These are two very common questions I get asked almost every day. There is a great deal of detail I could go into but I’ll reserve that for another blog. On this blog, I will keep it a simple explanation and open the door for further discussion. The answer to the first question is very simple, yes, most of us do have a tongue tie and lip tie (also known as frenulum). Should we have one? Is it normal?
Early in fetal development, when the left and right side of the face fuse together the cells at the midline should undergo auto disintegration to allow free movement of the tongue and lip. Something causes the incomplete auto disintegration to occur and it remains as a remnant tissue (congenital malformation).
In my practice, I examine every baby, child, and teenager during each exam visit for a tongue tie and lip tie assigning a classification to it. I also examine adults that seek me for this specific problem. I use the same classification Dr. Larry Kotlow uses. In my opinion, only a small percentage of the population does not have a tie and in my practice, I estimate this is less than 5%.
Tongue ties can contribute to different problems. Babies may experience problems breastfeeding, infants may experience feeding difficulties, children may have speech development challenges (r, s, t, d, l, sounds) and breathing disorders; teenagers may have experienced all the previously mentioned problems in addition to dental and jaws underdevelopment. Breathing problems may include mouth breathing, snoring, and sleep apnea. Adults may be experiencing all the above symptoms in addition to neck tension, headaches, TMJ problems, gagging, etc…
Socially, untreated tongue ties can affect a child’s interaction with their friends. For example, I treated a fourteen-year-old girl who had a significant tie and it was affecting her ability to easily communicate with her friends. She stated she would get “tongue-tied” and she would rarely participate in the conversation. She became a spectator and a listener rarely expressing her opinion and emotions. Her friends did not have the courage to tell her she sounded “different” until she informed them she was having surgery to release her tongue. They were happy for her and were hoping this would change her ability to participate in conversation. A simple laser procedure removed the tie and she has been doing much better since.
Upper lip ties may contribute to slightly different problems. Some lip ties can prevent babies from forming a seal on the breast during breastfeeding and thus struggle to feed. Some lip ties cause pseudo pockets above the top front teeth causing over-retention of foods and liquids exposing the teeth to sugars and starches for a longer period. This may lead to caries development. Per some speech therapists some very restrictive ties can interfere with “m”, “b”, and “p” sounds. In addition, thick, short, fibrous ties can lead to a larger than normal gap between the top front teeth. If your child needs braces due to crowding or other malocclusion problems, it is very likely the orthodontist will require the tissue be removed to prevent it from separating the front teeth.
So, if ties (frenulum) can cause several different problems, why has nobody said anything about it before? The simplest most obvious answer is that instruction about lip and tongue ties is not taught in medical or dental schools. It is also not incorporated in other health professions curriculums so it is easy to see why other health care providers are not aware of the negative effects of these ties. Many times, patients fall through the cracks because some health care providers do not know how to diagnose, treat, or refer to a specialist that can treat them. I have spent the past three years trying to educate as many healthcare providers as my schedule allows me to. I have invested a great deal of personal time researching the literature, attending continuing education courses, and talking to other professionals who have been treating these conditions for decades. My point with these statements is that it takes a professional to be personally interested in learning about ties to become knowledgeable about them and either treat them or refer to a specialist who can. I do not blame other healthcare providers (including other doctors) for not knowing but I do encourage them to refer when they cannot help their patients. It is what any reasonable person would do.
So, does every person that has a tie need to have it removed? Not necessarily. But ties must be ruled out as the cause for the previously mentioned problems and ruled out as a risk for these problems to develop in the future.