What is the normal function of the tongue?
In an infant, a normal tongue moves around freely and is not confined by teeth and therefore extends outwards between the upper and lower jaw. Whilst swallowing the infants keep their jaws parted and the tongue is placed between gum pads to produce a vacuum for swallowing (called the infantile swallow)
At 2.5 years of age when all the milk teeth have erupted, this “infantile swallow” is replaced by the adult swallow. Here the lips are closed, the jaws bite together and the tip of the tongue is raised and pressed against the front part of the upper jaw.
What is Abnormal Tongue Function
A tongue tie occur in children whose tongue is attached to the floor of the mouth and as a result can’t move the tongue around.
It may impede speech and many babies can find it difficult to suckle if they have are tongue tied. Mothers, midwives and doctors see this often.
What are other consequences of tongue ties?
A tongue tie in a baby may cause multiple developmental problems. These include from a younger age to an older age
1. Poor breastfeeding
with inadequate weight gain due to hunger and malnourishment
2. Sleep disturbances
3. Nipple pain for mothers
4. Unable to swallow normally
leading to a swallowing pattern which creates orthodontic problems such as open bite and crowded teeth.
5. Impaired speech
Some children can compensate well and have normal sounding speech, even those with a tongue tie attached very close to the front of the tongue tip. Unfortunately, many children may have imprecise articulation, especially when talking quickly.
6. Dental health problems
Cavities can occur due to food debris not being removed by the tongue’s action of sweeping the teeth and spreading saliva which may also result in gum disease.
7. Poor self-esteem
Children with poor communication as a result of being tongue tied often show low self-esteem.
8. Inadequate facial development
a.an open bite situation (where the front teeth do not touch with each other when the child closes his/her mouth). This happens because during swallowing the tongue sits between the teeth in the front part not allowing the jaws to come together.
b.The upper jaw does not develop fully resulting in
i. crooked or crowded teet
ii. the lower jaw being trapped inside the upper jaw this not allowed to grow properly as well.
iii.long term sleep disordere breathing problems that may lead to
- sleep apnoea leading to tiredness and therefore ADHD
- multiple ear infections
- bed wetting
Do all tongue ties look the same?
All tongue ties do not look alike – that is why it is sometimes difficulty to spot them. They can be thin and membranous, thick and white, short, long or wide, extending from the margin of the tongue all the way to the lower front teeth, or so short and tight that they make a web connecting the tongue to the floor of the mouth.
When they extend to the margin of the tongue, they cause a heart-shaped look at the front of the tongue and no tongue tip can be seen. When they extend across the floor of the mouth they cause pain when the tongue is elevated. They can cause separation or inward tilting of the incisors.
Many people have lips and tongues that are held too tight by the frenum (that ligament that attaches your lips and your tongue to your gum and jaw bone). This can cause
- gum recession in between the teeth (mainly the front upper and front lower teeth)
- gum recession on individual teeth
- gaps between teeth
Laser Resec. of Tongue Tie
Tongue tie surgery is carried out under topical (cream) anaesthetic on the tongue tie. We can precisely and painlessly remove the tissue making it very comfortable for your baby.
It takes practically 2 – 3 mins to perform but some cooperation from the patient is required to keep still.
There is no bleeding afterwards, no sutures and hardly any discomfort.
Tongue tied babies can suckle immediately after the procedure! It is a truly amazing way to have surgery.
Children go to school the day after and adults can go back to work the same day. Eating is normal.
Lasers are an excellent alternative to scissors or a scalpel as a means to incise soft tissue.In laser terms the tissue is “ablated”.
Light energy is used to incise tissue rather than cutting that occurs with scissors or scalpels.
The use of lasers in surgery has a distinct advantage over other methods for a number of reasons: it reduces the collateral damage as it is more precise and cuts layer by layer, it is bactericidal (kills bacteria as it ablates), reduces oedema, swelling and inflammation and therefore allows for better healing through the concept of photobiomodulation.
Laser Resection of lip tie
With a lip tie, together with an anaesthetic cream, a local anaesthetic may also be used. This procedure is also painless and takes about 2 to 3 mins to perform.
There may be some bleeding with this procedure which generally stops within 5 to 10 mins.
Does it hurt?
No. Laser resection of the tongue tie does NOT hurt.
Older babies do not like being wrapped up or held firmly so they usually cry out.
Following division, the baby is promptly unwrapped and returned for feeding. Although some babies will cry for up to 60 seconds, the average is just 15 seconds (and some just stay asleep).
What about the wound ?
A few drops of blood are normal, but this always stops quickly and is never a problem. The inside of the mouth heals much faster than most of the rest of the body because the lining of the mouth is being worn away and renewed all the time.
This happens even quicker in babies, so there is no need for any form of wound management, the baby just needs to be fed.
Often there is a white patch under the tongue which takes 24 - 48 hours to heal. This does not seem to cause the baby any discomfort.
What is the Follow Up after a laser release of the tongue tie?
- Dentist – will help improve problems with decay and development of the jaw
- Speech Therapist – will help in speech and language problems
- Lactation Consultant – will help you with improving breastfeeding and poor suckling
Some More Facts about Tongue and Lip Ties
- It is possible to have both an anterior (frontal) tie AND and posterior one. Although some (anterior) ties are associated with heart-shaped tongues, tongue tips can look rounded or squared if there is posterior tie
- Posterior ties are often misdiagnosed as a short tongue.
- A baby with a tongue tie may be able to stick out his tongue.
- Tongue and lip ties, like the webs of skin between your thumbs and index fingers, do not suddenly shrink, stretch, or disappear.
- Tongue and lip ties can affect a baby's ability to breastfeed.
- Babies who are tongue tied are often not able to drink well from a bottle or take a pacifier.
- Older tongue-tied babies may have difficulty in swallowing solid food. Their tongues may not be mobile enough to move the food to the back of their mouths.
- A mother whose baby is tongue tied may start out with plenty of milk, but the lack of adequate stimulation to her breasts can result in a decrease of her milk production. This, of course, can lead to poor weight gain in the baby.
- Digestion starts in the mouth, and so tongue ties can lead to digestive problems like colic and reflux.
- Tongue tie can affect speech, causing both delays in speech onset, and also in the ability to form certain sounds and words correctly.
- Tongue tie can affect the way teeth come in. For example, the front bottom teeth may be pulled inwards. Babies with tongue ties often have narrow palates, so teeth may be overcrowded.
- When you see a lip tie, there will almost always also be a tongue tie.
- Babies who have lip ties are not able to open up and properly flange their lips, and this can affect their ability to grasp the breast.
- Lip ties may push the two front teeth apart, leading to expensive orthodontic work later. In many cases, if the lip tie is not released, the front teeth will grow apart again after the braces have been removed.
- Tooth decay can be caused by food being pushed into the pockets on either side of a lip tie.
- It may seem trivial, but tongue-tied babies will eventually become tongue-tied children and adults who cannot lick an ice cream cone or French kiss - not trivial to those affected; it is much easier, safer, and less traumatic to fix a tongue tie in infancy than to wait until later childhood or adulthood
If you would like to know more about tongue tie in a baby, or tongue tied children then call Smile Concepts on 02 9267 7777