Ankyloglossia - Tongue Tie

What Is Ankyloglossia?

The term tongue tie is the layman's way of saying ankyloglossia or short frenum and it refers to a situation when the lingual frenum is short and restricts the movement of the tongue. The lingual frenum is the cord that stretches from under the tongue to the floor of the mouth. During the first three months of fetal development, the baby's face becomes separated or differentiated into its various parts. The frenum is tissue that is residual from the developmental period in the womb that should have disappeared as the areas around and inside of the mouth were formed. It is not uncommon for frenum or webbing (as it is sometimes called) to occur in the oral area between upper and lower lips and gums, cheeks and gums as well as tongue tie.

A good definition of tongue tie is a structural abnormality of the lingual frenum. When the frenum is normal (elastic) there is no interference with tongue movement in sucking, eating, clearing food from the teeth in preparation for swallowing, and in speech. When the frenum is abnormal (short, thick, tight or broad) it has a negative effect on the muscles in the oral area causing difficulty in feeding and speech. Should the frenum extend across the floor of the mouth to the base of the teeth, additional problems occur.

Are They All the Same?

Tongue ties vary in appearance, making it that much more difficult to spot them. The appearances range from thin and membranous to thick and white, from short to long or wide. They can extend the tongue to the front teeth or they can be so short that they make a web that connects the tongue to the floor of the mouth. Depending upon the features of the tongue tie, they can be very painful and even cause dental problems for a child.

The Genetic Factors

It seems that tongue ties run in families, with some members of the family only having a slight tongue tie with no apparent symptoms to situations where there is structural alteration to the facial muscles and features. Since such a strong family tendency is prevalent, it may become evident to parents of infants with tongue tie that other older children in the family are also affected. Similarities include the way the lips are held, speech habits and the shapes of the nose and face. Other congenital conditions are often present with tongue tie. Such conditions as cleft lip or palate, severe hearing loss or cerebral palsy can have tongue tie accompanying them.

How Do I Know if My Baby is Tongue Tied?

There are two traditional criteria that have been used to diagnose tongue tie. In infants it is acute malnourishment and in older children the inability to articulate tip-of-the-tongue sounds like‘t', ‘d' and ‘n'. Additional considerations when assessing the extent of tongue tie include the appearance of the tongue and its movements and whether there is lack of lingual mobility which, in turn, affects the speed and accuracy of the movements. In infants, weight, vomiting and gagging as well as other eating difficulties and prolonged drooling are indications. Maternal factors in a nursing situation are pain, injury to the nipple, blocked ducts or mastitis that occurs during breastfeeding. In older children severe and extensive dental problems and speech which is unclear, especially due to the inability to "wrap the tongue around a word".

What Can I Do About It?

Until the 1940s if a baby was tongue tied the frenum was routinely clipped. However, all of this changed after the war due to a fear of excessive or unnecessary surgeries as well as the arrival of formula, which reduced the numbers of breastfeeding mothers. There was also a prevailing belief that tongue tie was more the result of a parent's overactive imagination than a fact.