Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue by anchoring it in the bottom front of it to the floor of the mouth, it is called ankyloglossia.
Before we are born, a strong cord of tissue that guides development of mouth structures develops in the middle of the mouth. It is called the frenulum and all of us can feel a frenulum if we run our fingers underneath the front middle of the tongue as a thin veil of tissue anchoring the tongue to the floor of the mouth, this is called the lingual frenulum. After birth, the lingual frenulum continues to guide the position of incoming teeth. As we grow, it grows smaller and thins down. In some children, the frenulum is especially tight or tethers the tongue too close to its tip and fails to grow smaller leading to tongue mobility problems. This can lead to speech or eating difficulties.
When Is Tongue-tie a Problem That Needs Treatment?
A new baby with a too tight frenulum can have trouble sucking and may have poor weight gain. Luckily the solution is relatively simple with a quick procedure that releases the frenulum and allows the baby to move his or her tongue normally shortly after the procedure.
NOTE: Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue tie. Although it is often overlooked, tongue tie can be an underlying cause of feeding problems that not only affect a child’s weight gain, but lead many mothers to abandon breast feeding altogether.
In Toddlers and Older Children
While the tongue is remarkably able to compensate and many children have no speech impediments due to tongue-tie, others may. Around the age of three, speech problems, especially articulation of the sounds – l, r, t, d, n, th, sh, and z may be noticeable. Evaluation by a speech pathologist may be needed if more than 50% of a three–year–old child’s speech is not clear outside of the family circle. Although, there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common:
• V-shaped notch at the tip of the tongue
• Inability to stick out the tongue past the upper gums
• Inability to touch the roof of the mouth
• Difficulty moving the tongue from side to side
As a simple test, caregivers or parents might ask themselves if the child can lick an ice cream cone or lollipop without much difficulty. If the answer is no, they cannot, then it may be time to consult with a physician at Dagan MD NYC.
For older children with tongue-tie, appearance can be affected by persistent dental problems such as a gap between the bottom two front teeth. Dr. Dagan can guide you in the diagnosis and treatment of tongue-tie. The surgical correction of tongue tie is called frenulectomy.
Tongue-tie surgery is usually a simple procedure with few to no complications. I children younger than 6 weeks old, it may be done in our office. General anesthesia may be recommended when frenulectomy is performed on older children. But in some cases, it can be performed under local anesthesia in our office as well. While frenulectomy is relatively simple, it can be a game changer. Parents should consider that this simple procedure often yields greater benefit than meets the eye in restoring fluency and ease of speech as well as self-esteem.