I suppose I should be offended that a lot of people are sticking their tongue out at me these days, but I’m not. It’s all part of the job in my work as a myofunctional therapist, and kids delight in being allowed to do it without the threat of detention. I’m just happy to get to the bottom of things…the bottom of the tongue, that is, and all of the issues that can crop up when one tiny string of tissue there restricts your tongue from doing what it should to function correctly. That small string of tissue under your tongue is called the lingual frenum and stretches from the floor of the mouth to the underside of your tongue. Typically, the lingual frenum detaches before birth, allowing the tongue to have full range of motion. If it doesn’t detach fully, it can restrict your tongue’s ability to move. That’s called tongue tie.  To determine if one has a tongue tie, it is important to assess for proper function above all else and not just by appearance. Tongue tie can limit craniofacial growth and can cause issues with breathing, breast feeding, eating, talking and swallowing.  A minor surgical procedure called a frenectomy is often recommended to prevent or help correct these problems and should be done as early as possible.

Craniofacial Growth

One of the tongue’s most important roles in early childhood is to naturally expand the palate, with 90% of craniofacial growth occurring by age 12.  But if it’s tied to the floor of the mouth like a horse to a hitching post, it is inhibited from exerting the gentle, constant pressure against the palate that is needed to stimulate palatal bone growth, resulting in high, narrow palates and narrow dental arches. “Narrow” becomes synonymous with “no room at the inn for erupting teeth,” and this is often what first drives parents to seek orthodontic treatment for their children. Crowded teeth are the first obvious neon sign that grabs our attention, but far bigger problems are usually lurking in the back alley of the airway.

Breathing

Since the same bone that forms the roof of the mouth also forms the floor of the nasal sinus, it makes sense that a narrow palate also leads to narrow nasal airways and breathing problems, including mouth breathing, Upper Airway Resistance Syndrome (UARS) and obstructive sleep apnea. A high, vaulted ceiling (the palate) means a small attic space (the nasal airway), forcing you to breathe through your mouth. So…what’s the big problem with mouth breathing? Well, for starters, we were designed to breathe through our nose where air is warmed, purified and mixed with nitric oxide, a substance produced in the nasal sinuses that helps to open the sinuses and dilate the blood vessels throughout the body, thereby increasing blood flow and lowering blood pressure. Some of us have not only never experienced the health benefits of nasal breathing because we whizzed past that period of craniofacial growth with our tongue tied to the floor of our mouth (long, narrow face anyone?), but that low resting tongue can also fall back into the airway when we sleep, a dangerous condition known as obstructive sleep apnea that affects an estimated 22 million Americans, a majority of whom have never been formally diagnosed.  (For more about the menacing slew of health problems caused by sleep apnea, click here).

Eating, Swallowing & Speech

The tongue is also an integral player in our ability to chew, swallow and make sounds correctly. Go ahead and try a little experiment: grab the end of your tongue and hold on to it while you try to swallow or talk. You’ll find that it is VERY difficult to talk or swallow when the tongue isn’t able to do its thing! Tongue tie inhibits the tongue in a similar way: it prevents the tongue from being able to rest fully against the palate, from fully suctioning up against the palate during the swallow and from moving to the correct position in the mouth in order to make individual sounds. Babies with tongue ties and lip ties can also have great difficulty with breast-feeding, as they are physically unable to splay the lips and suction the tongue to properly stimulate the release of milk from the breast.

How Can Myofunctional Therapy Help?

Old habits die hard. You can’t teach an old dog new tricks. You’ve heard these sayings before and maybe even believed them, but the truth is that we are always capable of learning new things with both time and the right direction! Most people erroneously assume that if a tongue tie is released, the tongue will automatically do what it is supposed to do. In reality, it’s more like letting a domesticated animal out into the wild: it has no idea what to do or how to function out there! The good news is that myofunctional therapy can help bridge the gap and is recommended both before and after a frenectomy to prepare the tissues for release and to teach the tongue and all the associated muscles how to properly function together after the release is completed. I work closely with your frenectomy provider to help ensure that you get the best results possible. Watch your tongue…it’s a good thing!