Your Guide to Ankyloglossia (Tongue-Tie) Causes & Treatment
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Is your child having feeding issues or not latching properly when breastfeeding?
If this is the case, your child may have ankyloglossia. Ankyloglossia is also known as tongue-tie.
Infant tongue ties are common and can lead to severe complications. However, with the proper care, all of the problems associated with ankyloglossia can be resolved.
Learn more about ankyloglossia, what causes it, and whether it is treatable.
Related: What Are the Chances My Baby Will Be Born with a Cleft Palate?
What Is Ankyloglossia?
Ankyloglossia is a congenital disorder in which the tongue is tied to the floor of the mouth. This happens when the lingual frenulum, a thin tissue strand that connects the tongue to the floor of the mouth, is too short or tight.
The lingual frenulum function is to allow the tongue to move around freely for swallowing, chewing, and speech. When it is too tight or short, these functions may be impaired.
According to the National Library of Medicine (NIH), ankyloglossia is most common in males. Approximately 5 percent of newborns are born with tongue ties. Some doctors check newborns for tongue-ties immediately after birth, while others find out later in life during routine health visits.
Causes of Tongue-Tie
The lingual frenum is supposed to separate from the floor of the mouth before the baby is born. However, this doesn’t always occur which results in a tongue-tie.
The specific cause of ankyloglossia is unknown, but genetics may play a role in some cases. If tongue ties are found in the family, children are at higher risk of being born with a tongue-tie.
According to the NIH, the main possible cause of tongue-ties is a mutation in one of the genes of the infant, specifically the TBX22 gene. Mutations in this gene can cause other disorders like x-linked cleft palate syndrome.
Symptoms of Tongue-Tie
According to Bender, Kind & Stafford Dental, there are many signs and symptoms of tongue-tie in infants. However, not all infants with tongue-ties experience the following complications.
- The infant does not latch properly on the breast.
- The mother has nipple pain when breastfeeding.
- The infant is not gaining enough weight.
- The baby has feeding problems or chews more than sucks.
- The tongue of the baby does not stick out past the lower front teeth.
- When sticking out the tongue, it creates a v-shape or looks heart-shaped.
- The child finds difficulty lifting the tongue to the upper teeth or moving the tongue around.
When to See a Doctor for Tongue-Tie
If you think your child has a tongue tie, you should see a healthcare professional. A simple physical exam is done to diagnose someone with a tongue tie. The doctor may simply look at the lingual frenum and use an assessment tool to determine what type of tongue tie is present.
Types of Ankyloglossia: Mild to Complete Tongue-Tie
Tongue-ties are divided into categories. The type of ankyloglossia is based on how freely the tongue can move. According to the Journal of International Oral Health, there are different types of ankyloglossia based on Kotlow’s classification.
The different classifications of ankyloglossia include class I (mild ankyloglossia), class II (moderate ankyloglossia), class III (severe ankyloglossia), and class IV (complete ankyloglossia).
- Mild ankyloglossia has a free tongue length of 12 to 16 mm.
- Moderate ankyloglossia has a free tongue length of 8 to 11 mm.
- Severe ankyloglossia has a free tongue length of 3 and 7 mm.
- Complete ankyloglossia has a free tongue length of less than 3mm.
According to Lauren Wong, a lactation consultant, tongue ties can be anterior or posterior. Anterior ankyloglossia is usually found in the front of the tongue.
In contrast, posterior ankyloglossia is located further back, under the tongue, and is usually considered a severe form of tongue-tie. Luckily, most newborns have anterior ankyloglossia.
Tongue-Tie vs Lip Tie
Tongue-tie and lip tie are two different conditions. A tongue-tie is a disorder in which the tongue is tied to the bottom of the mouth by a short frenulum restricting tongue mobility.
A lip tie is a disorder in which the upper lip is tied too tightly to the upper gum limiting the movement of the lip. People with a lip tie cannot curl their lips.
Complications of Ankyloglossia
Ankyloglossia can cause complications including speech difficulties, breastfeeding problems, poor oral hygiene, and emotional problems.
Ankloglyssia and Speech
Pronouncing the letters of the alphabet requires a lot of tongue movement that may involve the tip of the tongue. Since ankyloglossia causes limited tongue movement, children with this disorder may not be able to pronounce some letters which could lead to future language problems and speech disorders.
According to Colorado Tongue Tie, children with ankyloglossia may not pronounce the following letters.
- The letter “S”
- The letter “T”
- The letter “L”
- The letter “R”
- The letters “TH”
- The letter “Z”
- The letter “D”
Ankyloglossia and Breastfeeding
Breastfeeding difficulties may occur with children who have ankyloglossia. Babies may struggle to latch onto the breast because of limited tongue mobility. When a child doesn’t latch properly, milk may not be released in sufficient amounts which would result in nipple pain and a malnourished baby.
According to the NIH, most babies with tongue-ties do not find any challenges in breastfeeding and latch on the breast properly.
In older children, eating may be difficult. For example, eating an ice cream cone would be very difficult. Food may stay longer than usual in their mouths. They may even vomit or choke when eating. If your child is experiencing these symptoms, contact their doctor.
Poor Oral Hygiene
According to Warm Family Dentistry, ankyloglossia can cause poor oral hygiene. The tongue helps in cleaning teeth and removing food that may be stuck in between teeth. Since tongue ties restrict tongue movement, people with this condition may not be able to remove leftover food from their mouths without a toothbrush. If the food debris stays too long in the mouth, inflammation of the gum may occur, as well as tooth decay.
According to Julian Center for Effortless Sleep, children with tongue-ties can have emotional problems. Older children with this disorder may have low self-esteem and lose confidence when speaking.
As these children get older, they would become more aware of their inability to speak like children without this disorder.
Is Ankyloglossia Treatable?
Many doctors do not recommend getting a tongue-tie treated immediately. Instead, they recommend waiting and seeing if it causes any complications. Sometimes, infants may have no symptoms at first.
However, as they grow up, they may begin experiencing problems with eating and speaking.
The Better Health Channel states that ankyloglossia can go away on its own. Sometimes, as children grow older, the lingual frenulum loosens up on its own.
For those whose tongue ties do not resolve on their own, treatment may be necessary. According to Kids Health, children do not always need treatment for this condition if it doesn’t cause problems in their daily life.
If treatment is necessary, there are various medical treatment options, and they include non-surgical and surgical treatments. Non-surgical treatments do not treat the disorder completely. The treatments are quite safe as the risks associated with all the procedures are rare.
Pediatricians, dentists, or otolaryngologists (head and neck surgery specialists) may be able to help treat tongue-ties.
Non-Surgical Procedures for Tongue-Tie
Non-surgical treatments for ankyloglossia are done to help minimize the complications of tongue tie. For example, some therapy and exercises can be done to help with speech articulation and feeding.
The Tampa Tongue-Tie Medical Center states that speech therapy and lactation training are two non-surgical treatments that may help with the two main complications of tongue-tie which include problems in speech articulation and breastfeeding.
Surgical Procedures for Ankyloglossia
Below are the most common surgical procedures for ankyloglossia.
According to the Cleaveland Clinic, a lingual frenectomy is a simple procedure in which the lingual frenulum is completely removed. Infants usually do not require anesthesia.
Older children and adults may get local anesthesia. This procedure takes about thirty minutes or less. Some possible risks of this procedure include:
- Excessive bleeding.
- Damage to the salivary ducts.
- Allergic reaction to the anesthesia.
- Reattachment of the lingual frenulum.
During a laser frenectomy, the lingual frenulum is removed with a laser to minimize the side effects that may arise after a typical frenectomy. There are little or no risks to this procedure.
This procedure is also known as Frenulectomy. According to Standford Medicine, during this procedure, the doctor will pull the tongue upward towards the roof of the mouth and hold it in place. The lingual frenulum would be tightened and visible.
The doctor will cut the lingual frenulum in one quick motion, and the lingual frenulum’s position is slightly changed. According to the American Academy of Pediatrics (AAP), some women have reported that they had less pain during breastfeeding after their infants had a frenotomy.
However, according to the BMC International Medicine Journal, some complications may arise after an infant frenotomy, but they are rare. Some complications include:
- Excessive bleeding.
- Infant Pain.
- The infant may refuse to breastfeed or eat after the procedure.
- The procedure may have to be repeated.
According to Johns Hopkins, frenuloplasty is usually done for children or adults who have a severe and complex form of tongue-tie. The lingual frenulum may be too thick for the other procedures to work.
This procedure includes plastic surgery and a complete revision of the frenulum, and usually, general anesthesia is required. After the frenulum is cut, the doctor may close the wound with stitches.
Other treatments like speech therapy with a speech-language pathologist and tongue exercises may be required, in addition to this procedure.
Risks are rare, but some possible risks for this procedure include:
- Damage to the tongue.
- Damage to salivary glands.
- Excessive bleeding.
- Allergic reaction to the anesthesia.
- Oral infection.
All in all, ankyloglossia is a condition in which the tongue is attached to the bottom of the mouth by a short frenulum causing the tongue to not be able to move freely. Children with this disorder may have problems in speech, feeding, and oral hygiene.
Luckily, there are non-surgical ankyloglossia treatments that can be done to help reduce the complications of tongue-tie. There are also surgical options to free the tongue.
If you think your child has a tongue-tie, do not hesitate to call your child’s doctor. Also, remember the earlier you treat the condition the better the outcomes.
Becker, S., & Mendez, M. D. (2022, August 22). Ankyloglossia - StatPearls - NCBI Bookshelf. Ankyloglossia - StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482295/
Briddell, J., & Eisel, L. (Eds.). (2021, July). Tongue Tie (Ankyloglossia). Kids Health. Retrieved March 27, 2023, from https://kidshealth.org/en/parents/tongue-tie.html
Department of Health & Human Services. (n.d.). Tongue-tie. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/tongue-tie
Frenectomy: What It Is, Procedure & Recovery. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22714-frenectomy
Frenotomy. (n.d.). Newborn Nursery. https://med.stanford.edu/newborns/professional-education/frenotomy.html#:~:text=Frenotomy%20(a.k.a.%20frenulotomy%20or%20frenulectomy,the%20infant's%20ability%20to%20breastfeed.
Gilliland, A. M., Bunik, M., & O’Connor, M. E. (2020, July 1). Pediatricians’ Concerns about Ankyloglossia and Breastfeeding. American Academy of Pediatrics. https://doi.org/10.1542/peds.146.1MA2.124
How To Treat a Child’s Tongue-Tie. (2020, December 21). Tampa Tongue-Tie Center. https://www.tonguetietb.com/how-to-treat-a-childs-tongue-tie/#:~:text=Rather%2C%20the%20non%2Dsurgical%20techniques,therapy%20to%20support%20speech%20development.
L. (2020, August 15). What is the difference between ‘anterior’ and ‘posterior’ tongue tie? - Lauren Wong IBCLC. Lauren Wong IBCLC. https://laurenwong.co.uk/faq-items/anterior-and-posterior-tongue-tie/
O’Connor, M. E., Gilliland, A. M., & LeFort, Y. (2022, May 21). Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey - International Breastfeeding Journal. BioMed Central. https://doi.org/10.1186/s13006-022-00481-w
Rowan-Legg, A. (2015). Ankyloglossia and breastfeeding. Paediatrics and Child Health, 20(4), 209–213. https://doi.org/10.1093/pch/20.4.209
Sambataro, G., DDS. (2022, October 25). Why Tongue-Tie Can Be Devastating For Children | Effortless Sleep. Julian Center for Effortless Sleep. https://juliancenterforsleep.com/why-tongue-tie-can-be-devastating-for-children/
Stafford, J. (2023, March 26). Warning Signs Of Tongue-Tie In Infants. BKS Dental. https://bksdental.com/blog/warning-signs-of-tongue-tie-in-infants/
Susanto, A., Komara, I., & Arnov, S. T. (2020). Surgical treatment for Kotlow’s class III ankyloglossia: A case report. Journal of International Oral Health, 12(4), 401. https://doi.org/10.4103/jioh.jioh_2_20
The Effects of Tongue Ties on Speech | Colorado Tongue Tie. (n.d.). https://www.coloradotonguetie.com/post/the-effects-of-tongue-ties-on-speech
The Relationship of Ankyloglossia With Gender in Children and the Ideal Timing of Surgery in Ankyloglossia - PubMed. (2021, March 1). PubMed. https://doi.org/10.1177/0145561319867666
Tongue-Tie (Ankyloglossia). (2022, April 12). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/tongue-tie-ankyloglossia#:~:text=Tongue%2Dtie%20Treatment&text=Frenotomy%20(also%20called%20frenulotomy)%20is,plastic%20surgery%20of%20the%20frenulum.
Tongue-tie (ankyloglossia). (2019, July 1). Warm Family Dentistry. Retrieved March 28, 2023, from https://warmfamilydentistry.com/tongue-tie-ankyloglossia/
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Deborah works as a news writer for Wild Sky, and is a freelance writer for a number of online parenting publications. However, she is best known for her writing and storytelling on her blog, The TRUTH.