By Gina Payne
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November 25, 2020
What Is a Tongue or Lip Tie? First, lets look at what tongue and lip ties are. A tongue tie is when the frenulum, or band of connective tissue that connects the tongue to the bottom of the mouth, causes restriction in the motion of the tongue. A lip tie is when the frenulum that connects the upper lip to the gums causes a restriction in the motion of the lip or causes structural change to the gums. There are also buccal ties that can occur too. These are less common but they form along the upper gum more towards the back teeth on either side. These connect the upper gum to the inner cheek. There are different grades to identify the type of lip and tongue tie, and is best done by your pediatric dentist, ENT, pediatrician or chiropractor. Why Do People Have Lip or Tongue Ties? So now that we know what we are looking at, let’s look at why this occurs. There are still so many unknowns as to why this occurs during development and often times can be genetically related. The frenulum normally thins and recedes before birth. Where this doesn’t happen, the frenulum may restrict tongue mobility. There is an association between high or unusual palates and tongue tie, because restricted tongue movement can affect the shape of the palate. What are Common Symptoms of a Lip or Tongue Tie? Lip and tongue ties can be difficult to diagnose, but there are some common symptoms that occur when a lip or tongue tie is present. Babies can have difficulty nursing. This can manifest as a painful latch or pain while suckling, clicking, choking or gaging while nursing especially upon milk letdown, inability to transfer milk affectively (this leads to more frequent nursing), shallow latch, or all together an inability to latch. Babies may also have digestive symptoms such as reflux, gassiness, spitting up, or colic. As the mother you may experience pain while nursing, creased or flat nipples after nursing, dryness or cracks on the nipple due to too much friction while nursing, clogged milk ducts, mastitis, or low milk supply. While these are not symptoms exclusive to lip and tongue ties, they are very common symptoms that should influence you toward getting evaluated by a professional. What Can be Done? Once it is determined that your baby has a lip or tongue tie there are a few options to help resolve the issue. Non invasive solutions include bodywork, myofascial therapy, chiropractic care, and craniosacral therapy. These focus on releasing the tight connective tissue, improving structural alignment, and increasing cranial and dural motion. This can be helpful in cases where the ties are not as severe and there are more mild symptoms. However, a more invasive treatment may be necessary. There are different types of frenectomy procedures that are available and should be discussed in detail by your provider. After care requires stretches every few hours to prevent reattachment. Once the revision is performed it is ideal to have bodywork, craniosacral therapy or chiropractic care to help release and unwind any underlying restrictions that still remain. The ties are like the tip of the iceberg, there can be a lot of underlying restriction and tightness that is not obvious, but can continue to affect function. Results after the revision can vary quite a bit. Some mothers notice an immediate improvement and can feel like the revision completely corrected all the problems. However, there are times when there seems to be little to no immediate improvement. This is when bodywork and chiropractic care is especially necessary. The underlying tightness needs to be released in order to notice improvement and is necessary when attempting suck retraining exercises. If there are still restrictions within the cranium, jaw, neck, upper back and throat, then nursing and suck retraining exercises are going to be hindered. Retraining exercises can be given to you by your providers. What Can Happen if Nothing is Done? So what can happen if you decide to leave the tongue or lip tie alone and not pursue any revision or fascial therapy? There are many possibilities. One being that there may not be any obvious issues, adaptations, or symptoms later in life. However, with the abnormal structure present of a lip and/or tongue tie there will be adaptations necessary, obvious or not, and there is a likelihood that other symptoms would arise. Some common symptoms are speech difficulties, gapping in the teeth, early or worsened tooth decay, narrow maxillary and mandible (jaw) development causing sinus problems or TMJ issues, headaches, neck/upper back/shoulder pain and tightness, reflux, digestive issues, torticollis, plagiocephaly and possibly others. Speech issues can be an obvious sign if the child was not diagnosed with a tie earlier. Most children will have trouble with R, S, L, Z, D, N, T, Y, K, -NG, CH, TH, SH, and –dge although other sounds may be difficult as well. Having a tongue tie can lead to mouth breathing which can contribute to asthma, allergies, sleep apnea, snoring, and enlarged tonsils/adenoids. Ear infections may be more prominent in someone with a tongue tie because the back of the tongue can not elevate enough to equalize the pressure in the Eustachian tubes. This can lead to fluid build up that can not drain properly, allowing for an environment for the growth of a bacteria or virus. When children get older the swallow mechanics are altered due to the tongue tie and can affect drinking from a straw or how the child is able to swallow foods. What Needs to Be Done After a Revision? If you choose to have the lip and tongue ties revised. there are several things to be aware of and to include in the care of your child. As mentioned earlier, there are varied degrees of improvement in symptoms with the frenectomy. Stretches for the tongue and lip should be shown to you at the time of the frenectomy and are typically done every few hours for the first 1-2 weeks and continued at a less frequent rate until the tissue is fully healed (about 1 month). Suck retraining exercises may be necessary to help strengthen the muscles necessary for a good latch and proper suckle. Bodywork, Craniosacral Therapy, and/or chiropractic care is very important regardless of the degree of tie and regardless of the type of symptoms you see. Very commonly, those with lip and tongue ties also have a tight dural tube. The dural tube is the connective tissue that surrounds the nervous system, the brain and spinal cord down to the sacrum. Unwinding the tightness in the dura and throughout the body will help your child feel more at ease and comfortable. Tummy time is another important addition to care after a frenectomy. Tongue and lip ties affect cranial nerve function, restrict normal range of motion and can diminish the baby’s ability to develop proper head control. Along with removing restrictions by utilizing chiropractic care and bodywork, having your baby build the muscles responsible for head control and movement helps to strengthen cranial nerve function and encourage a proper development. It is important to remember that not every child is the same and there are so many variables that can impact the decision of how to care for your child’s lip and/or tongue tie. Not every tongue tie will need a frenectomy. Some children can reestablish proper function just through chiropractic care and bodywork. Other children may need a frenectomy to be able to reestablish proper function. Tongue ties and lip ties can be a complex and sometimes overwhelming issue to navigate. However, with the right team of care providers on your side it can become a lot more manageable; and you can rest assured you are doing everything you can to help you and your baby thrive together.