A Brief Background on Tongue Tie
The medical term for tongue tie is a tight lingual frenulum. Everyone has a frenulum. In fact, we have lots of frenulum. A frenulum is just a piece of connective tissue that connects two anatomic parts. A lingual, or tongue, frenulum is the connective tissue that covers the floor of your mouth and undersurface of your tongue. It is most obvious when you look under your tongue while lifting the tip of your tongue to touch the roof of your mouth.
How Does Tongue Tie Happen?
When babies are developing in the womb, the tongue forms as two halves that fuse down the middle. This fusion also forms the lingual frenulum. After this fusion happens, most of the frenulum is supposed to dissolve away, leaving just enough to cover the structures underneath. When the frenulum doesn’t dissolve, it is called “tongue tie.” True tongue tie is genetic and happens in 4-10% of the population.
How Can You Tell If Your Baby has Tongue Tie?
It’s pretty easy to spot tongue ties in your baby. It looks like a string or band of tissue under your baby’s tongue when your baby cries. You can also check for it by lifting up your baby’s tongue with your pointer and middle finger. Tongue tie can also cause the tip of your baby's tongue to look like it is heart shaped.
Tongue Tie and Breastfeeding
Tongue tie can impact your baby’s ability to breastfeed. That’s because true tongue tie limits the tongue’s ability to move forward, up, down and back. But some babies with true tongue tie can still latch on reasonably well and transfer milk. If you have a big milk supply, your supply can make it even easier for your baby to get milk without having the best latch.
However, even if your baby is able to breastfeed, tongue tie may still make it harder for your baby to form a deep latch and transfer milk out efficiently. They may be able to get by, but breastfeeding may take more work. Tongue-tied babies can also tire more easily.
Navigating Tongue Tie Diagnosis
Unfortunately, there is a lot of confusion when it comes to diagnosing tongue tie. That’s because there are many babies who do not have tongue ties but still have trouble nursing. People in the lactation community coined the term “posterior tongue tie” or “lip tie” to describe these babies, but these terms are not anatomically or medically accurate. Because of this confusion, many babies are labeled as having tongue ties who don’t actually have it.
On the other hand, many babies with true tongue ties are often missed. Many doctors don’t screen for it or are unsure how to diagnose it. And even if they are able to diagnose it, they may not suggest treating it if your baby is able to nurse and/or bottle feed.
If you are concerned that your baby has tongue tie, you can use the method described above to confirm for yourself.
How is Tongue Tie Treated?
Traditionally, true tongue tie is treated by an ear, nose, and throat physician using sterile scissors in the office. The procedure is called a frenectomy. Anesthesia is not usually necessary, but babies older than two months may need a small injection of lidocaine. It should feel like an earring piercing when it is done on a newborn. Most babies show noticeable improvement in breast or bottle feed immediately after the procedure. Breast or bottle feeding immediately afterward is usually enough to stop the bleeding. Cautery or burning the tissue after the procedure is rarely necessary.
Over the last ten years, more and more dentists have been doing frenulectomies using lasers. There is a lot of controversy over their methods and protocols, including over diagnosing and overtreating with aggressive procedures. Lasers also carry the potential for severe risks. Also, there is no oversight into who is doing these procedures or how they are being performed.
When Should You Treat Tongue Tie?
There is a myth that true tongue tie stretches over time. This isn’t true. In fact, it gets thicker. The tongue is a muscle that develops its shape and strength based on the way it’s able to move. Because of the tongue’s intimate relationship with other head and neck structures, tongue tie can also affect the development of the palate, jaw, and teeth. This can cause a whole slew of potential issues, like speech problems, trouble moving food around, dental crowding, difficulty sticking out the tongue, jaw tightness, and quiet speech. The longer you wait to treat true tongue tie, the more likely these changes can become permanent and require other treatments down the road.
Frequently Asked Questions
What are the Risks of Treating Tongue Tie?
With an experienced doctor, a frenulectomy should be a safe, quick office procedure that usually does not require anesthesia. The main risk of a frenulectomy is that it can grow back to a certain degree as it heals. This regrowth can usually be treated with in-office stretching by the doctor who performed the procedure. If the frenulectomy is performed by an inexperienced practitioner or one who is not trained properly, there are many risks, such as excessive pain, bleeding, incomplete release, damage to other oral structures, and worsening of the tongue tie.
What Happens if Tongue Tie is not Treated?
The tongue is a muscle. Muscles develop their shape based on their ability to move. Since true tongue tie tethers the tongue and prevents it from moving, if you don’t treat tongue tie early, the tongue may not develop into its natural shape. Because of the tongue’s relationship to other oral structures, untreated tongue tie can cause issues like speech problems, trouble moving food around, dental crowding, difficulty sticking out the tongue, jaw tightness, and quiet speech.
Is it Safe to Treat Tongue Tie?
With an experienced doctor who is trained to perform frenulectomies and able to manage the risks, tongue tie can be safely treated in the office with minimal or no anesthesia. As with every procedure, there are risks. Your doctor should go over all of the risks before you or your baby undergo any procedure.
How Can I Tell If My Baby has Tongue Tie?
True tongue tie is easy to see. It looks like a string or band of tissue under your baby’s tongue when they cry. You can also check for tongue tie by lifting your baby’s tongue with your index and pointer finger. Often, a tongue-tied baby also has difficulty forming a deep latch and transferring milk from your breast efficiently.
Conclusion:
Tongue tie is a relatively common occurrence, happening in 4-10% of the population. However, many babies diagnosed with tongue tie may not have true tongue tie. Conversely, true tongue tie is often missed. Learning how to identify true tongue tie and being aware of its implications can help you decide how and when to have it treated. It’s also important to find a practitioner you can trust.
Reviewed by: Linda Dahl, MD
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