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Tongue Tie (Ankyloglossia)

Most people are aware of the slang term “tongue tied” as it pertains to someone who has suddenly lost the ability to speak, usually from surprise, excitement, or a similar emotion. But tongue tie is in fact a real medical condition which generally requires treatment, preferably at as young an age as possible.

What is tongue tie (Ankyloglossia)?

Tongue tie is a condition in which the bottom of the tongue is attached to the floor of the mouth by a band of tissue called the lingual frenulum. This connection restricts the free movement (range of motion) of the tongue’s tip. What causes tongue tie?

No one is sure what exactly causes tongue tie, but it’s believed to be at least partially genetic in nature. As many as 10% of all children born in the U.S. have tongue tie.

What are the symptoms of tongue tie?

Early symptoms of tongue tie are generally readily seen within the nursing relationship between a breastfeeding mom and her infant. Even a slight tongue tie can cause problems with breastfeeding. Symptoms affecting the infant can include:

- Acting irritable or fussy, even after feeding - Difficulty creating or maintaining suction. The infant may become tired in 1 or 2 minutes, or fall asleep before eating enough. - Poor weight gain or weight loss - Problems latching onto the nipple. The infant may just chew on the nipple instead.

In the mother, sore nipples, plugged milk ducts, and sore breasts are all symptoms that the child may have tongue tie. Frustration and depression at their apparent “failure” to feed their child can cause great emotional difficulty as well.

How is tongue tie diagnosed?

If the breastfeeding relationship has not been adequately established within several days, a pediatrician or dentist can examine a child for tongue tie. There are two types of tongue tie: anterior and posterior. Both can be diagnosed by a pediatrician, but not all pediatricians are aware of posterior ties, as it is a relatively new diagnosis. If the infant does not appear to have an anterior tie, a pediatric ear, nose, and throat (ENT) specialist can be seen for a second opinion and to check for a posterior tie.

How is tongue treated?

Anterior tongue tie can usually be treated quickly and easily by a pediatrician during an office visit. It requires a small clip in the front of the frenulum, which is a fairly simple procedure and results in only a drop or two of blood, as this area does not have many blood vessels to disturb. Most babies hardly react to an anterior clip. Posterior tongue tie requires a more complicated, but still fairly simple procedure wherein an incision is made in the rear of the frenulum. Posterior tongue tie clipping requires a visit to an ENT to ensure that it is done correctly. Generally, the ENT will numb the area to be clipped with topical ointment and an anesthetic shot. There is a bit more bleeding when clipping a posterior tongue tie, but the infant recovers within the day and is still able to nurse immediately after the procedure is completed. What happens if tongue tie is not treated?

A simple tongue tie that does not significantly restrict the movement of the tongue will generally not cause problems later in life, although it may impair the breastfeeding relationship. However, a moderate or severe tongue tie that goes untreated can cause a number of issues as the infant matures, including:

- Inability to chew age appropriate solid foods - Gagging, choking or vomiting foods - Persisting food fads - Difficulties related to dental hygiene - Persistence of dribbling/drooling - Delayed development of speech - Deterioration in speech - Behavior problems - Dental problems - Loss of self confidence - Strong, incorrect habits of compensation being acquired

If you suspect your infant or child has tongue tie, please give us a call at our Ann Arbor dental office at 734-677-2156 for more information, or to schedule a consultation. If needed, we are happy to refer you to a specialist if we find one is needed in order to treat the problem.


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