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24 November, 2009

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Tongue-tie

Tongue-tie is a condition that is caused by a short frenum that restricts tongue movement. For example, some people have difficulty licking around their lips or raising the tongue tip inside the mouth. This can mean that they have difficulties with eating and speech. The medical name for tongue-tie is ankyloglossia.

Frenula are little strings of tissue found underneath the tongue, inside the cheeks near the back molars and under the top lip. While an embryo is developing in the womb, these strings guide the growth of various mouth structures. Once we are born, the frenula are largely redundant, although they seem to help in positioning the baby teeth. The frenulum under the tongue is called the lingual frenum.

Estimates vary, but around two per cent of babies may be affected by tongue-tie. The condition can resolve in early childhood if the frenum ‘loosens’ or recedes by itself, allowing the tongue to move freely for eating and speech. However, in persistent cases, the child may need to have an operation (frenectomy) to release the tongue.

Symptoms
The symptoms of tongue-tie can include:

Tongue can’t poke out past the lips
Tongue tip can’t touch the roof of the mouth
Tongue can’t be moved sideways to the corners of the mouth
Tongue tip may look flat or square, instead of pointy, when the tongue is extended
Tongue tip may look notched or heart-shaped
A baby with tongue-tie may have breastfeeding or bottle-feeding problems
The front teeth in the lower jaw may have a gap between them
Activities like licking an icecream cone, ‘French (tongue) kissing’ and oral sex may be difficult.

Causes of tongue-tie
There are two main causes of tongue-tie: either the frenum is too short and tight, or it failed to move back down the tongue during development and is still attached to the tongue tip. In the latter case, a heart-shaped tongue tip is one of the obvious symptoms. It is not clear whether or not tongue-tie is inherited. However, there is no evidence to suggest that anything the mother did (or didn’t do) during pregnancy is responsible for the child developing tongue-tie.

Feeding problems for babies
Many babies with tongue-tie breast and bottle feed successfully. However, a tight tongue-tie can interfere with a baby’s ability to breastfeed and, in some cases, bottle feed. Mothers may experience sore and/or damaged nipples and the baby may have difficulty drinking enough to gain weight.

Tongue-tie can be hard to diagnose in newborns and there are many other causes of breastfeeding difficulties, so consult with your doctor or lactation consultant. Indications that a baby could be tongue-tied include:

Mother has sore nipples during and after breastfeeding
Mother has squashed nipples after breastfeeding
Mother has a white compression mark on the nipple after breastfeeding
The baby has difficulty latching on to the nipple
The baby often loses suction while feeding and sucks air
The baby’s mouth makes a clicking sound while feeding
The baby fails to gain weight.

Speech problems
Tongue-tie in toddlers seems to be less common than in babies, which suggests that the frenum can normalise itself as the child grows. In persistent cases of tongue-tie, the child may have a range of speech problems. Difficulties can include creating sounds that need the tongue or tongue tip to:

Touch the roof of the mouth, such as ‘t,d,n,l,s,z’
Arch off the floor of the mouth, such as ‘r’.

Treatment is controversial
In the past, the frenum under the tongue was routinely divided in babies or children with tongue-tie. Today, doctors are more inclined to wait and see what happens to the frenum with growth. Newborn babies with a tight lingual frenum and feeding problems sometimes have their tongue-tie divided without anaesthetic. This should be done by a doctor experienced in the procedure. Studies which have reported on this procedure have found few risks and problems. Possible problems are likely to be very rare but include: bleeding, infection, ulcers, pain and damage to the tongue and surrounding area.

Older children usually have the tongue-tie divided under a general anaesthetic. The main risk of this procedure is related to the anaesthetic, although (like all surgeries) there is a risk of bleeding, infection and damage to the tongue or the surrounding area. Generally, only severe cases of tongue-tie are divided.

Tongue-tied babies with feeding problems should see a lactation consultant or feeding specialist to confirm whether or not the tongue-tie is causing the feeding problem. Toddlers or older children should see a speech therapist to work out whether the tongue-tie is causing the speech or eating problem.

Frenectomy
Surgery to cut the lingual frenum is called frenectomy. The technique differs according to the age of the person and can include:

Babies less than 12 weeks old – the procedure can be performed without anaesthetic. The baby’s head is held firmly and the frenum is simply snipped (divided) with surgical scissors. A number of studies report that breastfeeding is improved immediately after the procedure for most babies. Reports also suggest that tongue movement is normal within three months of the procedure.
Older children and adults – a general or local anaesthetic may be given beforehand, and a laser or scalpel is used instead of scissors. Stitches are needed when the tongue-tie has been surgically divided. It may take a few weeks for the mouth to heal. Self-care suggestions include gargling with salt water and taking anti-inflammatory drugs such as aspirin or ibuprofen. Older children and adults may need speech therapy after the surgery to unlearn established patterns of articulation.

Where to get help

Your dental professional
Your doctor or paediatrician
Lactation consultant
Speech pathologist
Orthodontist
Dental Health Services Victoria Hotline Tel. 1300 360 054 – for information about public dental services

Things to remember

Tongue-tie is characterised by a short frenum (string of tissue) that stops the tongue from moving well during speech and/or eating.
Tongue-tie can improve by the age of two or three years.
Severe cases of tongue-tie can be treated by cutting (dividing) the frenum. This is called a frenectomy.

You might also be interested in:
Teeth - gapped teeth.
Tongue.

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