Functional Tongue Tie Release for Children and Adults
Dr Lim is involved in the release of tongue-ties for children (from around age 6 years and up, depending on each child) and adults.
There is growing awareness tongue-tie untreated at birth may have implications beyond breastfeeding challenges. We often see children and adults with untreated tongue-ties that present with other functional problems.
Some of the most common issues prompting people to seek management of tongue-ties beyond infant feeding challenges include:
Difficulty with speech articulation
Prolonged speech therapy without much improvement
Tendency to mumble when tired
Difficulty with kissing or sexual expression
Difficulty chewing food and swallowing
Jaw clenching and teeth grinding
Snoring and obstructive sleep breathing
Headaches and migraine like symptoms
Chronic neck and shoulder pain
A consultation is the first step to assess how much tongue-tie may be contributing to these problems and to determine realistic expectations regarding the impact of release. This will involve a review of current symptoms, functional history and an oral assessment.
Factors that may impact expected results include the size and position of the jaws which reflect how much space is available for normal tongue function, and whether therapy is instituted to rehabilitate normal function. If snoring or other obstructive breathing is an issue, tongue-tie release may be considered an adjunct to other front line treatments.
Dr Lim has complementary training in dental sleep medicine, orthodontics and myofunctional therapy, and can offer a broader view of any limitations of the procedure and what you can reasonably expect for your specific situation.
What is involved with tongue-tie release in an older child and adult?
Dr Lim uses Waterlase iPlus 2.0 to release tongue-ties and lip-ties at the practice. This uses light energy to vaporise the restricted attachments.
This laser compared to other commonly used soft tissue diode lasers has greater cutting efficiency with less heat and tissue damage.
A quick snip or revision of the tongue tie may on it’s own offer some immediate benefit and improvement of symptoms. However, this is really just the tip of the iceberg, and results will be less than optimal. Good therapy prior and after the release are important in the older individual to rehabilitate normal functions and teach the tongue the correct position to sit for optimal breathing during sleep.
What is a functional release?
The aim of a functional tongue-tie release is to achieve a full range of movements and muscle tone. This is critical for functions like speech, chewing and swallowing, and closed mouth nasal breathing and even jaw development in children.
Consider for a moment removing a cast that has been present on the arm throughout life, even before birth. Removing this cast will not automatically translate to proper function after release. Complementary therapies are often required for rehabilitation. A tongue-tie restriction is very similar to this scenario.
Compared to an infant, an older child or adult will have greater compensatory function. This may include overuse of the muscles of the face, jaws and neck to overcome the anatomical restriction of the tongue during function.
When the back of the tongue has been tied to the floor of the mouth, it loses tone throughout life due to disuse. It is prone to sitting low in the mouth where there is greater risk of it obstructing the airway during life. Some people may be aware of teeth grinding which tends to be associated with obstructive breathing.
Muscles will need to be taught how to work properly and develop sufficient tone, including the back part of the tongue.
Myofunctional therapy pre- and post-release is aimed at breaking old muscle patterns and creating new ones. This involves weekly or fortnightly visits to review new sequences of mouth exercises. These exercises are then performed at home 2-3 times per day.
It is important to complete these exercises prior to release for a couple of reasons. Firstly, by encouraging greater tone and range of motion we can achieve better definition and access to the area to achieve a more thorough release. Secondly, it helps create awareness and promotes better function immediately after release. This is important post-release to interfere with the normal process of primary wound healing occurring. Reattachment (where the wound edges heal back together) is the biggest risk of the procedure and will limit the available range of motion.
Bodywork may also play a role in releasing adjacent areas of tightness and over-compensation. When those structures are relaxed it allows freer movement of the entire area including the tongue. In addition, the tongue is connected to the spine through a covering layer of tissue called fascia. More attention is being given to this tissue and the understanding that there may be implications on tongue-tie on forward head and general body posture. We often collaborate with body workers who have expertise in this area pre and post release to help ensure optimal outcomes for our patients.
To find out more about the concept of a functional tongue-tie release, please review the following article.
It refers to use of a carbon dioxide laser that is not yet approved for use in Australia but the concepts are the same.
Functional Tongue Tie Release Article: https://dentalsleeppractice.com/articles/tongue-tie-functional-release
These following videos are produced by Dr Soroush Zaghi of the Breathe Institute.
They share the experience of his patients with pre-release myofunctional therapy.
More about Myofunctional Therapy
Myofunctional therapy involves re-education of the muscles of the face and mouth through exercises. This constant repetition helps create new brain pathways for more normal function.
It has been used for a century by orthodontists in some regions to promote more normal development of the face and jaws.
More recently, a lot of research particularly in Brazil has been focused on its application in patients with snoring and obstructive sleep apnoea. This issue due to the identification or poor function of the tongue and other orofacial muscles as a root cause in its development.
Reviews of the best available studies to date support this therapy as an adjunct to help reduce obstructive sleep apnoea in both children and adults. It is believed this is through improving muscle tone of the tongue and other airway muscles. In children, it further encourages normal jaw and airway development.
Links to find out more about Myofunctional Therapy
American Academy of Orofacial Myofunctional Therapy
What about lip ties?
It is rare for a patient to require a lip-tie release in isolation. Lip-ties most commonly occur with tongue-ties, which can often be harder to identify to the untrained eye.
The most common reasons we would consider release of a lip-tie beyond the breastfeeding age, are if they prevent normal relaxed lip closure, or interfere with myofunctional therapy exercises. Less commonly they may interfere with good dental hygiene.
Sometimes upper lip ties may contribute to spacing between the two upper front upper teeth. It is normal for children to have gaps between their front baby teeth. This maintains space for the larger adult teeth to come through. In general, we do not release these in children to prevent spacing in the absence of the above problems. This decision is best reserved once the adult teeth start to come through.
There is no good evidence to suggest that lip ties can affect speech at present. Speech issues are more likely to be linked to poor tongue function.