotlow shows the optimal way to examine infants for TOTS(tethered oral tissues) lip-ties and tongue-ties. Videos of CO2 laser (Solea) surgery and post surgical active wound management therapy.

The above video is found on the YouTube Channel of Dr. Lawrence Kotlow.

Dental Clinic East Berlin -  East Berlin Smiles

Tel: 717-259-9596

418 West King Street

East Berlin, PA 17316

USA