B] Myths and Facts About Tongue Tie and Lip Tie
MYTH 1: The tongue tie will stretch itself out/ My child will outgrow his/her tie!
FACT - Ties do not stretch or tear and will cause interference when attempting to achieve a good secure latch to the mother’s breast or bottle’s nipple. The tongue tie is composed of a thick webbing of fascia that stretches less than 1%. If left untreated, it will persist into adulthood, show nursing difficulties in babies and compensations later in life. So, a fact check to the question can babies outgrow tongue ties? The answer is no they can’t.
MYTH 2: A tongue tied infant cannot extend their tongue past their lower gum/lip!
FACT - Most infants with a tie can protrude their tongues out. This protrusion is not the correct way to assess the tongue’s functionality and a tie. The tongue needs to have a normal motion in ALL directions. The most important movement for the tongue during breastfeeding is UP and DOWN, RIGHT to LEFT - not just IN and OUT.
MYTH 3: What does the upper lip tie have to do with feeding?
FACT - When the upper lip fails to elevate or flange upward adequately, the infant might find it difficult to maintain a good, secure latch. An upper lip tie can also interfere with the closing of the mouth (a typical appearance of a cupid's bow), make brushing teeth difficult or lead to gaps between teeth.
MYTH 4: All tongue ties have speech issues! Do lip ties affect speech?
FACT - While not all lip tied and tongue-tied children have speech issues, some may struggle with sounds that require articulation by tongue with letters like R, S, L, Z, D, CH, TH, and SH. Even though some kids or adults can make these sounds in isolation, stringing the sounds together during speech can be very difficult. Some may also have difficulties with stammering, stuttering and lisping of speech.
MYTH 5: Treating tongue ties is a Fad/ Tongue tie is a new concept!
FACT - Tongue ties have been written about for thousands of years. There are references to treatment being performed in the Bible. Also, in the 18th century, midwives used their fingernails to divide the lingual frenulum. With the renewed emphasis on breastfeeding and more information about its long term impacts, we are now seeing increased diagnosis and as well as treatment of tongue ties.
MYTH 6: Posterior tongue tie doesn’t exist!
FACT - The real restriction of a tongue tie is typically at the fascia, which is a type of connective tissue covering the muscle. A posterior tongue tie may not be visible to the naked eye as an obvious tongue tie, but can be a symptomatic tongue restriction. Restricted fascia or webbing under the tongue is sometimes clearly visible, and other times is not easily seen.
The baby or child who has no obvious string, but has all the symptoms of a tongue tie often has a posterior tongue tie. When released, parents see an immediate improvement because now the posterior aspect of the tongue can elevate better allowing for improved swallowing, speech, and sleep.
MYTH 7: If your child has a lip tie and/or tongue tie, you need to wait to revise the ties until he/she turns 1-2yrs old!
FACT - Infants who have tethered oral tissues can and should be treated as early as they are born. Waiting to correct tongue ties and lip ties in babies does nothing to improve the latch, and can lead to more complex problems at a later age.
MYTH 8: Tongue tie if left untreated rarely impacts any area of health in later years!
FACT - Untreated tongue ties in infants can lead to difficulty in chewing, swallowing foods, and speech problems. It can alter the jaw and dental development, including:
A high palate and backwardly placed jaws
Posture and poor sleep patterns
Mouth breathing and snoring
Frequent tonsils and adenoids
ADHD and clenching of teeth
MYTH 9: Tongue has nothing to do with sleep, airway and breathing! Tongue tie and sleep issues are not correlated
FACT - The back of the tongue should be resting high up on the palate. If only the front of the tongue rests on the top, the back of the tongue will fall back and block the airway, which makes it difficult to breathe through the nose. Tongue tie is one of the things that affects tongue posture, and once you begin mouth breathing, the vicious circle of events will further affect your breathing and sleep.
MYTH 10: Tongue tied babies have no issues with eating and swallowing food!
FACT - Tongue tie and swallowing problems are correlated. When solids are introduced, eating difficulties appear to resurface and kids are often labelled slow eaters, picky eaters and messy eaters.
They tend to stuff a lot of food in their cheeks, as the tongue cannot retrieve food that has fallen to the sides of the mouth, it builds up there. Once the cheeks are full, additional food cannot fall to the side, which makes eating and swallowing food difficult.
MYTH 11: Tongue tied babies have no issues with eating and swallowing food!
FACT - Snipping a tongue tie with scissors often causes bleeding and less precision in babies, which could eventually need a second release. Likewise, snipping or clipping the tongue tie without any pre or post-operation exercises wouldn’t yield the desired functional result. Thus, to yield a more precise result, laser treatment is recommended.
For adults, however, apart from snipping the tongue tie, the fascial band of tissue also needs to be released. Here, using the Functional Frenuloplasty procedure (involving scissors & sutures) along with Myofunctional Therapy is proven to be very successful.
In laser tongue tie release, the tight fascial band of tissues (connecting to the underside of the tongue) is released. It is a simple procedure performed with a topical local anaesthetic gel, so there is no pain. Also, since the laser cauterizes the tissues within the mouth, it limits bleeding and reduces the risk of infection.
Following the laser frenectomy procedure, a post-op stretching & care routine is advised. These daily stretching exercises ensure that the release is a functional success and prevents re-attachment.
MYTH 12: Treatment is recommended for all lip and tongue ties
FACT - It takes an experienced provider to thoroughly investigate the tongue function and symptoms associated with each tie. This is the reason why lip-tie or tongue-tie assessment should be done only by a skilled and trained provider. A skilled provider will advise treatment only after a thorough history taking and clinical examination, depending on the severity of the condition.
We follow a precision-based tongue-tie release procedure for adults, wherein the focus is on releasing the appropriate extent of tissues for maximum relief. We incorporate a multidisciplinary protocol, wherein Myofunctional therapy and sometimes even physical therapy is used before, during, and after the surgery. This ensures a complete & effective release of tethered oral tissues.
MYTH 13: Snoring in adults can’t be caused by tongue tie
FACT - Tongue tie could be one of the causes of snoring in adults. Rather than the roof of the mouth, in tongue tie, the tongue sits on the floor of the mouth. This can make eating, drinking and swallowing difficult. It can also affect jaw growth, breathing and posture. If left untreated, tongue tie can cause snoring, eventually progressing to sleep apnea. Hence, treating tongue tie is essential as it could improve nasal breathing and help open up the airway, preventing serious health issues.
MYTH 14: Post-surgical tongue tie exercises are too difficult
FACT - Post-op stretching & care routine is essential for the tongue tie release to be a functional success and prevent re-attachment. We follow a multidisciplinary team approach to diagnose and comprehensively treat a myriad of tongue ties. Pre and post-treatments are provided under the guidance of different healthcare professionals whose collective expertise makes the entire process seamless. Together, the team can solve all problems related to tongue ties - be it breathing & sleep patterns or jaw growth and speech issues.
MYTH 15: Tongue tie doesn’t cause TMD
FACT - Tongue tie restricts the tongue from normal movement & function, which could lead to compensations like unfavourable movements of the TMJ, lower jaw, and tension in the floor of the mouth, neck, face and head. Likewise, the tongue also helps keep the airway open. However, in the case of a tongue tie, it could lead to compensations where one starts mouth breathing, snoring, or clenching & grinding their teeth. These constant compensations could eventually result in Orofacial pain and TMJ dysfunction.
MYTH 16: Obstructive Sleep Apnea is not caused by tongue tie
FACT - The tongue performs many functions, with diaphragmatic breathing being one of them, wherein the tongue rests high up on the palate, keeping the airway wide open. But, due to tongue tie, the tongue sits on the floor of the mouth, which can cause an airway function disorder. In airway function disorder, since the posterior part of the tongue falls back and narrows the airway, it could cause mouth breathing, snoring, UARS and obstructive sleep apnea and oral muscle dysfunction.
MYTH 17: Lip ties do not exist
FACT - When the frenulum (a piece of tissue) behind the upper lip is too stiff or thick, it could restrict the upper lip movement, giving rise to a condition called lip tie. A lip tie can give rise to a Cupid-bow kind of lip, preventing complete mouth closure. If the tissue passes between teeth, it can cause cavities. It can also give rise to a diastema (a big gap) between the front teeth. After a complete evaluation, the provider can tell you whether or not you need treatment for lip tie, which is done via frenectomy.
MYTH 18: Anyone can perform a laser tongue tie surgery
FACT - Laser frenectomies must be performed by a certified laser surgeon and a tongue tie specialist. We, at TMJ, Tongue Tie and Sleep Institute, carry out a comprehensive functional assessment of the tongue before recommending a treatment. Laser tongue tie releases are more successful in babies.