Tongue & Lip Ties

Tongue ties are a fad. There is no evidence or research base.

Tongue ties have been around since ancient times. There are accounts of early midwives using a long pinky fingernail to slice the restricted lingual tissue, which improved baby’s feeding skills. Tongue ties have definitely increased in incidence and diagnosis over the past 30 years, but this does not mean that they are a new finding. Prior to the 1980’s, mothers breastfed their babies, tongue ties were treated, home births were more prevalent. Formula was invented and marketed to be “better than breastmilk” due to the scientific advances of formula ingredients. Thus, arose the prevalence of the baby bottle and pacifier. Bottles are often easier for the tongue tied baby to drink from due to the consistency of their nature (every time the baby drinks from a bottle, it feels the same in their mouth, it is the same firmness, it smells the same, it is the same shape), as opposed to the breast, which frequently changes tension, shape, smell, and temperature before, during, and after feeding. In the early 2000’s, breastfeeding once again rose in popularity, which again brought to light the difficulties of breastfeeding that are frequently seen by babies with tethered oral tissues. 

My pediatrician will know whether baby has a tongue tie.

Pediatricians are often generalists. They study for a very long time and have a vast range of knowledge about your child’s development and illnesses. However, when it comes to oral development, structure, and function, you should look to the specialists who study for a long time to be able to treat disorders of the mouth: dental professionals and speech pathologists who are trained and experienced in infant feeding and oral strength, function, and development.

Everyone needs a release

While it may seem so, with the heightened awareness of ToTs in the US today, this is simply not the case. There are plenty of babies, children, teens, and adults that we assess who may have tension evident in their oral tissues, but have great function and do not need intervention. We specialize in infant feeding disorders, childhood feeding disorders, motor speech disorders, and myofunctional disorders here at Flight Therapy Services, and often so many of our families are seeking help from us as a last resort. They have seen multiple specialists and generalists, and googled, and asked moms groups, and researched on their own, until they are exhausted. We strive to be the voice of reason and to fully educate families to make the best decisions for their child/family. We will always present as much information as possible for all arguments for and against a tongue tie release and leave it up to the parents to decide what is best for their child.

Tongue ties only need to be released once

Sometimes, there are cases in which the tongue tie has been released and requires a second revision. (The first procedure is a “release,” and any subsequent procedures are “revisions,” or re-do’s of the original release). This could be due to several reasons, including wound reattachment, excess tension in the body due to trauma or other reason, severity of restriction, skill of the release provider, tolerance of the patient to aftercare stretches, among other reasons. In order to prevent a second revision, we highly recommend interdisciplinary care from a bodyworker (to provide necessary balancing of tension present in the body), speech pathologist who specializes in infant feeding disorders and myfunction to help pre-teach the wound management stretches and prepare the oral cavity for the surgical procedure, an experienced caring release provider who listens to the family’s/patient's concerns and collaborates easily with other disciplines involved, and, for infants, a lactation consultant (IBCLC) who can help the family reach breastfeeding goals.

Tongue releases are only effective in babies. It is too late for adults to get their tongue tie released

Tongue and lip ties are more recently found in our infant population. However, we are seeing more and more teens and adults who have an undiagnosed tongue/lip tie. Symptoms that you may have a tongue tie as an adult include: sleep disordered breathing/sleep apnea, chronic headaches, TMJ pain/popping, malocclusion, forward head posture, shoulder/back tension, tongue thrust swallow, lisp, mouth breathing, Reflux/GERD etc.

Baby is gaining weight, therefore he doesn’t have a tongue tie

Weight gain is not a factor in diagnosis of tongue ties. Experienced providers will look at both structure and function of the jaw, lips, cheeks, and tongue. The tongue is the major player in infant feeding and if the tongue is not cooperating with baby’s innate feeding skill, then because baby has a will to survive, s/he will use any means necessary to extract milk for nutrition. This can mean using extraneous muscles of the face, neck, shoulders, back, abdomen, and even arms and legs. Some babies may figure out how to effectively compensate for feeding to get sufficient nutrition, but that does not mean they are using the appropriate muscles or sucking appropriately. Compensation during feeding can lead to rapid pattern of fatigue at the breast, falling asleep, excessive breathing breaks, wiggly body, pulling on/off frequently, coughing/choking/gagging, etc.

Tongue ties should always be clipped because it will affect future feeding, speech, swallowing.

Diagnosis of lip and tongue ties are made based on structure (the way it looks, the way it feels, and where it inserts in the tongue and mandible) and function (range of motion, shaping, strength). We do not put a patient through an unnecessary procedure based on what problems *might* arise in the future.

Lip ties vs tongue ties

Lip ties are often easier to recognize and view, and parents can more confidently identify a tight labial frenulum in their young infant or child. A full functional assessment is important to complete in order to rule out the need for a labial release. 80% of lip ties co-occur with tongue ties; therefore, both the lip and tongue should be assessed by an experienced clinician. 

Is it Necessary?

-Benefits of Pre-frenectomy Therapy:

+Pre-teach active wound management (AWM) stretches to be 

prescribed by release provider

+Acclimate baby/child to fingers in the mouth

+Acclimate baby/child to what the stretches will feel like

+Acclimate parents to oral anatomy and motor plan for stretches

+Prepare surrounding tissues for a surgical procedure

+Elicit increased strength and function for improved and faster 

rehabilitation in the post-frenectomy period

-Benefits of Post-frenectomy Therapy

+Parents to establish competency with AWM stretches prescribed by 

release provider

+SLP to answer questions and assure parents of appropriate healing

+Provide strategies for home exercise plan

+Provide neuromuscular re-education for muscle memory

+Improve functional feeding/chewing/swallowing skills

+Improve functional speech and language skills

Braces should not be a rite of passage for teenagers. Retainers should not be the norm after braces are removed. It is our goal to collaborate with your orthodontist to elicit appropriate early jaw and facial growth, in order to minimize the effects of improper oral muscle movements. The constant pressure of soft tissue (muscles) is what shapes our hard tissues (bones). The tongue is nature’s palate (roof of the mouth) shaper and the lips are nature’s retainer. We train the tongue to remain lightly suctioned to the roof of the mouth and the lips to remain in a closed position at all times  of rest. We train the proper chewing and swallowing techniques in order to avoid placing unnecessary pressure on the teeth and jaws. In training these functional movements, we help patients to avoid orthodontic relapse and to prevent the reliance on using retainers to keep teeth in place after orthodontia/invisalign is completed.