Let’s Talk About Tongue-Tie! (A.K.A Ankyloglossia A.K.A Short Tongue A.K.A High Lingual Frenulum)

Midwives aren’t common in Singapore nowadays. However, midwifery continues to be a respected profession elsewhere around the world. If you’ve ever met a midwife, you may have noticed something unusual about her pinky finger. Midwives often keep the nail on the pinky finger extra long. Historically, the long and sharp pinky fingernail was used to cut off the fibrous tissue causing tongue-ties in newborn infants.

Till this day, lingual frenulum surgeries (lingual frenulectomies) are routinely performed around the globe. Tongue-ties are often associated with issues related to breast feeding, standard feeding, oral vices like tongue thrusting, as well as alterations of speech and the social difficulties stemming from it.

Some studies have also shown that tongue-ties present a positive correlation with mouth breathing and obstructive sleep apnea. Evidence, however, is not conclusive. Mouth breathing and obstructive sleep apnea are both precursors to a host of other problems that have a lifelong impact.

Diagnosis

Visual

(Apologies for the coffee stains! I can’t study without caffeine)

The severity of you or your child’s tongue tie-can be classified into 4 classes, in ascending levels of severity as seen above.

Mobility and position

Your tongue movements and position within the oral cavity will also be assessed. Tongue-ties often result in restricted tongue movements.

Speech production

It is often assumed that individuals with tongue-tie have resultant speech problems. Clinical evidence for this, however, is actually weak. Commonly referred to as having a “short tongue”, such individuals have difficulties creating sibilants (or S sounds) in their daily interactions. It is postulated that this is because the tongue is unable to form a seal against the anterior teeth, which is required for sibilant enunciation.

What about babies?

We don’t expect babies to be able to comply with the mobility and speech tests! Therefore, there is a protocol available specifically for babies that will determine if surgery is recommended or not.

Treatment

Not all individuals with a visible tongue-tie require surgical treatment! It is critical for a proper examination and diagnosis to be performed prior to the prescription of surgery. Lingual frenulectomies are only indicated if the diagnosis meets the minimum criteria from the assessments mentioned above.

Pre-Surgery

However, if surgery is indicated, the patient would first require a month of tongue exercises prior to the date of surgery. This is to promote familiarity with the exercises that the patient will be performing post-surgery. This helps them achieve better muscle coordination post-surgery for a better long-term functional outcome.

Surgery

The surgical procedure is a short one. Local anaesthesia is deposited (optional) and the lingual frenulum is released, either with a blade, or with a laser. At my clinic, the laser is the much preferred option as it results in less bleeding and promotes better healing. Stitches are rarely required and the patient is in and out of the chair in a matter of minutes.

Treatment with the Biolase Waterlase dental laser available in our clinic

Post-Surgery

It is critical for the patient to perform a series of tongue exercises for 3 months post surgery. This is to ensure that the lingual frenulum heals in an ideal position. Without exercise, there is a likelihood that the tongue would revert to its original position.

Bottomline

The impact of being tongue-tied is often unrealized until much later on in one’s life. Prudence should be practised to determine if your child (or you) requires intervention to treat this condition. Remember: treatment is not always necessary. Consult a dentist that’s familiar with the condition to find out more.