Tongue Ties
Tethered Oral Tissues (TOTs)
The tongue attaches to the floor of the mouth via a thin band called a lingual frenulum.
When the lingual frenulum is too short or too thick, it can impede an infant's ability to latch effectively and cause a variety of other issues.
Common Signs + Symptoms Associated with Oral Dysfunction
Babies that have tension, oral ties or a poorly functioning tongue may present with some seemingly unrelated symptoms.
These signs and symptoms do not mean your baby has a tongue tie, but are commonly noted in tongue tied babies:
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Breastfeeding difficulties (painful latch, clicking/smacking, a lot of milk dribbling out of the mouth, coming off the breast frequently)
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Taking in a lot of air with feeding (reflux, fussy, gassy)
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Sleeping with mouth open
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End of the tongue is heart-shaped
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Neck is often extended
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Really early to hold their head up/people remarking that baby has a really "strong neck"
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Rolling earlier than usual
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Milk tongue (white film on tongue after feeding, potentially misdiagnosed as thrush)
Not every tongue tie looks the same
A common misconception (and a reason why many tongue ties go undiagnosed) is that the frenulum has to extend to the tip of the tongue in order to be considered a tie.
There are four types of tongue ties that are graded based on where the frenulum attaches to the tongue. The following explanations are taken from the Johns Hopkins website.
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Type I: The frenulum is thin and elastic, and anchors the tip of the tongue to the ridge behind the lower teeth.
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Type II: The frenulum is fine and elastic, and the tongue is anchored 2 – 4 mm from the tip to the floor of the mouth close to the ridge behind the lower teeth.
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Type III: The frenulum is thick and stiffened, and anchors the tongue from the middle of the underside to the floor of the mouth.
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Type IV: The frenulum is posterior or not visible, but when touching the area with the fingertips, the examiner can feel tight fibers anchoring the tongue, with or without a thickened, shiny surface on the floor of the mouth.
"She was checked and doesn't have a tongue tie"
As someone who deals with tongue ties every day, I am less concerned with how far the frenulum extends, and more with how the tongue is functioning.
When a baby comes in with various signs or symptoms, I always check the tongue because:
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they may have a tie that has gone undiagnosed
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the tongue could be weak
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the tongue may not be functioning properly
Babies are born having already been drinking amniotic fluid. If the baby's tongue wasn't functioning properly, they had to compensate by recruiting the jaw muscles and chomping. This muscle memory can continue after they're born, and cause the tongue not to work effectively and the jaw to work too much.
Treatment for Oral Ties
Treatment varies depending on the issues at hand and the routes parents are choosing to take.
For example, you may choose to have the tongue/lip tie revised. In this case, I work collaboratively with the dentist or ENT to loosen the body pre and post-revision.
Chiropractic care is also great for babies who have oral dysfunction without a tie, or when parents what to try conservative care before or instead of opting for surgical revision. I work hands-on to stretch, strengthen and re-train your baby to use their body optimally, and provide parents with exercises that can be done at home.