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Complexities of a Tongue Tie

Complexities of a Tongue Tie

I am often asked how a tongue tie can impact a person’s speech and eating. Let’s begin with understanding how the mouth structures may be affected. The frenulum, the band of tissue connecting the tongue to the floor of the mouth creates one type of tongue tie if it restricts and anchors the tongue to the floor of the mouth. The mouth structures may be impacted by causing an imbalance in the growing bones, and the tongue and lip muscles. This imbalance may cause orthodontic problems by mal-positioning the teeth because the frenulum pulls the teeth in toward the restricted tongue. Also, as a result of the restriction of tongue movement the shape of the palate (roof of the mouth) will be affected due to the low tongue position. Therefore, the tongue is unable to shape the roof of the mouth as the child grows. This results in a high, narrow vaulting of the palate. The tongue restriction may also influence facial growth and development by not allowing the lower jaw to develop normally as the restriction stunts the lower mandibular growth. Furthermore, mid-facial growth may also be impacted.

Once normal oral and facial structure is impacted there is a need to assess and determine the extent to which the tongue tie is impacting the function of speech and for eating a variety of foods.To fully address these abnormalities, tongue tip elevation, retraction, lateralization, protrusion and licking around the lips without jaw movement and lips closing (to assist the tongue with this movement) along with a more in-depth orofacial evaluation must all be assessed by an orofacial myofunctional therapist.

A tongue tie may also involve the jaw which may cause an inability for jaw, tongue, and lips to disassociate. The individual demonstrates a difficult time with what appears to be simple tasks, such as ‘stick out your tongue and say ahhh’, ‘have your tongue touch the roof of the mouth and suction while mouth is open’ and ‘pucker and make a kissing sound for more than 3 seconds’, eating a cracker and clearing the food from the mouth completely with one swallow. Food often is scattered around the mouth and on the tongue, rather than being swallowed quickly. These individuals move their tongue and jaw together and their lips are unable to separate movement from the tongue and jaw as well. These abnormal movements often result in speech being affected. Speech is mostly a vertical movement and most tongue-tied individual’s produce speech with horizontal movements. Also, speech sounds will be made with tongue tip down and without the tongue tip up to the alveolar ridge (bumpy area of the roof of your mouth behind your teeth).  Therefore, the following sounds are impacted  /n/, /t/, /d/, /l/, /s/, /z/  /r/, /sh/, and /ch/.  Keep in mind these sounds may  ‘acoustically’ sound reasonably correct, but the tongue placement results in a  ‘mumbled’ speech that makes longer and connected speech difficult to understand. Some of these individuals may have been in speech therapy for months or years working on these sounds, especially /s/, /l/,  and /r/ without anyone perceiving that they structurally are unable to make those sounds.

A significant tongue tie not only impacts the oral structures, function, and speech but also feeding and swallowing. The tongue tie prohibits the individual’s ability to clean and clear the molar teeth and cheeks after chewing. A tongue tie directly impacts the oral preparatory (chewing/drinking) and oral phase of the swallow. The tongue is unable to do what it was meant to do—gather the chewed food into a nice bolus (ball of chewed food) in preparation for the swallow. Individual’s that present with a tongue tie, will likely have been difficult to breastfeed, take a limited diet, have frequent stomach gas/pains and are more prone to reflux. Many will constantly bite and mouth straws or shirts and have chronically chapped lips.

The individual’s behavior is also negatively impacted. Due to the mechanical/structural limitations, often a person with a tongue tie eats a limited diet of soft/processed foods because they are inefficient and messy eaters. They are often  “grazers “ and generally have negative behaviors around food. They are truly ‘picky eaters’. Even worse, individuals that are tongue-tied may also limit their verbal communication because they have become aware of their difficulty with speaking clearly and the need for longer utterances. They may feel psychologically distressed as they realize they sound different from their peers which may cause a lower self-esteem. Some individuals also have sleep-disordered breathing which may affect their cognition, restfulness, and overall health.

If you suspect a tongue tie, please set up a consultation with a specialist who is knowledgeable in not only the structure of the tongue tie but how the tongue tie impacts function and behavior.

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