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Tongue Tie

Tongue Tie: There are seven frena (also called frenula) in the mouth, found in the top, bottom, sides of the mouth, underneath the upper and lower lips, and below the tongue.

A frenum (singular for frena) is a fleshy piece of soft tissue comprised of elastic and striated muscle fibres attached between the gums and the other tissue structures like the lips, cheeks, tongue etc. The primary function of frena is to keep the different structures together with flexible but restricted movements. The flexible and yet controlled movement of the organs (lips, cheeks, tongues etc.) allows proper food capturing, swallowing, speech, and mouth movement.

What is a Tongue Tie?

A tongue-tie is a condition someone is born with that the frenum is too tight that the tongue has limited, overly restricted movements, resulting in ankyloglossia – the frenum is too short, too thick or too broad. Boys have more prevalence for tongue ties than girls.

In neonates, tongue-tie causes the infant to have trouble drinking breast milk because the tongue cannot latch on the nipples. When the infant cries, the tongue appears to have a V shape or a heart shape. Because of not drinking adequate breast milk, the growth and development are impaired and slow.

If gone undiagnosed and untreated, tongue ties can cause many issues to children like small body size, Intellectual disability, ADHD, teeth grinding, dental malocclusion, restricted airway development, dental malocclusion, chronic mouth breathing, speech difficulties, snoring, problems with swallowing, elongated face, small lower jaw, frequent upper respiratory infections. The list can go on and on further.

Adults who have not had the issues corrected before suffer from the signs and symptoms listed in the previous paragraph. Moreover, they also can be experiencing craniofacial deformity, lower self-esteem, lisping and difficult speech, laud snoring, sleep apnea, tongue and cheek biting, soreness in the jaw, TMJ pain, lethargy, gum recession at the site of the frenum attachment (the frenum pulls the gums away), difficult kissing, painful denture (the denture irritating the frenum constantly) etc.

How is it Treated?

A frenotomy is a procedure that releases the tight ligament in the tongue tie by making an incision in the frena. Most laypeople use the term frenectomy, which means the total removal of the frena. Frenectomy is not indicated in most cases.

Frenotomy is simple and adequate for most tongue-tie cases. Since there are few blood vessels or nerve endings, it can be done without any numbing or anesthesia. We just cut the frenum so that the tongue can move normally. After the procedure, the baby can feed without discomfort.

We apply topical numbing gel first for adults and then a bit of local anesthetic around the site. Diode laser is then used to severe the ligament in the frenum with minimal to no bleeding. The laser seals the cut surfaces, so the pain level is usually minimum after the local anesthetic is gone.

Recognition of tongue-tie in babies is essential. The best outcomes from a frenotomy treatment are usually within the first three months after birth. After three months, the infant will take a pregressively longer time to readapt their tongue position during latching after the treatment. Most cases are recognized by a lactation consultation or a nurse at the maternity ward. The mother should look out for it if she is experiencing:

  • pain during or after breastfeeding
  • breasts that feel engorged even right after nursing
  • blocked milk ducts or mastitis
  • fatigue from constantly breastfeeding even though your child never seems to be full
  • colic baby

Should the mothers experience the above symptoms, they should consult with their pediatricians to find out if some issues with the babies affect the feeding.

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