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Ankyloglossia, AKA Tongue-Tie
Ankyloglossia, more commonly called tongue-tie, is a fairly common abnormality that occurs at about 4-5% in newborns, and is 3 times more common in boys than girls. Usually, it is detected soon after birth.
If you ask your child (or any person) to elevate their tongue (lift their tongue up to the roof of the mouth), you will see a fold of tissue in the middle portion of the tongue that extends from the tip of the tongue to the floor of the mouth. This fold of tissue is called a frenum or frenulum. A frenum or frenulum connects a moveable part of the body to a fixed part of the body. Normally, the lingual (for tongue) frenum helps to stabilize the base of the tongue without interfering with the movement of the tongue.
However, depending on how short the frenum is, it can cause virtual adhesion of the tongue to the floor of the mouth, restricting movement . The degree that the tongue is restricted depends upon how short the lingual frenum is. Tonue-tie is caused by a partial or total fusion of the tongue to the floor of the mouth when the baby is developing before birth. Usually, if there is a tongue-tie, the child is unable to touch the roof of the mouth with the tongue tip when the mouth is open. Also, if the child attempts to stick his or her tongue out, the tongue tip becomes notched in the midline which looks like a heart shaped edge. (For some good pictures, click on: http://children.webmd.com/tc/tongue-tie-topic-overview or http://www.ghorayeb.com/TongueTie.html, [more graphic]).
Only about 25% of infants with tongue-tie have breast feeding difficulties that occurs when the frenum is so tight that it prevents the tongue from moving properly in order to effectively breastfeed. In most cases, there are no problems with feeding. However, it may be more painful for “mom”, because of the way the tongue retracts and compresses the nipple. If you are a breast-feeding mom and are having extremely sore nipples in spite of a good latch and position technique, there may be a possibility that your child is tongue-tied.
Sometimes parents of infants and toddlers will be advised that the tongue will stretch and break as the child grows, allowing for a freer range of movement. However, these “stretching” and “breaking” phenomena have not been formally documented or studied in the medical or speech pathology literature, according to Caroline Bowen, PhD.
Tongue-tie rarely impairs the ability to speak, and most children (people) will have normal sounding speech. Children may not be able to participate in some play practices that involve tongue movements or gestures, such as sticking out their tongue. Some children, especially older children and adults, may become self-conscious or embarrassed about their tongue-tie.
Because of the restriction of the tongue, children cannot tidy up the inside or outside of their mouth during or after a meal. Some children may be unable to circle their lips with their tongue to fully lick their lips. Besides being messy, food debris is not removed by the action of the tongue and saliva (which has anti-cavity properties) is not washed over the teeth. Consequently, your child may be more at risk for cavities or caries, gingivitis, bad breath, and even periodontitis if good oral hygiene practices are not established and practiced. When brushing is not possible, help your child clear his or her mouth from food debris by having him or her drink or rinse with water after eating. Your child may also need more frequent dental check-ups and dental cleanings.
Sometimes tongue-tie surgery (called a frenectomy) may be recommended. A speech pathologist will assess whether or not it is needed by looking at several factors, such as the range of tongue movements, if the tongue-tie affects speech, dental health, and/or self-esteem. The surgery is then performed by either a general surgeon, an otolaryngologist, a plastic surgeon, or an oral surgeon. However, a frenectomy is rarely recommended, unless there is a good speech, or dental justification, or self-esteem issues for performing the surgery. It is also recommended that parents/caregivers seek more than one opinion before making the decision to proceed with the surgery.
Links:
www.asha.org/publications/leader/archives/2005/051227/f051227a.htm
This is a Manila site.