The frenula are strong cords of tissue in the front – center of the mouth that guide the development of mouth structures during gestation. Important during fetal development, the frenula continue after birth to guide the positions of the baby teeth as they come in. Adults may still feel the remnant of their lip (labial) frenulum, which is what is left of the cord located between the center of the upper lip and the center of the upper gum.
Tongue-tie is a condition in which the free movement of the tongue is restricted due to abnormal attachment of the base of the tongue (lingual frenulum) towards the tip of the tongue. The lingual frenulum may be too short and taut after birth, or may not have receded and may remain attached too far along the base of the tongue. Children with tongue-tie may be unable to protrude the tongue, touch the roof of the mouth, or move the tongue from side to side. If the lingual frenum extends to the tip of the tongue, a v-shaped notch or heart shape can be seen at the tip. Ankyloglossia is often hereditary, and there is no means of prevention.
Tongue tie can cause feeding problems in infants; if this is the case, feeding difficulties are usually noticed early in an infant’s life. Feeding difficulties may include problems breastfeeding and sucking, poor weight gain for the baby, and poor milk supply for the mother. Feeding difficulties may be a reason to consider early surgery to cut the lingual frenulum and loosen the tongue.
In some children, tongue tie may also cause speech defects, especially articulation of the sounds - l, r, t, d, n, th, sh, and z. Preventing speech defects or improving a child’s articulation may be another reason to consider surgical intervention. The tongue is remarkably able to compensate, however, and many children have no speech impediments due to ankyloglossia.
Although it is difficult to predict which infants with tongue tie are likely to suffer articulation problems later, the following characteristics are common in children with speech problems:
Tongue tie may contribute to dental problems as well, causing a persistent gap between the bottom two front teeth.
When tongue tie surgery (frenulectomy) is recommended in an infant, it may be done in the office. Older children require a brief general anesthesia. It is a simple procedure and there are normally no complications.