The tongue is one of the most important organs in the body. It is so essential to human functioning; the tongue starts to develop just after the heart as a fetus gestates.
During pregnancy, the body of the fetus develops from structures called branchial arches, and the tongue forms from four out of the five total arches. A fully developed tongue consists of eight paired muscles that are fed with blood and controlled by four nerves. It’s a big deal!
Issues with tongue development
As you might imagine for any complex organ, there can be problems with the development of the tongue. One of the most common issues, and the issue we are going to discuss today, is tongue tie. This is where the strip of skin that connects the tongue to the floor of the mouth is too short, restricting the movement of the tongue.
As an amazing illustration of the power of a tongue tie diagnosis, we can look at the story of six-year-old Mason Motz. Mason’s parents thought that he could not speak, as he was non-verbal all his life. Mason came to see us at Kidstown Dental because of our D’Termined Program. At his first visit we diagnosed dental needs that were too much for him to cope with and so we recommended a sedation to give him a fresh start. At the sedation visit, we noticed that he had a tongue tie. We were able to treat the tongue tie, and Mason’s parents were astonished to discover that hours after the operation, he could speak in full sentences! Mason is now communicating verbally and thriving, as you can see from this video. Not only was Mason able to speak after the tongue was released, but his sleep finally got better, which led to a happier healthier child. Mason also got ear infections almost every month of his life prior to the frenectomy, he hasn’t had one ear infection since the surgery! In addition, it is very likely that the breakdown on Mason’s teeth that led to the need for dental surgery was caused by silent reflux his tongue tie caused. This is a demonstration of the power of a tongue tie diagnosis and treatment on a young child’s life. I will do my best to breakdown the most common things seen at different ages below to help explain why a tongue tie caused all these issues for Mason, and for many kids!
Tongue ties in different ages
To explain how tongue ties, affect children and adults, we’re going to go through the stages of tongue tie and how it appears in patients of different ages, from development in the womb right up until adulthood.
At 16-20 weeks in utero, swallowing begins. This swallowing actions drives the growth and development of the face, jaws, and airway. When a baby is born the palate should be shaped broad like the tongue. A narrow palate, or a bubble palate at birth is a sign the tongue was not able to fully elevate on swallow. This won’t cause problems during the in utero stage, but can cause problems right from birth.
A baby born with a tongue tie can have problems with breastfeeding, as they cannot suck and swallow correctly. Some babies with tongue ties can breastfeed fine, but this is due to variations in the anatomy and milk supply of the mother. We say the mother is “compensating” for the baby when they are able to breastfeed without issues. Many mothers will struggle to feed their tongue tied baby, may loose supply due to baby’s inability to create the feedback to make more milk. In addition, while human babies are born “nasal obligate breathers” tongue-tied babies quickly turn into mouth breathers. This creates many issues as they grow. A more immediate issue it creates in babies is breathing problems, such as gasping awake or having “junkie” sounding breathing. We now know that airway issues start very early in life for tongue tied people.
It is a good idea to check babies for tongue tie and a high palate, which indicates restriction of tongue elevation at birth. In Brazil, all babies have their tongues inspected within the first 48 hours after birth, and are treated if there is a tongue tie. This is because Brazil finds that treatment now saves money in long run, rather than paying for extensive healthcare costs later in life. Similarly, here in the US, New Jersey and Texas also recommend screening although this is not yet enforced in Texas.
See our blog posted titled “Myofunctional Issues Start in Infancy” from August 2, 2016 for more about tongue ties and breastfeeding.
At six months
The next period where issues are commonly seen occurs at around six months to one year, when solid foods are introduced. The tongue should move food around the mouth to create a “bolus” which can be easily swallowed. But with tongue tie, this function is impaired. Right before the food is swallowed, the food is scattered across the back of the tongue leading to choking and gagging. Often this is mistaken for being a picky eater, as the child may refuse meat or vegetables, but actually they just prefer soft food, as they don’t gag on it. This is again a bigger problem. One of the biggest functions of the tongue is guiding the growth and development of the face jaws and airway, and if it isn’t swallowing properly growth is changed. But, when you add soft foods you compound the issues. Chewing REAL foods is the second biggest driver of growth for good facial, jaw and airway development. Eating mostly soft processed foods will lead to smaller face, jaws, and airway, and it will increase risk of cavities, reflux and systemic inflammation!
At eighteen months to two years
A common sign of tongue tie in young children is delayed speech. Between eighteen and months and two years, you may notice that your child is not talking as much as their peers or is not as articulate. Sometimes the child will get frustrated that they cannot communicate and throw temper tantrums. A tongue tie diagnosis can be overlooked as parents can assume that their child is having behavioral problems, not realizing that this is due to a speech issue.
Around this time, you can also see changes in the development of the face, jaw, and airway. This is not always noticed because it is so common, but it is a sign of tongue tie. Because the tongue drives development of these areas, a problem with the tongue can lead to a flatter face, a cross-bite or under-bite, or crowding of the teeth where the jaws have not grown forward enough.
Another sign that can be seen in babies and children is frequent infections of the sinuses and ears A healthy tongue will push against the roof of the mouth and clear the maxillary, nasal, ocular, and ear sinuses. But with a tongue tie, there is not enough room in the palate for the tongue and it doesn’t push fully against the palate to clear the sinuses properly, which leads to more infections and breathing problems. In babies with tongue tie, for example, you can see stuffy breathing, ear infections, and goopy eyes.
As mentioned above, related to this is the problem of mouth breathing. Naturally, children breath through their nose from birth. The nose performs the important tasks of warming and humidifying the air, as well as releasing nitric oxide, a chemical which encourages rest and digestion. But when a child’s airway is blocked due to a tongue tie, they often start to breathe through their mouth instead. This abnormal breathing pattern puts a lot of stress on the tonsils and adenoids in order to clear and warm the air. What’s more, breathing higher in the chest also adds stress. The overworked tonsils and adenoids will thus enlarge, further blocking the airway, and making breathing even more difficult.
These breathing problems can lead to sleep issues. It is estimated that currently 80% of the US population has some form of sleep disordered breathing. This is huge. It doesn’t mean everyone has sleep apnea, but any form of sleep disorders breathing can have significant impacts on cognitive function and physical health. A lack of quality sleep is a big problem for a child and can lead to ADHD-like symptoms such as hyperactivity, difficulties focusing, and a short attention span. In Australia all providers must have a sleep study before prescribing any ADD/ADHD medicine because the behaviors in children with sleep issues are identical to these behavior problems. Please see this video called “Finding Connor” to learn more of what is common, but not normal!
In addition to breathing and sleep issues a tongue tie will always create a different swallow which will impact the shape of the face and the size of the jaws. When a tongue tied person gets braces they need more harmful forces to move the teeth and must have lifetime retention or the teeth will move back to where they were before. If the tongue tie is released early and myofucntional therapy is done to retrain the tongue, often no braces will be needed later!
Lastly is an issue of silent reflux in children with tongue ties. When the tongue rest down and back in the mouth the upper airway is small and there is therefore a negative pressure created in the thorax or chest. This negative pressure gradient creates reflux of stomach acid in the mouth. This acid can cause a person who eats very healthy and brushes and flosses to have lots of cavities and wear on the teeth. I have seen many frustrated kids and parents who never understood why they suffered with so many cavities. Once we address the tongue tie and retrain the oral rest posture, cavities are no longer an issue!
As an adult
Adults with tongue tie may have been able to overcome many these problems as a child and can function fairly well. We again call this compensation. However, with age, with decreased overall physical fitness, changes to diet, or stressors such as illness or injury, decompensation happens and big problems can arise. Alternatively, sometimes people have suffered from symptoms their entire life but have not known they were due to tongue tie. Symptoms that you commonly see in adults include jaw pain, headaches, chronic sinusitis, reflux (cavities and wear on teeth for “no reason”), neck tension and pain, orthodontic relapse, slurred words (with minimal alcohol consumption or exhaustion), stuttering, sleep issues, and the need for a CPAP (continuous positive airway pressure) ventilator machine.
A tongue tie has a range of symptoms across the lifespan which can have a major impact on a person’s well-being. If you are concerned that you, your baby or child might have a tongue tie, then get in touch with us and we can advise you further.