Tongue-tie & Its Effects
Tongue-tie (Ankyloglossia) is a developmental anomaly characterized by an abnormally short, thick or tight band of tissue between the tongue and the floor of the mouth. Tongue-tie affects 4-11% of the population and tend to affect boys more than girls. The exact cause of this condition is still unknown, although genetic causes might have a role to play due to the observation of this condition affecting family members. This condition is present at birth and can severely restrict the tongue movement.
Presentation of tongue-tie includes difficulty in touching the upper teeth when mouth is fully opened, difficulty in moving the tongue from side to side, difficulty in extending tongue past the lower incisors or tongue that appears notched or heart-shaped when extended.
Severe tongue-tie can impair an adult’s speech and eating. This is because the tongue has to have the freedom of movement to produce sounds like “t”, “d”, “z”, “s”, “th”, “I” and “r”. Tongue-tie can also interfere with activities such as licking an ice-cream cone, licking the lips or playing wind instruments. In some cases, the attachment can happen between the tongue and the gums on the lower incisors. In such cases, brushing can be difficult and this can in turn lead to decay and gum problems.
Babies Can Be Affected By Tongue-tie too!
Severe tongue-tie can negatively affect the baby’s feeding from both the breast and bottle. For proper latching and feeding to occur, the tongue has to be positioned over the lower gums. If this position cannot be maintained during feeding, the baby might chew on the nipple instead. This can lead to nipple pain and interfere with the baby’s ability to get breast milk. However, there are also many children and adults who can adapt to milder forms of tongue-tie with minimal impact on their daily activities.
How Do You Know If Your Baby Has Tongue-tie?
Often, lactation specialists and/or speech therapists will be able to assess and diagnose the presence and negative impact of tongue-tie. Some lactation specialists prefer to treat tongue-tie soon after birth. However, there are also some lactation specialists who prefer to adopt a “wait-and-see” approach. This is because some tongue-tie situations can improve as the tissue causing the attachment can loosen with time. If treatment for tongue-tie is indicated, 2 main types of surgical approaches are used.
Treatment For Tongue-tie
Frenotomy is a simple procedure that can be done with or without anaesthesia as an out-patient procedure. A sterile scissor is used to snip the tissue attachment between the gums and the tongue. This procedure can only be done for infants when the tissue attachment is not thick. The post-operative pain and bleeding is minimal.
Frenectomy is indicated when the tissue attachment is thicker or when the patient is older. This procedure can be done under local anaesthesia. A surgical blade is used to separate the attachment and simple stitches are placed after the surgery. Laser can also be used in place of surgical blades for frenectomy. Lasers are associated with less bleeding and post-operative pain.
By Dr. Ang Chee Wan
MDS (Periodontology) (Singapore)
MRD RCS (Edinburgh, UK)
Dental Specialist in Periodontics
Clinical Director, T32 Specialist Division
Visiting Faculty, National University of Singapore