Tongue Ties in Babies and Children. When Should We Treat?
Tongue Tie (or Ankyloglossia) is a condition which affects just under 5% of the population. The lingual frenulum is a band of fibrous tissue which runs from the bottom of the tongue to behind the lower teeth or gums. In affected people it can limit the range of movement of the tongue which can cause problems with breast feeding in babies, and problems with speech and eating in children and adults.
Tongue tie is a problem that has been under-recognized in the past. There are concerns that with increased awareness it is being over-diagnosed , and now treatment for tongue tie is being recommended for situations where there is limited or no evidence that it may help.
Tongue Tie in babies shows up as difficulty for the baby in attaching and nipple pain for the mother. The nipple pain does not diminish with time as it does for babies who attach normally. Tongue tie is not the only cause of attachment problems and it is important that someone who knows the screening techniques makes the diagnosis. A recent review recommended assessment by a lactation consultant, followed by a review by a Paediatrician or a GP.
Once the diagnosis is made the decision must be made whether or not to carry out any treatment as about 50% of babies with a tongue tie do not have problems feeding. The treatment recommended is a Frenotomy. This involves cutting the frenulum with a pair of surgical scissors. This is done as soon as possible, and in babies under 3 months without any anaesthetic. There is almost always little post operative pain or bleeding and the procedure only takes a couple of seconds. The baby is able to breastfeed immediately which helps recovery, and to elongate the tongue.
It is however important that the procedure be carried out by someone who is trained as there are blood vessels and salivary glands nearby. In addition I was not able to find any recommendations for more complicated procedures (frenectomy) or other techniques in the scientific papers. It is also important to understand that the procedure will help on average about half the babies who are treated and in a small number of cases the frenulum will reattach.
Children and Adults
Problems with speech, such as difficulty rolling r’s and with consonant sounds such as s,t,z,l,j and ch may be signs of a tongue tie. Again it is important to have the condition correctly diagnosed. A consultation with a speech pathologist to have other possible causes eliminated before treatment is strongly recommended. It has also been suggested that a tongue tie can effect the growth of the jaws, specifically promoting forward growth of the lower jaw while reducing growth of the upper jaw causing orthodontic problems. I was not able to find any studies which supported this claim, nor any studies linking tongue ties to airway problems, postural problems or snoring.
There are a number of different treatments proposed for the treatment of tongue ties in older patients. These include the previously mentioned Frenotomy, Frenectomy (surgical removal of the frenulum), or Frenoplasty (partial removal and reshaping of the frenulum). These second two procedures are more invasive and are commonly carried out under a general anaesthetic. These may be done using traditional sugical techniques or using a laser.
Again these procedures are best carried out by someone with the appropriate training. A consultation with a Paediatrician or an Oral-Maxillofacial surgeon to determine the patients suitability, as well as the pros and cons of the different procedures.
Upper Lip Tie
The Labial Frenulum is a similar band of fibrous connective tissue which runs from the upper lip to the upper jaw. If it is too large it can cause orthodontic issues and gum issue in children and adults, but there is currently no evidence that it causes issues attaching for babies. In babies it often attaches high on the gum, and the as the teeth grow its position migrates up away from these areas. Because of this there is not thought to be any advantage in early intervention. In fact it is often recommended that the procedure not be performed until the adult canines (eye teeth) have erupted, generally about 11-12. In addition I can only find references to Frenectomies, not to the less invasive Frenotomies when looking in the scientific papers and text-books.
Tongue ties, and the treatment of them is a controversial topic currently, as we do not have enough research as yet to know exactly who will and won’t benefit from treatment of tongue ties. Hopefully over the next few years this research will become available and we will have more concrete guidelines. Our recommendation at Plaza Dental is to make sure that anyone you see is trained, and that if you have any concerns at all please do seek a second opinion.
References available upon request.
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