Lip and Tongue-Ties

What is Tongue-tie?
Tongue tie can be defined as a structural abnormality of the lingual frenum. When the frenum is normal, it is elastic and does not interfere with the movements of the tongue in sucking, eating, clearing food off the
teeth in preparation for swallowing and, of course, in speech. When it is short, thick, tight, or broad, it has an adverse effect on oromuscular function, feeding, and speech.

What does it look like?
All tongue ties do not look alike – adding to the difficulty of spotting 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 language is elevated. They can cause separation or inward tilting of the incisors. A baby with a tongue tie will look different from an older child with the same condition.

What is a lip tie?
Similar to a tongue tie, a lip tie is a short, thick, or tight frenum that restricts the movement of the lip. Everyone has a frenum, but in some people, the frenum is especially tight or fails to recede and may cause tongue/lip mobility problems. The key to diagnosing a lip tie is understanding if the upper lip’s movement is restricted. If the lips aren’t able to move because the membrane is rigid or tight, your child may have a lip tie. If no symptoms or problems are resulting from a membrane connecting the upper lip to the upper gum line, your child may simply have a labial frenulum. Did you know, most infants have a low-connecting upper lip frenum. A gap between the two front teeth (often up to 10 years of age) is developmentally appropriate! “A gap” alone does not require a lip tie correction in young children.

Signs of Tongue Tie in Newborns

  • Open mouth posture
  • Mouth breathing
  • Sleep apnea symptoms

Breastfeeding Tongue Tie Symptoms (For the Child)

  • Shallow or difficulty latching
  • The latch cannot be sustained for long
  • Sliding off the nipple
  • Prolonged feeds
  • Restlessness after prolonged feeds
  • Refusal or irritable during feeds
  • Dribbling and spilling
  • Falling asleep on the breast
  • Arching the back and pushing away
  • Gumming and chewing on the breast
  • Clicking noise while nursing
  • Inability to hold a pacifier or use bottle
  • Excessive gas
  • Reflux
  • Colic

Breastfeeding Tongue Tie Symptoms (For the Mother)

  • Cracked, bleeding nipples
  • Lipstick or inverted nipple
  • Pain while nursing
  • Over/undersupply (inefficiently empties breast)
  • History of plugged ducts, mastitis and supply issues

Other Symptoms

  • Delayed speech, or problems with certain letters or sounds
  • Lisp
  • Food & texture aversions
  • Tooth decay (even with constant brushing)
  • Gagging or choking
  • Pocketing food in cheeks
  • Difficulty talking fast
  • Can’t move tongue past lips
  • Jaw joint and posture
  • Jaw pain
  • Migraines
  • Neck and back pain
  • Forward or slumped posture

Treatment

Once a tongue tie has been diagnosed, the primary need is to correct the structural anomaly causing the problem. After the structural problem has been successfully corrected, it is reasonable to expect to improve function and to treat secondary issues successfully. A lactation consultant can help with correcting poor sucking, which will improve breastfeeding. A speech-language pathologist will help with speech and language problems. The procedure may be performed as early as a couple of days after birth and can be performed into adulthood. Typically, once a problem with a tongue-tie or lip-tie has been discovered, the sooner it is addressed, the better the procedure will work and the fewer issues the child will have.

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