Could You Have a Tongue Tie? Signs to Look for in Children and Adults
When most people hear the term “tongue tie,” they think of a baby having difficulty breastfeeding. But a restrictive lingual frenulum can also affect tongue function in older children, teenagers, and adults.
Some people do not realize their tongue movement is limited until they begin orthodontic treatment, have difficulty establishing proper tongue posture, struggle with certain oral functions, or are evaluated for concerns involving breathing or swallowing.
The important question is not simply, “Do I have a tongue tie?” It is, “Is the tissue underneath my tongue restricting how my tongue functions?”
What Is a Tongue Tie?
A tongue tie, also called ankyloglossia, is a condition in which a restrictive lingual frenulum limits tongue mobility.
The lingual frenulum is a normal structure underneath the tongue. Simply being able to see or feel it does not mean there is a problem.
A tongue tie becomes significant when the restriction affects function.
This is why looking under the tongue alone is not enough. A functional evaluation considers how well the tongue can lift, move independently, coordinate, rest against the palate, and function during activities such as swallowing.
What Might a Tongue Restriction Look Like?
A restrictive frenulum does not look or function the same way in every person. Some restrictions may be more noticeable than others.
Signs that may warrant a closer functional evaluation include:
- Difficulty lifting the tongue to the roof of the mouth
- Difficulty maintaining the tongue lightly suctioned to the palate
- The floor of the mouth lifting when the tongue is raised
- Neck, jaw, or facial muscles engaging when trying to move the tongue
- Limited ability to move the tongue independently from the jaw
- A low resting tongue posture
- An open-mouth resting posture or habitual mouth breathing
- Tongue thrust or an altered swallowing pattern
- Difficulty reaching certain areas of the mouth with the tongue
- Speech concerns when limited tongue mobility may be contributing
None of these signs automatically means someone has a tongue tie. Mouth breathing and open-mouth posture, for example, can also occur because of nasal obstruction, allergies, enlarged tonsils or adenoids, structural differences, or learned patterns.
These signs are pieces of a larger functional picture.
Tongue Tie in Children
In children, a tongue restriction may become more noticeable as oral functions become more complex.
A parent might notice that a child has difficulty lifting the tongue, frequently rests with the mouth open, pushes the tongue forward when swallowing, or moves the jaw along with the tongue instead of moving the tongue independently.
Some children may also have feeding or speech concerns. However, tongue tie is not the cause of every speech, feeding, dental, or breathing problem. Each concern needs to be evaluated individually.
Because children are still growing, it is important to look at tongue function alongside breathing, oral posture, dental development, and airway health rather than focusing only on the appearance of the frenulum.
Tongue Tie in Adults
Adults can also have a restrictive frenulum that was never identified earlier in life.
Sometimes adults discover a limitation while learning proper tongue posture and realize they cannot comfortably lift or suction the tongue to the roof of the mouth without significant effort or compensation.
Others may notice that they tighten the jaw, lift the floor of the mouth, or recruit muscles in the face or neck when attempting certain tongue movements.
A restriction may also become more noticeable during orthodontic treatment or while working to improve long-standing oral posture, swallowing, or mouth-breathing patterns.
These concerns do not prove that the frenulum is responsible. A functional evaluation helps identify whether tongue mobility is limited and how that limitation may be affecting oral function.
Does Every Tongue Tie Need to Be Released?
No.
This is one of the most important things to understand about tongue ties.
The appearance of a frenulum alone is not a reason for surgery. Professional organizations, including the American Academy of Pediatric Dentistry, recognize that not every person with ankyloglossia requires surgical treatment and that treatment decisions should consider function and individual needs.
For some people, the frenulum may appear prominent while tongue mobility and function are adequate.
For others, a restriction may significantly limit movement and function.
If a release, often called a frenectomy, frenotomy, or frenuloplasty, is being considered, the decision should be based on functional limitations and made in collaboration with the appropriate healthcare providers.
Why Not Just Release the Tongue Tie?
A tongue tie release may improve the tongue’s available range of motion, but increased mobility does not automatically change long-standing functional patterns.
Someone who has compensated for a restriction for years may have developed particular ways of swallowing, chewing, positioning the tongue, or using the jaw and surrounding muscles. Those patterns may need to be retrained even after greater tongue mobility is available.
Think of the release as creating greater potential for movement. The tongue still needs to learn how to use that movement effectively.
That is where myofunctional therapy can play an important role for appropriate patients.
How Myofunctional Therapy Fits In
Myofunctional therapy evaluates much more than whether someone can stick out their tongue.
I look at how the tongue moves, whether it can function independently from the jaw, where it rests, how the lips and facial muscles participate, how a person swallows, and whether compensations are occurring in the jaw, floor of the mouth, face, or neck.
When a tongue restriction is suspected, a myofunctional evaluation can help identify how limited mobility is affecting function and whether collaboration with another healthcare provider may be appropriate.
For someone preparing for a tongue tie release, therapy may help improve awareness, coordination, mobility, and the functional patterns that will be needed after the procedure.
After a release, therapy can help a person learn to use the tongue’s increased range of motion and work toward healthier tongue posture, swallowing, and oral muscle patterns.
Studies have reported functional improvements when myofunctional therapy is combined with surgical treatment for ankyloglossia.
Function Comes First
Tongue tie has received a great deal of attention in recent years, and it can be tempting to attribute many symptoms to one small piece of tissue.
The reality is more complex.
Tongue function can be influenced by the frenulum, but it can also be affected by nasal airway health, dental and skeletal structure, learned muscle patterns, strength, coordination, and other factors.
That is why I believe the most useful question is not simply whether a tongue tie is present.
The better question is whether the tongue can comfortably perform the functions it needs to perform.
A thorough myofunctional evaluation can help identify restrictions, compensations, and dysfunctional patterns and determine whether therapy, additional evaluation, or collaboration with another healthcare provider may be appropriate.
Warmly,
Sandra M. Randolph, RDH, OMT
Founder, Montana Myo