What are tight frenums?
Ankyloglossia is often referred to as “tongue tied,” and is described as an abnormal shortness of the frenum located under the tongue which limits the tongue’s normal movement. It can interfere with oral, facial and airway development, feeding, speech and swallowing, and can create long term problems associated with these functions.
When one opens their mouth and elevates the tip of the tongue, one can clearly see the lingual frenum, (also referred to as a frenulum); the cord that attaches the tongue to the floor of the mouth. In some cases, the frenum might be visible but too short to allow full tongue movement. In other cases, the shortened frenum might not be visible at all, and is then defined as submucosal anklyloglossia.
A labial attachment can be viewed by lifting the upper lip and examining the tissue cord that attaches the upper lip to the upper gum tissue.
What are the causes of tight frenum attachments?
The exact causes of tight attachments are not known, but often times there is a genetic component.
How are tight lingual attachments classified?
There are several ways to classify tight frenum tissue but the most important aspect of tight tissue is the functional ability of the tissue it is connecting.
Why the concern?
Ankyloglossia can seriously affect an individual’s health at any age. To experience what ankyloglossia feels like, try to talk and eat while keeping your tongue on the floor of your mouth. You can see it is very challenging. In infants ankyloglossia can be associated with breast feeding difficulties, failure to thrive and difficulty with the introduction of solid foods.
In children, it is associated with “sloppy” eating due to difficulty chewing food and moving it around in the mouth, impaired articulation of words, poor oral hygiene, dental problems, such as incorrect tooth eruption or excessive crowding of teeth, or a change in the development of the face and jaw. Most significantly, a strong emergence of incorrect compensatory habits such as tongue thrusting may develop.
In adults it is associated with poor sleep, misarticulating of sounds, clicking or pain in the jaws, migraines, negative effects on social situations such as eating out, kissing and relationship development. Dentally, tight tissue may be associated with inflamed or receding gums, crowded teeth, cavities or broken teeth.
How can tight frenum attachments be treated?
Once a frenum restriction has been diagnosed, a recommendation may be made to have a lingual frenum release through a frenectomy, also know as a frenulectomy or a frenotomy. It is a simple procedure using local anesthetic. Most of the time it takes less than 5 minuses and causes little post procedure complications.
What is the role of an oral myologist?
We commonly recommend with children, teenagers, and adults, that one consult an oral myologist prior to surgery. Post-procedure, the myologist with prescribe home based daily exercises to avoid scarring and ensuring the tongue remains untethered and begins to regain the strength lost from the restriction of the frenum. Once the tongue is released it will be able to move around the oral cavity properly and begin to hold a posture to promote healing of any symptoms the patient may have been having related to the tethered tissue as well as begin promoting proper development of oral facial structures.
In addition, muscles of the tongue may be weak from being anchored to the floor of the mouth. Specific exercises are given to strengthen the muscles of the tongue to assist the tongue in moving vertically and achieving appropriate tongue resting postures. Achieving appropriate tongue resting posture and recapturing dental space is essential.
Release of an attached frenum can eliminate a tongue thrust that may accompany a restricted lingual frenum. Improved chewing and swallowing skills are important for a person of any age. Incorrect speech patterns, incorrect tongue placement at rest, and swallowing functions will likely not correct themselves. Over the years, individuals with tight frenums develop strong abnormal habits to compensate for the tongue being attached to the floor of the mouth.
A habit is not something easy to change, and most people are not aware of their improper tongue position. An oral myologist with experience in tongue posture can be helpful in learning correct placement of the tongue for articulation, while eating, drinking and swallowing.
Research has shown that by releasing a “tongue tie, ” airway issues such as upper airway resistance and obstructive sleep apnea are often improved.