As a speech-language pathologist specializing in tethered oral tissues (TOTs), I frequently encounter adults grappling with the often-overlooked challenges posed by tongue/lip, and cheek tie.
While these conditions are commonly associated with infants and children, their presence in adults can lead to a myriad of functional issues.
In this comprehensive exploration, we’ll delve into each condition individually and then examine the compounded effects when they coexist, shedding light on assessment, treatment, and the transformative potential of myofunctional therapy.
Reaching Adulthood with Tongue/Lip and Cheek Tie
Tongue ties are a fad, lip ties will bust on their own, and cheek ties have zero impact upon eating and speech skills. These are the big three mantas of the non-specialized medical professionals who tend to downplay the effects of ties.
It’s not easy to sit in front of a doctor who says, “Absolutely no reason to address your tie!” and continue forward. But that is indeed what needs to happen.
As an adult, you are experiencing difficulties that can be corrected. After a lifetime of being tied together you deserve to break free. Don’t start your journey with an inexperienced doctor or dentist. Use the website Tongue Tie Life to identify preferred providers near you.
Understanding Tethered Oral Tissues Tongue/Lip and Cheek Tie
Tongue/lip and cheek tie are tethered oral tissues and refer to abnormal attachments of the oral mucosa that restrict the mobility and function of the tongue, lips, or cheeks. Often referred to by the acronym TOTs, these restrictions can manifest individually as:
- Tongue Tie (Ankyloglossia): A condition where the lingual frenulum (the tissue connecting the underside of the tongue to the floor of the mouth) is unusually short, thick, or tight, limiting tongue movement.
- Lip Tie (Maxillary Labial Frenulum): This occurs when the labial frenulum (the tissue connecting the inner lip to the gum) is restrictive, potentially affecting lip mobility and function. It can occur on the top or bottom lip but is more typically seen in the upper lip.
- Cheek Tie (Buccal Tie): Involves tight buccal frena (tissues connecting the cheeks to the gums), impeding cheek movement and oral function. There are four possible sites for attachment. The first two are located at the upper cheek (maxillary gum ridge). Usually just behind the canine tooth, on both the left and right side of the face. Then, it is also on the lower cheek (mandible gum ridge) on both the left and the right side. Cheek ties are interesting because you can have one area tied and restricted, but the other three are typically presenting. Having one require release does not necessarily mean you need all four areas released.
Surprisingly, you can have a total of seven restricted oral frenulum. A thorough evaluation will help determine which area or combination of areas are causing oral restrictions. The most common tie to rule out is that of tongue tie. Let’s look at that one first.
Tongue Tie in Adults As Part of Tongue/Lip and Cheek Ties
Symptoms and Functional Implications
While there can be several functional impacts from tongue ties in adults, ankyloglossia most commonly is seen to lead to:
Speech Difficulties
Imprecise articulation, particularly with sounds requiring tongue elevation or posterior side spread, such as L R S SH CH J. Possibly you attended speech therapy as a kid, but just never seemed to get that sound 100% correct.
Some adults report a feeling of sluggishness in their speech when speaking for a longer time. Others note vocal strain and more frequent cases of laryngitis. There is a general feeling of strain and tension throughout the oral facial muscles, leading to quick muscle fatigue.
Eating Challenges
The tongue has a significant role in chewing and masticating our food. It requires dynamic movements such as tongue bowl, and posterior side spread to control the food bolus and prepare it for propulsion down the throat.
When a tie is present, these movements are limited, and the proper breakdown of the food is affected. The mouth is the first step in the digestive system, and when there is a problem here, it can lead to digestive upset. Difficulty with tasks like licking an ice cream cone, clearing food debris from the mouth, or swallowing pills can annoy the adult with tongue tie.
Oral Hygiene Issues
The inability to effectively sweep the tongue across the teeth and gums leads to increased plaque buildup and a higher risk of dental problems. Poor range of motion due to a tie may mean not reaching the back molars or into the cheek space to clear that annoying little piece of food! This can also lead to bad breath.
Temporomandibular Joint (TMJ) Disorders
Compensatory jaw movements due to restricted tongue mobility can contribute to TMJ pain and dysfunction. The jaw will slide, glide, and jut forward to adapt to the tongue’s limited reach. Over time, these types of compensations wear down the joint, leading to clicking and pain.
Sleep Apnea and Snoring
A restricted tongue may contribute to airway obstruction during sleep, exacerbating conditions like obstructive sleep apnea. A resting tongue should be placed into the roof of the mouth and easily rest there. A tied tongue, however, lives in the floor of the mouth. This makes it more likely to fall back and block the airway.
Assessment of Tongue Tie
Some adults are unsure if they need a complete evaluation. We know that fully understanding your condition helps one to decide to move forward.
To that end, we developed the 1-2-3- Self Assessment for adult tongue tie. Just follow this LINK and you will have the self-assessment delivered directly to your inbox!
Once ready to get that expert opinion, it’s imperative to seek the advice of preferred providers.
A thorough assessment with a trained speech-language pathologist specializing in oral facial myofunctional therapy involves:
- Visual Examination: Observing the appearance of the lingual frenulum and tongue mobility. The therapist will show you what they see in a mirror and identify the color, length, and thickness of the frenulum. Pointing out restrictive movement vs. fluid movement.
- Functional Tests: Evaluating the tongue’s range of motion, such as the ability to lift the tongue behind the upper teeth, click/pop the tongue, make a tongue bowl, and side spread the posterior portion of the tongue. The therapists will judge the TRMR- tongue range of motion ratio with you. This ratio helps to determine if you have a grade 1-2-3- or a 4 severity of tie.
- Patient History: Discussing symptoms, including speech issues, eating difficulties, and any related pain or discomfort. The history is typically in depth as we search for patterns of difficulty across the life span.
Treatment Options Tongue Tie
Treatment may include:
- Myofunctional Therapy: A regimen of exercises designed to improve tongue strength and mobility, addressing functional deficits leading to surgical intervention. Once surgical intervention, myofunctional therapy continues to ensure proper alignment of the oral facial muscles.
- Frenectomy or Frenuloplasty: Surgical procedures to release or modify the frenulum, often considered when significant functional limitations persist. Post-surgical myofunctional therapy is crucial to retrain tongue movements and prevent scar tissue formation. A preferred provider should provide the surgery. On this website, Tongue Tie life, you can locate one close to you.
Lip Tie in Adults as Part of Tongue/Lip and Cheek Tie
Symptoms and Functional Implications
Lip ties in adults can manifest as:
- Gum Recession: A tight labial frenulum can pull on the gum tissue, leading to recession and potential tooth sensitivity or loss. This can happen on the top or bottom row of teeth.
- Difficulty with Oral Hygiene: Restricted lip movement may hinder effective brushing and flossing, increasing the risk of cavities and gum disease.
- Speech Articulation Issues: Limited lip mobility can affect the production of sounds that require lip movement, such as ‘p,’ ‘b,’ and ‘m’, w’, ‘o.’
- Mouth Breathing: Inability to close the lips comfortably can lead to habitual mouth breathing, which is associated with dry mouth and increased susceptibility to oral infections.
Assessment of Adult Lip Tie
Assessment involves:
- Visual Inspection: Identify the attachment point and tightness of the labial frenulum. The therapist will show you in the mirror the level of thickness, length onto the gum space that the tie reaches, and the color of the frenulum.
- Functional Evaluation: Assess lip mobility, the ability to close the lips without strain, and any compensatory habits like mouth breathing. Check for alternating movements such as a big smile and then a big pucker. How easily and quickly can you alternate these helps to determine the function of the muscles.
- Patient History: Discuss your symptoms, including speech issues, eating difficulties, and any related pain or discomfort. History is typically in-depth as we search for patterns of difficulty across the life span.
Curious about your lip tie, if it even needs fan expert to examine it? Check out our 1-2-3- Lip Tie Self-Assessment, it will be delivered directly to your inbox!
Treatment Options Lip Tie
Treatment strategies include:
- Myofunctional Therapy: Exercises aimed at enhancing lip strength and flexibility, promoting nasal breathing, and improving oral posture.
- Frenectomy or Frenuloplasty: Surgical intervention to release the lip tie, followed by therapeutic exercises to optimize function and prevent reattachment.
Cheek Tie in Adults as Part of Tongue/Lip and Cheek Tie
Symptoms and Functional Implications
Cheek ties in adults can manifest as:
- Gum Recession: A tight cheek frenulum can pull on the gum tissue, leading to recession and potential tooth sensitivity or loss. This can happen on the top or bottom row of teeth, and the left or right side. In fact, the number one reason to not release a cheek tie is often cited as “it only causes gum recession when older.’
- Difficulty with Oral Hygiene: Restricted cheek movement may hinder effective brushing and flossing, increasing the risk of cavities and gum disease. Most report brushing or flossing the back molars when the cheeks are tight isn’t easy.
- Speech Articulation Issues: Limited cheek mobility can affect the production of sounds that require lip movement. This is because of the interconnectedness of the cheek and lips for smiling and puckering movements. Sounds such as ‘s’, ‘sh’, ‘ch’, and ‘z’ are often produced a bit slushy or with lateral air escape. More commonly referred to as a lisp.
- Mouth Breathing: The inability to close the lips comfortably can be related to tight cheek ties. If the checks ties are pulling the lip out of alignment, the lips will not easily rest closed. This can lead to habitual mouth breathing, which is associated with dry mouth and increased susceptibility to oral infections.
- Increased facial tension and eye strain: Adults note increased facial strain and impact upon vision and focus when they have a tight cheek frenulum. Notation of improved vision, as if going from normal to HD vision, has been reported with release of tension in the cheek frenulum.
Assessment of Adult Cheek Tie
Assessment involves:
- Visual Inspection: Identify the attachment point and tightness of the cheek frenulum. The therapist will show you in the mirror the level of thickness, length onto the gum space that the tie reaches, and the color of the frenulum.
- Functional Evaluation: Assess cheek mobility, puffing cheeks and sucking them in (fish face). Check for alternating movements such as a big smile and then a big pucker. How easily and quickly can the cheeks alternate these patterns helps to determine the function of the muscles.
- Patient History: Discuss your symptoms, including speech issues, eating difficulties, and any related pain or discomfort. History is typically in-depth as we search for patterns of difficulty across the life span.
Treatment Options Cheek Tie
Treatment strategies include:
- Myofunctional Therapy: Exercises aimed at enhancing cheek strength and flexibility, promoting nasal breathing, and improving oral posture.
- Frenectomy or Frenuloplasty: Surgical intervention to release the cheek tie, followed by therapeutic exercises to optimize function and prevent reattachment.
The Role of Myofunctional Therapy and Myofascial Release For Tongue/Lip and Cheek Tie
Myofunctional therapy plays a pivotal role in both the non-surgical and post-surgical management of tethered oral tissues.
As we can see above, each tie on its own can bring a cascade of issues as one ages. But if there are multiple ties in the oral cavity, then problems are compounded.
A dynamic oral rehabilitation program that involves both myofunctional exercises and myofascial releases for the face is paramount to success.
- Exercise Regimen: Customized exercises targeting the tongue, lips, and cheeks to enhance strength, flexibility, and coordination. The jaw may need to be addressed, as ties can move it out of alignment, compensating for restricted muscles. Each person is different, ties are like snowflakes, no two impact the same.
- Breathing Retraining: Promoting nasal breathing to improve oxygenation, reduce mouth breathing, and enhance overall health. Invariably, breathing is impacted by oral ties. Improving oral rest habits to closed mouth and nasal breathing can significantly impact one’s focus, attention to task, and daytime alertness.
- Swallowing and Chewing Optimization: Training correct tongue and lip posture and function facilitates efficient swallowing and prevents digestive discomfort. The balance and harmony of the oral muscles allows for efficient manipulation of food and drink. This can also improve digestion, significantly impacting one’s overall health.
- Post-Surgical Rehabilitation: Preventing scar tissue buildup and optimizing mobility after a frenectomy or frenuloplasty. The surgical procedure is the smallest piece of this puzzle. It only takes about 20-25 minutes to have seven oral restrictions released by a preferred provider. Less time if fewer ties are being addressed. What takes place afterward in the post op exercise plan can make or break the procedure’s success.
Myofascial Release Therapy
Myofascial release therapy complements myofunctional therapy by addressing muscle tension and restrictions in the fascia, the connective tissue surrounding muscles. Techniques include:
- Manual Soft Tissue Release: Gentle manipulation to release tension in the orofacial muscles, reducing pain and improving mobility.
- Intraoral Techniques: Specific massage and stretching exercises to alleviate tightness in the tongue, lips, and cheeks.
- Integration with Myofunctional Therapy: Combining both approaches maximizes functional outcomes, ensuring long-term oral mobility and function improvement.
Conclusion Tongue/Lip and Cheek Tie Unraveling the Complexities
Tongue, lip, and cheek ties in adults are more than just anatomical variations; they are functional impairments that can impact speech, eating, breathing, and overall quality of life.
While many individuals have unknowingly adapted to their restrictions, these adaptations often lead to compensatory issues such as TMJ pain, sleep disorders, and oral hygiene challenges.
By combining myofunctional therapy with myofascial release and, when necessary, surgical intervention, adults can achieve significant improvements in function and well-being.
If you suspect tethered oral tissues are affecting your daily life, seeking an evaluation from a trained specialist can lead to effective treatment. Through targeted therapy and proper intervention, optimal function can be restored, and overall oral health can be improved, leading to a more comfortable and fulfilling life.
At Lynn’s Tied Together Hub, we offer guidance and information on your adult journey with tethered oral tissues.