Thursday, June 3, 2004
Dear Dr. Mady: My son is now five years old and he has always had a tongue tie. Our dentist wants to refer him to an oral surgeon to have it fixed even though I have never really noticed any problems with it. What exactly is a tongue tie and does it have to be fixed?-Jamie Lynn in Knoxville
Dear Jamie Lynn: As we all know, the tongue is an extremely integral and important part of our anatomy. It is needed for many functions including but not limited to tasting, eating, speech, chewing, sucking, swallowing, drinking, cleaning the mouth, and gum and tooth health. Any anomaly that changes the tongue’s natural growth and action can affect many variables.
In human anatomy, a fraenum is a small fold of tissue that limits the movements of a body part or organ. It can also be called frenum, frenulum, or fraenulum. Everyone has one under their tongue known as a lingual fraenum. It is formed as a thin, vertical fold of oral tissue that attaches the underside of the tongue to the floor of the mouth.
If this stretch of tissue is abnormally short, the condition is known as ankyloglossia (or tongue tie). “ankylo” means adhesion and “glossia” stands for tongue. It can also be called “short fraenum” or “short fraenulum”. It usually leads to a mild, moderate or severe reduction in the mobility of one’s tongue.
Individuals that have a tongue tie generally have difficulty sticking their tongue out or touching it on the roof of their mouth. Most even cannot protrude their tongue beyond the edge of their lower incisors or even near the lingual or back of the upper front teeth. When attempting to protrude the tongue, the tip of it usually takes on the shape of a heart or a “v”, or the tongue itself may shape like a “w”.
In infants with ankyloglossia, there are often problems with sucking and breastfeeding. In many instances, this restriction will stretch or break on it’s own or be severed from trauma. For this reason, parents of infants and toddlers with this condition are usually advised by dentists and physicians to just let it go and worry later if needed. If the tie breaks with or without intervention, for any reason, the tongue instantly is permitted to a free range of motion. This may or may not happen immediately, but over time the tongue will adapt. It is an actual muscle and a powerful one, so it bounces back usually without recourse.
Many think that individuals with tongue tie have impaired speech, but although possible, this is usually not the case. Those who have their speech affected usually experience difficulty when trying to articulate or talk rapidly. My biggest worry about a restricted lingual fraenum is the fact that proper cleansing of food debris and bacteria from the teeth and gums cannot be accomplished. As a result, periodontal and dental health is commonly affected, especially with age.
Brushing and scraping of the tongue during oral home care becomes limited and thus bad breath or halitosis from bacteria and sulphur acids is common and unpleasant. Some children become messy eaters as they grow because they can not “clean up” like others. Food almost always becomes lodged up in the vestibules (inside the cheeks) and licking the lips is usually impossible. If the ankyloglossia is severe, it can even lead to digestion and thus nutrition problems because the oral cavity is where this begins for the entire body. It has even been noted clinically that some older children or adults that are tongue tied become embarrassed or self-conscious, especially if the tongue condition is visible.
If you are concerned that any of these potential problems exist in your child, first talk to your child. I advise to consult with your dentist, a speech-language pathologist and if necessary, an oral surgeon. They will take all the factors into account and help you to make a more informed decision with respect to treatment or no treatment.
Ankyloglossia or tongue tie may disturb proper speech, early childhood feeding, and the ability to properly clean the mouth. It is important to realize that these problems usually exist in the more severe cases of this condition. Realize that each person with a tongue tie requires their own accurate examination in order for the most suitable method of management to be selected. Your child may require no treatment at all, but if a fraenectomy (surgical removal or severing) is indicated, it is a minor procedure in reality.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5