It’s being talked about in parenting groups. It’s trending on social media. It’s being covered by the media and discussed by pediatricians and other health professionals. Is the condition being overdiagnosed or underdiagnosed? Overtreated or improperly dismissed?
But just what is tongue tie? And why does it matter?
Let’s start with the basics. Clinically known as ankyloglossia, tongue tie is when the thin strip of tissue that connects the bottom of the tongue to the floor of the mouth (the lingual frenulum) is so short, thick, or tight that it limits tongue movement in ways that can cause real functional problems.
For instance, tongue tie in an infant can interfere with breastfeeding, making it hard for the baby to latch properly and get enough milk, which can mean insufficient weight gain for the child and significant nipple pain for the mother. A restricted tongue can also affect speech development – particularly sounds that require the tongue to reach the roof of the mouth – as well as eating, oral hygiene, and the very growth and development of the jaws and airway.
When a tongue tie is severe enough to cause functional problems, it can be released through a procedure called frenectomy. Traditionally done with a scalpel, frenectomy is increasingly done with laser – and recent research in BMC Oral Health helps explain why.
This randomized controlled trial involved 174 patients who were randomly assigned to one of three treatment groups. Members of one group had conventional scalpel surgery, while those in the other two groups had laser surgery – each group at different wavelengths (445 nm and 980 nm).
The conventional surgery involves cutting the frenulum with a surgical blade. Typically, the wound is then closed with sutures so it can heal. The procedure is effective, to be sure, but it has its downsides: the need for sutures, bleeding, post-op pain, and a recovery period that requires careful management.
Laser frenectomy, on the other hand, removes tissue with focused light energy, which simultaneously cuts and cauterizes the wound. Because of that, there’s usually little bleeding during the procedure, and sutures are seldom needed. The precision of the laser allows for a very controlled release of tissue.
Each study participant was tracked after their procedure – at 7 days and again at 30 days post-treatment. Researchers measured intraoperative bleeding, pain levels, tissue healing, and discomfort when chewing and speaking.
By study’s end, it was clear that both laser groups experienced significantly less pain than the scalpel group, both right after the procedure and through the first week. Laser patients also had less bleeding during surgery and reported less discomfort when speaking and chewing during recovery.
Those are some pretty substantial benefits for the patient – along with typically faster recovery and no need to return to the office to get the sutures removed.
Still, there are some who think that tongue tie release is done too often, that not all cases merit frenectomy. A new systematic review in Otolaryngology – Head and Neck Surgery, for instance, notes an “exponential rise in publications without exponential increase in evidence.” Its authors express concern that much of the recent research lacks the methodological rigor needed to draw strong conclusions.
And it’s true: Not every tight frenulum necessarily needs to be released. Always, we should ask whether the restriction is causing problems with eating, speaking, and so on. Is a lack of tongue mobility really the reason why the baby can’t latch? Is the child’s speech impaired in ways that suggest restricted tongue movement? Is the tongue unable to move as needed for eating neatly? For oral hygiene?
And if the answer is yes, are there alternative therapies that could solve the issue or is frenectomy the most sensible solution?
Such questions are important to consider, for tongue function not only plays a role in feeding and speech; it also plays a crucial role in orofacial development and airway health – which, itself, can affect whole body health in many ways, large and small
You see, during nursing, the tongue’s movement against the palate helps shape the upper jaw and promotes proper forward growth. If the tongue is restricted, this developmental stimulus is diminished. Over time, this can result in a narrow palate, dental crowding, and compromised airway development.
The tongue is also meant to rest lightly against the roof of the mouth, not lay at the bottom or against the lower teeth. This proper oral posture supports optimal nasal breathing. If a tongue tie prevents this, it can set the stage for mouth breathing patterns and subsequent changes in facial growth patterns, disrupted sleep, and a higher risk of orthodontic problems.
To be clear, not every child with tongue tie will develop such issues – which is another reason why it’s so important to have your child properly evaluated if you suspect a problem. So here at Pride Dental, we look at how the tongue actually moves, whether functional limitations exist, and whether a frenectomy is likely to improve any problems we observe. We also consider the full picture: feeding history, speech development, oral habits, and overall orofacial development.
And when frenectomy is needed, our laser technology lets us provide treatment that’s quick, precise, comfortable, and designed to support optimal recovery. You can learn much more about the procedure here.
