Ankyloglossia or tongue-tie, occurs in patients whose lingual frenum is short and tight resulting in decreased mobility of the tongue.

Tongue-tie is generally diagnosed in childhood and symptoms include: Interference with feeding in infants. There are infants who cannot suck toddlers who cannot chew, children who cannot lick ice creams, and children and adults who are disadvantaged by their poor speech.

Tongue-tie is more commonly found in boys (60%) and there will often be other family members who have had this problem. The most immediate impact of tongue-tie is on the baby’s ability to breastfeed effectively. There may be an affect on ongoing oral hygiene. The effect of tongue-tie on speech development remains controversial.

You can test for a tongue tie by having your child stick out his tongue. If he can’t do so or if when he does so the tip is held back – looking like a sort of W shape at the tip rather than a V shape – then he probably is tongue tied. The incidence of ankyloglossia reported in the scientific literature varies from 0.02% to 4.8%. This decreased tongue mobility can be associated with speech problems in children. Specifically, a child may exhibit difficulty with the articulation of the sounds L, R, T, D, N, Th, Sh, and Z.

Why tongue tie?

It is a real medical condition and has its own typical problems and presentation. Symptoms can be mild or severe, and where no difficulties are caused no intervention is needed. Where problems exist, it can be diagnosed, assessed, and successfully treated. It is not well known – although the expression ‘tongue tied’ is generally used to mean ‘unable to speak’. The frenum is a remnant of tissue that was part of the facial structure of the infant during early pregnancy. Usually it disappears or reduces to a very slight membrane which is elastic and does not limit the tongue in its movements or disrupt function.

Similar webs of tissue can also occur joining the cheeks or lips to the gums and these –like a tongue tie – also can be released surgically. When the lingual frenum does cause problems it is because tightness, thickness or width of the frenum affects the function of the tongue in various ways. There is a very strong tendency for tongue tie to run in families, and it is more common in boys.

Who should diagnose it?

Tongue tie may be diagnosed by ENT (ear, nose and throat) surgeons, dentist or speech therapist or a pediatrician.

Advantages of using laser

This relatively new option is suitable for neonates, older children and adults. No general anesthetic is used, but an analgesic gel might be applied. The procedure is very quick, taking only 2 to 3 minutes to perform, but some cooperation from the patient in keeping still is required.
There is virtually no bleeding, no pain, no risk of infection and the healing period can be as short as 2 hours. It is best to have this procedure performed by a laser surgeon.

Management and Speech Therapy

Speech symptoms in tongue-tied patients vary enormously, and speech therapy without surgical intervention in such cases is at best a lengthy process, and at worst, expensive, frustrating for patient and therapist, and unsuccessful. Following surgery, speech therapy to address areas of difficulty identified in the assessment process should begin as soon as possible after healing is complete. Articulation of specific sounds may be consistently defective, particularly where pronunciation requires lingual elevation, as in T, D, and N and these errors can be addressed with conventional therapy exercises. However, it is more important to address issues such as the ability of the tongue to transfer from one articulatory posture to another.

Post-operative exercises

1. Stretch your tongue up towards your nose, then down towards your chin. Repeat.
2. You can vary the exercise above and make it more interesting by putting a dab of food in various positions above the top lip, to be retrieved with the tongue tip
3. Open your mouth widely. Touch your big front teeth with your tongue with your mouth still open.
4. Look in the mirror. Still with your mouth open wide, say dar-dar-dar, now say nar-narnar, now say tar-tar. Look in the mirror to see what your tongue is doing. Can you FEEL where it is?
5. Lick your whole top lip from one side to the other.
6. Poke your tongue out as far as it will go.
7. Now see if you can make your top lip fat without opening your mouth.
8. Can you go in-out-in-out-in-out with your tongue