Ankyloglossia, a disease often referred to as the "tongue tie" by many dentists including a Bellevue dentist and seattle dentist, is a hereditary abnormality that is typically noticed soon after birth. This cause the tongue to fuse to the floor of the mouth due to an abnormality in the lingual frenulum.
The lingual frenulum is normally found under the middle part of the tongue. With ankyloglossia, however, the lingual frenulum has an anterior attachment near the tip of the tongue and may also be unusually short. This causes adhesion of the tongue tip to the floor of the mouth and can result in restricted tongue tip movement to some extent says a seattle dentist and cosmetic dentist.
By definition, a frenulum, which is a small frenum, is a narrow fold of mucous membrane connecting a moveable part to a fixed part. Its purpose is to stabilize and check undue movement of that part.
Usually, the patient is unable to protrude the tongue past the edge of the lower gingiva or mandibular incisors. With protrusion attempts, the tongue tip becomes notched in midline, resulting in a heart-shaped edge. In addition, the patient is unable to touch the roof of the mouth with the tongue tip when the mouth is open when asked by the cosmetic dentist. The diagnostic characteristics of ankyloglossia are easy to detect.
Important during fetal development, the frenula continue after birth to guide the positions of the baby teeth as they come in. Adults may still feel the remnant of their lip (labial) frenulum, which is what is left of the cord located between the center of the upper lip and the center of the upper gum. The alveolar ridge grows in height, the teeth begin to erupt, and the tongue grows and narrows at the tip. The frenula are strong cords of tissue in the front – center of the mouth that guide the development of mouth structures during gestation. At the same time, the lingual frenulum recedes, stretches, and may even rupture.
The prevalence of ankyloglossia is unclear to a bellevue dentist sometimes, since the reported figures vary significantly from less than 1% to as frequent as 97% in newborns (Lewis & Counihan, 1965). More recent reports place the prevalence at about 4%-5% in newborns (Messner et al., 2000; Ricke et al., 2005).
Although ankyloglossia can be significant at birth to a kirkland dentist, the severity and functional effects tend to decrease with time and oral growth. During the first 4 to 5 years of life, the oral cavity changes significantly in shape and size.
Tongue-tie is a condition in which the free movement of the tongue is restricted due to abnormal attachment of the base of the tongue (lingual frenulum) towards the tip of the tongue. The lingual frenulum may be too short and taut after birth, or may not have receded and may remain attached too far along the base of the tongue.
Children with tongue-tie may be unable to protrude the tongue, touch the roof of the mouth, or move the tongue from side to side. If the lingual frenum extends to the tip of the tongue, a v-shaped notch or heart shape can be seen at the tip.
Relatively short at birth, the tongue grows longer, and thinner at the tip, as we get older.
As well as having a speech function, the tongue is needed for sucking, chewing, swallowing, eating, drinking, tooth and gum health, kissing, sweeping the mouth for food debris and other particles (such as hairs), warming the air during mouth-breathing, and oral play (for instance, poking the tongue out and waggling it about for fun).
Ankyloglossia is often hereditary, and there is no means of prevention says a redmond dentist. Therefore, as the child grows, the severity of the tongue-tie lessens and the initial restrictions of lingual movement are diminished.
The most important articulator for speech production is undoubtedly the tongue. During speech, the amazing range of movements the tongue can make include tip-elevation, grooving, and protrusion says a cosmetic dentist.
Tongue-tie
In anatomy, a fraenum (or fraenulum) is a small fold of tissue that checks or limits the movements of an organ part. Everyone has a lingual fraenum (lingual fraenulum) under the tongue. It is a thin, vertical fold of tissue with attachments to the under-surface of the tongue and to the floor of the mouth.
The terms 'ankyloglossia', 'short fraenum', 'short fraenulum', or 'tongue tie', refer to a restricted lingual fraenum due to a consolidation of tissue, usually leading to reduced mobility of the tongue.
Parents of infants and toddlers with tongue tie are sometimes advised that the tie will "stretch", or "break" permitting a free range of movement, as the child grows. These stretching and breaking phenomena have not been formally studied or documented in the medical or speech-language pathology literature.
It is commonly observed by a bellevue dentist that people with tongue tie cannot protrude the tongue tip beyond the edges of the lower incisors, or to the maxillary alveolar ridge (behind the upper incisors). Sometimes when a person with tongue tie attempts to protrude the tongue it forms a characteristic 'W' shape.
Potential effects of tongue-tie
Appearance
Sexual function
Restricted tongue movements may affect sexual expression.
Oral play
Children in particular may not be able to participate in play routines involving tongue movements and gestures.
Periodontic health
Gingivitis (gum disease) can develop, for the reason stated above.
Dental health
Speech development
Self esteem
Oral hygiene
Eating and digestion
Some children with tongue tie are messy eaters due to a restricted ability to tidy up inside and outside of their mouths while they are having a meal says a cosmetic seattle dentist. Some are unable to circle their lips with their tongues in order to fully lick their lips. In extreme cases poor oral hygiene can lead to digestive complaints.
Assessment
When asked by parents or a bellevue dentist or seattle dentist to assess the need for tongue tie surgery (frenectomy), a speech-language pathologist takes into account the above factors. They look at the range of tongue movements, the two points of attachment of the fraenum, and speech development.
As a Seattle dentist and Redmond dentist, as well as Bellevue dentist, cautions, not every tongue-tie requires surgery:
Subjective factors, such as concerns about self-esteem, cosmetic appearance, sexual function and oral play tend to be the domain of the child’s parents, with the speech-language pathologist fulfilling an information-sharing role, if required. Primary concerns for the speech-language pathologist are the effects of the ankyloglossia on the particular child’s speech, dentist and periodontic health and oral hygiene.
Examining for tongue tie
Tongue-tie surgery (lingual frenectomy) involves more than just a simple clipping or a quick snip, but more involved tissue resection under general anaesthetic. It is therefore not recommended unless there is a good (speech, dental or other) justification for doing it.
Some bellevue dentists or cosmetic dentists like to seek two speech-language pathology opinions to help them make their decision whether to not to proceed with tongue tie surgery.
A speech-language pathologist prior to tongue-tie surgery should assess children. Some require pre-operative exercises, and most require post-operative exercises under a speech-language pathologist's supervision.
Lingual frenectomy and lingual frenotomy are different procedures. Lingual frenotomy is often performed on newborns and neonates with tongue-tie to enable them to latch and suckle. Lingual frenotomy is sometimes referred to as "tongue clipping". It is done with a local anaesthetic. this is about frenotomy.
The potential for complications and discomfort need to be discussed with the surgeon and anaesthetist.
The purpose of post-operative exercises
Post-operative exercises following tongue-tie surgery are not intended to increase muscle-strength, but to:
- Increase kinaesthetic awareness of the full range of movements the tongue and lips can perform. In this context, kinaesthetic awareness refers to knowing where a part of the mouth is, what it is doing, and what it feels like.
- Develop new muscle movements, particularly those involving tongue-tip elevation and protrusion, inside and outside of the mouth.
- Encourage tongue movements related to cleaning the oral cavity, including sweeping the insides of the cheeks, fronts and backs of the teeth, and licking right around both lips.
Exercises
Discuss these suggested exercises with YOUR child's speech-language pathologist before commencing them. The SLP will modify them according to your child's age and requirements.
Encourage oral play generally, and do a selection of the following exercises, in any order, in 3 to 5 minute bursts, once or twice daily for 3 or 4 weeks post-operatively. Have a torch and hand-mirror handy. Make it fun.
- Can you go in-out-in-out-in-out with your tongue? (demonstrate)
- Put your tongue behind your teeth and shut your mouth. Can you find your big top teeth with your tongue while your mouth is still shut? feel how tough your teeth are.
- Look in the mirror. Still with your mouth open wide, say dar-dar-dar, now say nar-nar-nar, now say tar-tar. Look in the mirror to see what your tongue is doing. Can you FEEL where it is?
- Stretch your tongue up towards your nose, then down towards your chin. Repeat.
- Lick your whole top lip from one side to the other.
- Now go back the other way.
- Lick your whole bottom lip from one side to the other.
- Go back the other way.
- Shut your mouth and poke it into your left cheek to make a lump.
- Do the same on the other side.
- You can vary the exercise above and make it more interesting by putting a dab of food in various positions above the top lip, to be retrieved with the tongue tip (You could call this game "Elephant Tongue" and read books about elephants (e.g. "Babar") to stimulate your child's interest in playing the "tongue games" spontaneously at other times - not just when you are there.
- See how many times you can lick your lips right around.
- Now see if you can make your top lip fat without opening your mouth.
- Play your own version of copycats, Simon Says or Follow the Leader incorporating the preceding movements.
- Poke your tongue out as far as it will go.
Problems Associated with Tongue Tie
Tongue-tie can cause feeding problems in infants; if this is the case, feeding difficulties are usually noticed early in an infant’s life. Feeding difficulties may include problems breastfeeding and sucking, poor weight gain for the baby, and poor milk supply for the mother. Feeding difficulties may be a reason to consider early surgery to cut the lingual frenulum and loosen the tongue.
In some children, tongue-tie may also cause speech defects, especially articulation of the sounds - l, r, t, d, n, th, sh, and z. Preventing speech defects or improving a child’s articulation may be another reason to consider surgical intervention. The tongue is remarkably able to compensate, however, and many children have no speech impediments due to ankyloglossia.
Although it is difficult to predict which infants with tongue tie are likely to suffer articulation problems later, the following characteristics are common in children with speech problems:
- V-shaped notch at the tip of the tongue
- Inability to protrude the tongue past the upper gums
- Inability to touch the roof of the mouth
- Difficulty moving the tongue from side to side