What Causes Tongue Tie?

Sometimes patients, especially new parents, ask us, what causes tongue tie? Tongue-tie, also known as ankyloglossia, is a congenital issue that originates at birth that may cause problems eating and eventually speaking.

Basically, some infants are born with a frenulum (the fold of skin beneath the tongue, or between the lip and the gum) that didn’t develop as normal. Usually, there is a short or tight band of tissue that tethers the tongue and limits movement. This limits the mobility of the child’s tongue. For example, children with tongue-tie may have trouble sticking their tongue out or moving it from side to side.

There are many variations in the severity of ankyloglossia, and it presents itself differently in different children. Since each case is different, individual medical attention is essential. This article is not a substitute for medical attention. We hope this article on what causes tongue tie raises awareness about an issue that affects some children’s dental and overall physical health. 

What Causes Tongue Tie

As mentioned, tongue tie presents itself at birth, but it may take longer before parents and medical professionals notice.  Your dentist is usually the first person to diagnose a tongue tie. Typically the lingual frenulum separates before birth, and this allows for the tongue’s normal range of motion. In cases of ankyloglossia, this doesn’t happen in the usual way.

Physicians and healthcare professionals do not know exactly what causes tongue tie, but for some reason, the tongue and frenulum don’t form normally. Genetics may be a factor as family history seems to play a role. Tongue-tie is more common in boys than it is in girls, but it can happen to children of any gender. 

Signs and Symptoms of Ankyloglossia 

It isn’t always obvious when a child has tongue-tie. Parents sometimes notice symptoms that lead their pediatrician or dentist to diagnose ankyloglossia. Some of the symptoms include:

• Difficulty breastfeeding
• A gap between the bottom two front teeth
• Trouble making certain sounds or learning how to speak
• Difficulty licking, moving the tongue, or kissing
• A notch at the tip of the tongue or a tongue that looks “heart-shaped”.
• Difficulty sticking the tongue out beyond the lower front teeth.

Less well known symptoms of a tongue tie:

• Teeth grinding
• Snoring
• Mouth breathing
• Crowded teeth
• Small, narrow mouth
• Poor gut function
• Vaulted palate
• Sleep apnea
• Sleep disordered breathing
• Acid reflux
• Bed wetting
• ADHD

When to Seek Medical Attention 

If you suspect your child might have ankyloglossia, be sure to discuss your concerns with your child’s dentist since they are usually the first to recognize the problem. The condition is diagnosed through a thorough physical examination and a discussion of the symptoms. Your child’s dentist will check the tongue’s mobility as well as look for other symptoms and signs. Sometimes your dentist will refer the child to an ear nose and throat specialist or a myofunctional therapist.

Depending on the severity, the condition is treated in different ways. Treatment depends on the severity of the tongue tie and also the symptoms that the child or adult are experiencing. If the condition keeps your child from breastfeeding, a tongue tie release should be performed by a trained dentist or surgeon.

If the tongue tie is diagnosed later than in infancy, the release will need to be combined with myofunctional therapy.  The tongue will need to be strengthened and trained where to go once the tie is released.  Research shows that a tongue tie release without myofunctional therapy is only 25% successful whereas with therapy, success rate increases to 95%. 

As mentioned, the severity and symptoms of tongue-tie vary so much from child to child. It is impossible to specify the exact course of treatment in all cases. Sometimes no medical intervention is required and other times surgery may be recommended.

Since there is a genetic component to tongue ties, it also tends to run in the family, if you or another adult family member has experienced problems associated with it, then be sure to inform your child’s doctor as this may result in more proactive screening and treatment.

Possible Complications of Tongue Tie

One of the most serious issues with babies who have tongue-tie is trouble breastfeeding. Breastfeeding is more complicated than it appears. When feeding, the baby must be able to keep her or his tongue placed over the lower gum while sucking. The decreased mobility makes this difficult and may result in difficulty latching or nipple pain in the mother. If your baby has trouble feeding, be sure to see a pediatrician or lactation specialist immediately, as this can result in malnutrition and failure to thrive.

Another time when tongue-tie may present a unique challenge is when the child first starts learning to speak. Depending on the exact nature of the tongue-tie condition, it can hinder the child’s ability to make certain sounds, including the sounds associated with the letters r, l, s, z, d, and t. Depending on the severity, a speech therapist may be able to teach the child ways to compensate for the lack of tongue mobility.

Poor oral hygiene is another unfortunate problem children and adults with tongue-tie may face. The condition may make it difficult to sweep food debris from the teeth and may, as a result, contribute to tooth decay. Sometimes gaps between the teeth may form as a result of tongue-tie, this most commonly presents as a gap between the two bottom front teeth.

Tongue ties are linked to mouth breathing, snoring, sleep apnea, grinding, mouth breathing and crooked teeth because the tie prevents the tongue from resting on the roof of the mouth.  Most people don’t realize that when their mouth is resting, their tongue should be touching the gums behind the upper teeth and the back of the tongue should be fully pressed in the roof of the mouth.  If the tongue tie is preventing the tongue from reaching the roof then the mouth can hang open and mouth breathing can occur.  When we mouth breathe, the tongue stays low and can block the air from flowing smoothly leading to snoring noises and progressing to apnea.  Crowded teeth come from the tongue not being in the roof of the mouth guiding the position of the teeth.

As mentioned,  a child may adapt to a minor tongue tie and be able to function well. However, they will not “grow out of it” and more severe cases with more serious impact may require surgery. By now you must have a clear understanding of what causes tongue tie.

Seeing a Dentist or Myofuntional Therapist May be the Best Next Step

If a member of your family has ankyloglossia, please discuss the matter with an airway trained dentist, even if your primary care doctor or pediatrician does not recommend immediate treatment.

This issue can have dental or oral health implications that your dentist will want to carefully monitor. Your dentist will be able to offer customized recommendations for your home care plan. Be sure and follow this advice. Your dental team may also need to recommend a more personalized dental screening schedule so they can monitor the development of the teeth and whether any unusual gaps are forming.

If you have questions about the oral health implications of ankyloglossia or what causes tongue tie, contact your dentist. If you live in the Charlotte, NC area, then feel free to contact us at Southview Dentistry.