Frequently Asked Questions About Tongue Tie

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The band of tissue under the tongue that connects the tongue to the floor of the mouth is called the lingual frenum or frenulum. If the frenum is too tight or too short, it may affect the tongue’s function when chewing, swallowing, talking, or breathing. The type of tongue tie and severity will determine whether or not treatment may be beneficial. An anterior tongue tie primarily affects the tongue tip while a posterior tongue tie primarily affects the middle or back part of the tongue. While an anterior tie is often more obvious, a posterior tie may be less obvious. A specialized provider will consider the type and severity during a functional assessment. 

A frenectomy or frenotomy is a procedure that is performed by a specialized provider (dentist, ENT, oral surgeon, orthodontist, etc.) to release the restriction and improve tongue function. Laser procedures are common although some providers may choose to use scissors or a scalpel. Other factors will determine whether local or general anesthesia may be used. Treatment options will be discussed and determined on an individualized basis.

A collaborative team approach, including orofacial myofunctional therapy and body work before and after the procedure, will help to facilitate the most successful outcome. Orofacial myofunctional therapy is often recommended 4-6 weeks before the procedure in order to prepare the frenum and surrounding tissue. In addition, therapy is important to continue after the procedure in order to minimize the risk of reattachment.

Proper oral rest posture is critical for development of the orofacial structures, including the jaw and airway. The most efficient oral rest posture involves the tongue resting on the roof of the mouth (palate) together with the lips closed and the use of nasal breathing. If there is a tongue tie, the restriction may prevent the tongue from resting in the correct position, which may lead to various negative consequences described below. Proper oral rest posture (lips together and tongue up on the palate) helps maintain balance of the muscle forces in the orofacial structures and guide ideal growth and development of the jaw, teeth, and airway.

A functional assessment is important to determine whether or not treatment of a tongue tie may be beneficial. Potential consequences may include one or more of the following symptoms: high or narrow palate, underdeveloped jaw, malocclusion (misaligned teeth), poor oral hygiene, difficulty with chewing or swallowing, digestive issues, speech errors, TMJ issues, forward head posture, and/or poor body posture. For example, a tongue tie may cause difficulty with chewing of food, which may in turn lead to digestive issues due to food that is not properly chewed. Another example includes a tongue tie that may cause upper body tension and/or poor posture since the entire body is connected. Because every case is different, a functional assessment will consider the impact of the restriction on chewing, swallowing, talking, or breathing.