Child and Adult Frenectomies, AKA tongue ties

The last post was about infant frenectomies.  Today I want to follow up with information on older children and the consequences of untreated, restricted oral tissues.

After breastfeeding issues, the next signs indicating a child has a tongue restriction are:  gagging easily, “picky eater”, speech delay and trouble with certain sounds, growth and development issues,  crooked or flared teeth, snoring, grinding, and sleep apnea.

Why do these particular issues occur? Speech problems related to a tongue tie is obvious to most people.  If the tongue is restricted, it cannot coordinate well to make certain sounds like “s” and “r”.  The “gagger” and “picky eater” often are chalked up to “mommy gags easily” or “my child is just a picky eater.”  In reality what is most often happening is that the tongue, which is a collection of many muscles wrapped in facia, when restricted, cannot process and move the food efficiently.  Because of these challenges, certain textures and foods truly do get “hung up” in the back of the mouth and cause gagging.  Smart children will learn what is comfortable to eat and does not illicit this response.  In addition to helping us speak and eat, the tongue guides growth of the jaws.

A healthy tongue rests in the roof of the mouth, behind the upper front teeth, and also pushes in this same area on swallow.  This is important because the tongue exerts 500grams of force on swallow.  It is this force that naturally expands the upper jaw to fit over the lower jaw.  When the tongue rests where it is supposed to, the upper jaw fits all the teeth, including the wisdom teeth, and the upper jaw has a nice broad U-shape.  If the tongue rests in the bottom of the mouth and presses against the teeth on swallow, you will often see crowding and sometimes even an underbite.  If the tongue pushes through the front teeth or the side teeth, called a tongue thrust, you will see flaring or an open bite.  The tongue is a very important determinant in development of jaws and teeth.  I will go more into this concept in the next post about Myofunctional Therapy and explain how simple retraining of the tongue and oral muscles can correct the face and teeth without braces!

The last thing to mention about a restricted tongue is sleep disturbances, and sleep apnea in particular.  This year Dr. Christian Guilleminault, a neurologist and sleep medicine physician at Stanford, released research that showed a tongue restriction IS a marker for sleep apnea.  The reason this is so is about anatomy.  If the tongue, a group of muscles, is sitting low instead of in roof of mouth, when a child (or adult) lays back and relaxes, during sleep the muscles all relax, and the tongue relaxes back into the airway.  This can cause a restriction of the airway or even obstruction.  In children, less airway equals less oxygen which equals lots of issues.  I won’t go into the ADD/ADHD associations, but if your child: grinds their teeth at night, snores, has night terrors, and restless sleep, they are showing warning signs of airway/oxygen disturbances at night.  It is wise to have these issues evaluated with a trained professional.

One last note on the topic of frenums and the association of breastfeeding issues, speech issues, growth and development issues, and sleep issues…these are not associations I was taught in dental school or residency.  I say this because there is a windfall of research that has come out in the past decade, and international associations and organizations that are focused on these issues.  If I only practiced what I learned long ago in school, I would not be providing my patients with research-based, evidenced-based care that they deserve.  I see patients everyday who are confused because they went to another provider who said, “No, everything is okay.”  Parents kept searching because they knew everything was not okay.  I applaud those parents.

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