Treating Tongue Tie – The role of surgery and myofunctional therapy, part 3

This post is the third in a series on tongue tie, its symptoms and classification, and its treatment using functional frenuloplasty and myofunctional therapy. If you haven’t read parts 1 and 2 yet, I recommend you do before continuing.

Treating tongue tie (continued)

In tongue tie cases where surgical intervention is required to restore proper function and range of motion of the tongue, the key question is this: what is the smallest possible revision a surgeon can make to achieve the desired result? This is important to consider because the less tissue has to be revised, the faster the patients recovery will generally be, and the less pain they will generally experience. Historically, if the lingual frenulum was causing any problems, doctors would perform a large revision. This usually solves the problem, but it’s a bit like going after a cockroach with a sledgehammer. Any modern, researched performer of frenuloplasty will only perform the surgery when absolutely necessary, and only revise the minimum possible amount of frenulum to achieve the desired result.

Healthy tongue mobility pictured. Tongue tie

Functional frenuloplasty and myofunctional therapy

While tongue tie has occurred in humans in humans as far back as we’re aware, and even frenuloplasty has been around for generations, myofunctional therapy is a relatively new field by comparison. While the treatment for tongue tie is nearly always surgical, myofunctional therapy still has an important role to play in these cases.

After the frenulum has been appropriately revised, the next step is to get the patient into myofunctional therapy. First of all, this will help accelerate their recovery. But, more importantly, the muscles and structures of the mouth need to be retrained. They’ve become accustomed to the pre-surgical condition of the mouth, which means they essentially need to be taught new patterns of functional movement. This is particularly true in older patients whose speech was affected by the tongue tie. Under the guidance of a myofunctional therapist, a simple routine of exercises can strengthen and retrain the muscles of the tongue, face, and jaw to speed recovery and ensure proper post-surgical function.

Want to learn more about tongue tie? Check out our page on treating tongue tie with functional frenuloplasty and myofunctional therapy.

Treating Tongue Tie – The role of surgery and myofunctional therapy, part 2

This post is the second in a series on tongue tie, its symptoms and classification, and its treatment using functional frenuloplasty and myofunctional therapy. If you haven’t read part 1 yet, I recommend you do before continuing.

Classifying tongue tie (continued)

In a class 4 tongue tie, the connection point of the lingual frenulum may be submucosal, meaning beneath the mucus membrane. This class of tie must be diagnosed by feel rather than by sight. Babies with class 4 tongue ties are sometimes misdiagnosed as having a short tongue, since the lingual frenulum cannot readily be seen.

Young girl shown healthy tongue mobility. No tongue tie here

Why does it seem like we’re seeing more and more cases of tongue tie?

Babies have been born with tongue ties for a very long time. In the old days, many midwives used to keep one sharp fingernail so they could correct tongue ties at birth. However, when bottle feeding began to gain widespread popularity around the middle of the twentieth century – oftentimes because it was promoted by doctors as a superior alternative to breastfeeding – fewer tongue ties were diagnosed in infants because they weren’t being breastfed. Now that science has come around again to promoting breastfeeding over bottle feeding, we are once again seeing many cases of tongue tie getting diagnosed in infants.

Treating tongue ties – not too much, not too little

While many tongue ties my never present any symptoms, in cases where they do the most common treatment is surgical. This surgery is called a functional frenuloplasty. Just like in other medical procedures like rhinoplasty, the “-plasty” refers to the molding or shaping of a specific part of the body – in this case, the frenulum.

Check back soon for Treating Tongue Tie – The role of surgery and myofunctional therapy, part 3. In the meantime, check out our page on tongue tie treatment and myofunctional therapy.

Treating Tongue Tie – The role of surgery and myofunctional therapy, part 1

What is tongue tie?

Tongue tie is a condition present at birth. It occurs when the lingual frenulum – the strip of skin that connects the tongue to the bottom of the mouth, is attached too far forward on the tongue, is too short, or too thick. Depending on which population and data source you look at, somewhere between 5% and 15% of people are born with tongue tie. In some cases, these ties might never present any symptoms. However, in some cases it presents many difficulties.

Young woman with healthy tongue mobility. Tongue tie

Symptoms of tongue tie

The symptoms of ties oftentimes present in infancy. Ties can cause issues in breastfeeding for both mother and child. If a breastfeeding infant has trouble latching, chews excessively, isn’t gaining weight as expected, fusses while feeding, or makes clicking noises, they could have tongue tie. Tongue tie also oftentimes presents alongside lip tie, but we’ll save that one for another post.

In older patients, these ties are most commonly diagnosed because of its impact on speech patterns. Myofunctional therapy can play a large role in rectifying these speech problems – we’ll get to that shortly.

Classifying ties

There are four classes of ties. While class 1 is the most noticeable and severe, all classes of ties can cause problems – it just depends on the individual circumstances of the case. In a class 1 tie, the lingual frenulum is attached far forward, almost to the tip of the tongue. Class 2 and 3 tongue ties attach progressively further back on the tongue, but can still be seen by lifting the tongue. Class 1-3 tongue ties are known as anterior ties, while a class 4 tie is called a posterior tie.

Check back soon for part two! In the meantime, check out our page on tongue tie treatment and myofunctional therapy.

The importance of diagnosing and treating OMDs, part 5

This post is the fifth in a multi part series on the diagnosis, symptoms, and treatment of OMDs. If you haven’t read parts 1 – 4 yet, I recommend you do before continuing.

Effects of OMDs on oral hygiene, stability of orthodontic treatment, and facial esthetics (continued)

Various OMDs also cause the muscles of the face to stay in unnatural tension. This not only affects facial aesthetics but leads to aches and in some cases even muscle spasms, as well as a distorted, sluggish appearance in the face.

Myofunctional therapy offers relief for sufferers of OMDs

Treating OMDs

Myofunctional therapy offers relief to sufferers of a wide range of OMDs. A dentist office is a great place to diagnose and treat OMDs for a few reasons. First, dentists are often the healthcare provider that people see most frequently. Furthermore, dentists and dental hygienists are experts on the anatomy and function of the mouth and jaw area. Dental professionals are also in a great position to spot myofunctional disorders in children, when they commonly affect development.

Orofacial myofunctional therapy, or OMT, treats myofunctional disorders by strengthening and retraining the muscles and structures where the problem lies. It achieves this in several ways, the most common being via a personalized regimen of exercises that target the affected area. The exercises are simple and pain-free. As long as the patient can stick with them and do them regularly, they can provide relief for a wide variety of OMDs by correcting postural issues and restoring natural function.

Myofunctional therapy can also be extremely helpful alongside other treatments. For example, the most common treatment for patients with tongue tie is called a surgical procedure called a frenuloplasty. After surgery, myofunctional therapy allows for the muscles of the mouth, jaw, and throat to be properly retrained and strengthened for maximum patient benefit.

Dr. Abeyta and her team take a holistic approach to orofacial health. She integrates myofunctional therapy, acupuncture, and more into her practice to treat her patient’s maladies wherever they lie. If you want to learn more about treatment of OMDs, or you’re ready to schedule a consultation, give the office a call today!

The importance of diagnosing and treating OMDs, part 4

This post is the fourth in a multi part series on the diagnosis, symptoms, and treatment of OMDs. If you haven’t read parts 1, 2, and 3 yet, I recommend you do before continuing.

Effects of OMDs on oral hygiene, stability of orthodontic treatment, and facial esthetics

The effects of OMDs on all three of these are interrelated. Numerous OMDs might affect stability of orthodontic treatment, one of the most common being tongue thrust. In a patient with tongue thrust, the excess muscular forces produced by the tongue are misdirected into the teeth, rather than being transferred into the hard palate where they can dissipate safely. Over time, these repeated, misplaced forces push the teeth out of alignment. This condition is known as an open bite. The most common type of open bite is an anterior open bite, meaning that the front teeth are being pushed out, but open bite can also affect the teeth on either side of the mouth if the tongue pushes sideways during the swallow.

OMDs affect the stability of orthodontic treament

Misaligned teeth and an improper bite both negatively impact oral hygiene. Crooked teeth are harder to clean, and therefore more likely to develop cavities. Malocclusion – the medical term for a misalignment of the bite – often causes premature erosion of tooth enamel. When the teeth don’t come together as they’re supposed to, it creates unnatural pressure points that eventually erode the enamel. Once the enamel is worn through, the interior layers of the teeth are open to decay, which causes cavities. This is one reason why dentists say there’s no such thing as a functional malocclusion.

The jaw line is one of the most pronounced features of the face. When the jaw has improper resting posture, facial esthetics will be affected.

Check back soon for The importance of diagnosing and treating OMDs, part 4. In the meantime, check out our page on treatment of OMDs.

The importance of diagnosing and treating OMDs, part 3

This post is the third in a multi part series on the diagnosis, symptoms, and treatment of OMDs. If you haven’t read parts 1 and 2 yet, I recommend you do before continuing.

Symptoms of OMDs (continued)

Effects of OMDs on facial skeletal growth and development

Next up; facial skeletal growth and development. Many OMDs can have a negative impact on the development of the bones of the face, but one of the most common is tongue thrust. When a human swallows, we use the muscles of our mouth, jaw, and throat in concert to create the necessary force and pressure. In a normal swallow, that force passes from the tongue to the hard palate – the part of the roof of the mouth directly behind the front teeth. The hard palate is designed to take that force, so it’s no big deal, even though the average person swallows around 1000 times per day, transferring that force to the hard palate each and every time.

In a tongue thrust, the tongue pushes against the teeth rather than the hard palate. Over time, this moves the teeth, leading to what is known as an open bite. Until the tongue thrust is corrected, orthodontics will be useless in aligning the teeth – the tongue will just push them back out of alignment once the braces are removed.

OMT can help TMD and other OMDs

Effects of OMDs on temporomandibular joint movement

The temporomandibular joint, or TMJ, is the joint that forms the connection between the jaw and the skull. Temporomandibular disorder, or TMD, is a painful condition that affects this joint. Symptoms include pain in one or both TMJs, aching, clicking, locking of the joint or joints, difficulty in chewing or pain while chewing, and more.

The precise causes of TMD can be difficult to determine and vary from case to case. However, for many sufferers of TMD, OMT can provide relief by strengthening the muscles of the face and jaw and retraining them so that they have the proper posture.

Check back soon for The importance of diagnosing and treating OMDs, part 4. In the meantime, check out our page on treatment of OMDs.