Q: Aren’t tongue ties being over-diagnosed these days? I mean, it seems like this is a new fad, and lots of people are getting frenectomies. Do THAT many people really have a tongue tie?

A: Great question! It’s always a good idea to thoroughly research any treatment recommendation that you might receive and to ask lots of questions about your particular diagnosis so as to better understand the benefits, cost and any potential risks that may be associated with any recommended treatment. No, this is not a new fad, just an area that is now much better understood than it was in the past. Thankfully, there has been lots of credible research done in recent years on the subject of tongue ties and the sly companions to which they are often found fatefully “tied,” including insufficient craniofacial growth, problems with breathing, eating, swallowing, breast-feeding, speech and jaw/neck pain. As you wade through this abundant research, there are a few important points worthy of consideration:

• Consider the source: Although it may seem as if a disproportionately large number of tongue tie diagnoses come from a certain practice or specialty, take a closer look at the issues that are commonly treated there. In the field of orthodontics, for example, a majority of the patients are there due to symptoms stemming from insufficient craniofacial growth (narrow jaws, crowded/misaligned teeth, mouth breathing/sleep issues) as well as other problems that can develop from a tongue tie (tongue thrust swallow pattern, difficulty breast-feeding, problems with speech, and jaw pain). It makes sense that a provider would not only want to treat the symptoms, but also identify and treat the underlying cause that led to those symptoms in the first place. In addition to orthodontics, many other health professionals, including ENT’s, dentists, myofunctional therapists, speech/language pathologists, chiropractors, physical therapists, doctors and craniosacral therapists may see a larger population of patients with tongue tie in their practices and will commonly treat or refer these patients as necessary for tongue tie release.

• Don’t judge a book by its cover: First, let’s clear up a common point of confusion: Yes, everyone has a frenum, and yet NOT everyone is tongue tied. That little string under the tongue, the lingual frenum, can attach near the tip of the tongue (a more obvious, anterior tongue tie) or further back along the base of the tongue. When assessing for tongue tie it is imperative to assess the overall functional capabilities of the tongue and not just rely on appearance. Most tongue ties do not necessarily look like the photo above. Many times a frenum that may look tight or restrictive to the naked eye does not necessarily impede the normal movement and function of the tongue at all, and at other times a frenum that may look somewhat normal may not allow the tongue to move and function as it should. The term posterior tongue tie refers to an unusually thick or short frenum or one that attaches deep within the submucosa in the floor of the mouth that restricts the movement of the middle and back of the tongue and inhibits the tongue from performing several of its most important roles: 1) to move food to and from the chewing surfaces during eating, 2) to suction completely against the palate during the proper mechanics of swallowing, 3) to aid in the production of speech and 4) to stimulate palatal expansion during the years of craniofacial growth by resting entirely, front to back, against the palate during times of rest.

• They are a real pain in the neck: Neck pain can stem from many different things, but a rather common and yet little known culprit is tongue tie, where chronic neck pain can occur due to the compensation of the neck muscles during chewing and swallowing. A “forward-head” posture is often noted when the tethered down tongue cannot move properly and muscle tension in the neck pulls the head low and forward. Shoulder pain, chronic headaches, and TMJ pain may also be experienced. Many people often experience immediate relief from neck and shoulder muscle tension when the tongue tie is released during the minor surgical procedure called a frenectomy.

To get back to the crux of your question, paradigm shifts, especially in the field of medicine, can take time to catch on and are often first met with doubt. Sometimes it can helpful to remember that many treatments we now rely on and trust, among them antiseptic hand washing, balloon angioplasty and immunotherapy to treat cancer, once followed much the same path and were dismissed by many before their merit was widely seen and accepted. Just remember, “You can’t change the fruit without changing the root.” (Dr. Stephen Covey) That’s wise advice, if you ask me!