Tethered oral tissues, particularly tongue ties, are often overlooked in adults, leading to a host of functional and health challenges. The difference between anterior vs. posterior tongue tie is a crucial aspect of understanding how tongue restrictions can affect everything from speech to digestion.
At Lynn’s Tied Together Hub, we dive into these complexities to provide you with expert guidance. Let’s break it down.
Anterior Tie: Anterior vs. Posterior Tongue Tie
An anterior tongue tie is the most noticeable form of tongue restriction. This type occurs when the frenulum, the thin tissue connecting the underside of the tongue to the floor of the mouth, restricts the tongue’s movement near the tip.
Because it is located close to the tip it is more easily visualized. Anterior ties are more frequently noticed in infancy and surgically released at that time. If you made it to adulthood with an anterior tongue tie, you’re a superhero.
Grab your free Adult Tongue Tie self-check here to self-assess your tongue structure at home!
Key Features of Anterior Tongue Tie
Difficulty Lifting the Tongue to the Upper Teeth
The tip of the tongue will not move easily at all. The tip will feel strained in reaching up to the top teeth. Due to the shortened frenulum, the jaw will be tight. The opening of the mouth will be small with little ability to open widely while lifting the tongue.
It is unlikely that you can stick your tongue out of your mouth. It may be difficult for you to lick your lips or clean your teeth with your tongue.
A Heart-Shaped Tongue Tip When Extended
The anterior Frenulum pull on the body of the tongue will form an indent. The middle of the tip will be pulled down, forming a heart shape. This heart shape is a consistent characteristic of an anterior tongue tie.
Limited Tongue Mobility Affects Speech Clarity and Feeding
As a child, you were more likely to have needed articulation therapy for speech sounds. Commonly the L is produced incorrectly due to the limited ability to raise up behind the teeth.
Then you may have struggled with S SH CH J sounds due to lisping, lateral air escape, or jaw slide. The R phoneme is often difficult to achieve and can take through high school to approximate its movements.
Picky eating is common amongst those with anterior tongue ties. The ability to create a tongue bowl to capture food and to effectively lateralize is compromised.
It’s likely that as an adult you have food preferences and often do not enjoy eating salads and steaks.
Unique Symptoms
Though we often find common symptoms amongst those adults with anterior ties you may have unique symptoms.
Trouble with enunciation is common, but you may have vocal fry or laryngitis more frequently than expected. Anterior tongue ties can impact the muscles in the floor of the mouth.
These muscles run back to the hypoid. The hyoid then becomes lifted into tension, pulling tension into the vocal cords. Tension on the vocal cords can cause hoarse or rough voice quality and, at times, lead to laryngitis.
Unexplained and persistent symptoms may be related to your anterior tongue tie. A full evaluation with a speech-language pathologist will help to rule out symptoms as part of a tie.
While anterior tongue ties are easier to detect, their counterpart, the posterior tongue tie is visually challenging to detect.
Posterior Tie: Anterior vs. Posterior Tongue Tie
A posterior tongue tie is subtler but often more problematic due to its hidden nature. The restriction lies deeper under the tongue, closer to the base, making it harder to diagnose without trained eyes.
Again, we have a shortened, tight, or restricted frenulum, but typically, the tip of the tongue can move freely. The mid-to-back of the tongue is anchored and does not move harmoniously.
Key Features of Posterior Tongue Tie
Tongue Click
The best way to visualize a posterior frenulum is to click your tongue. When you click, the tongue’s body is sealed against the palate. This placement will provide an easier view of the underneath of the tongue.
Additionally, this allows you to judge the posterior or back movements of your tongue. Can the back lift to seal? Or is it just the tip touching the roof of the mouth?
A tongue That Appears Free at the Tip But Lacks Full Mobility
Often a doctor will ask you to stick your tongue out when assessing for a tongue tie. The problem is with a posterior tongue tie the tip is free moving.
Therefore, the tip does most of the work, and compensations such as tongue thrust develop. When asked to stick your tongue out, sure you can do that. But that in no way assesses for a posterior tongue tie.
In fact, most posterior ties are missed due to the movement observed in the tip of the tongue.
Compensatory Movements
The back of the tongue should raise up to the palate and push back to swallow. When a posterior tie is present this is a difficult motion for the tongue.
Rather the tongue will thrust forward to move the food bolus. This thrust can push against the front teeth or slide between them. The teeth may have visual clues to this thrust pattern, as they may be jutting forward or there me be an overbite.
The jaw will also slide to compensate for the lack of tongue movement. The jaw, being a base of support for all oral-facial muscles has to move to support them. When the range of motion is hindered by a tie, then the jaw will slide forward, or glide left to right to assist the tongue in reaching its target.
Over time these compensatory movements wear down the TMJ area. Complaints of TMJ pain and signs of overuse are common among adults with posterior tongue ties.
Common Symptoms Anterior vs. Posterior Tongue Tie
If the tongue is hindered by an anterior or posterior tongue tie, there is limited range of motion and other health issues may arise.
Chronic jaw or neck pain
Due to the tie, also known as a tethered oral tie, pain can arise from overuse and compensation from other structures. The first direct line of pain will travel to the jaw and neck.
The jaw is being overused and the joint is wearing down as it tries to assist the limited range of motion in the tongue.
Physical therapists are the go-to referral for TMJ issues. The problem is that where they can address the joint, they are not trained in tethered oral tissues and often miss the underlying cause.
This results in therapy failure once the treatment period ends. The patient cannot maintain jaw control due to forces from the tether pulling it out of alignment.
When the jaw is out of alignment, the neck will follow it. The structure next in line is the neck. It is holding and supporting the jaw. Forward-head posture is common amongst tongue-tie adults, which places stress on the neck.
With this amount of disharmony noted we anticipate an impact on functional tasks such as swallowing and sleep.
Difficulty Swallowing
Both anterior and posterior ties will limit tongue mobility for swallowing tasks. The tongue is a dynamic muscle system, it is more than one muscle. Within the oral cavity, it can create unique shapes.
First, it can dip itself down in the mid-blade and create a tongue bowl. Then it can lift and spread the lateral edges out to contact the molars. Finally, it can produce a wave-like movement from tip to back to propel food down the throat.
Each of these unique movement patterns is hindered by a tongue tie, whether anterior or posterior.
Picky eating as a child, limited food repertoire as an adult, and feeling strained and tired when eating are all indications of tethered oral tissues.
Signs of Poor Sleep – Snoring or Sleep Apnea
Yes, our tongue has an important job while we sleep. It anchors onto the palate, allowing the airway to remain open for nasal breathing to be efficiently dominant.
When the tongue is tethered, it does not rest in the palate. It rests low in the mouth. The mouth may drift open due to this low placement of the tongue. Open-mouth breathing, day or night, is unhealthy for our bodies.
At night, this is more so true. The restorative sleep one needs overnight is not achieved when the tongue blocks the airway, or mouth breathing is dominant.
Snoring is one sign that the tongue is out of place. Apnea is another sign that years of disharmony are wreaking havoc on your health.
Adults with either anterior or posterior tongue ties often suffer in silence, unaware that their issues stem from this hidden restriction.
The good news is there is help for both types of tongue ties!
Surgical Release Anterior vs. Posterior Tongue Tie
Surgical release, or frenectomy, is a procedure used to free the tongue from its restrictive frenulum. For both anterior and posterior tongue ties, this intervention can dramatically improve function and comfort.
Types of Release
Laser Frenectomy: A minimally invasive option that reduces bleeding and healing time.
Traditional Scalpel Release: Often used for more complex cases requiring precision such as scar tissue from previous release.
A preferred provider is the key as a skilled surgeon will be able to successfully release the tether with any instrument. Largely we find that laser is preferred due to its speed and help in recovery.
At Tongue for life you can find state-by-state lists of providers to help you locate a preferred provider near you.
At Lynn’s Tied Together Hub, we emphasize the importance of pairing the surgical release with targeted therapies for the best results.
Myofunctional Therapy Anterior vs. Posterior Tongue Tie
Myofunctional therapy is a cornerstone of treatment before and after a surgical release. This specialized form of therapy focuses on retraining the muscles of the tongue, lips, and jaw to optimize function.
Benefits of Myofunctional Therapy
First, it prepares the tongue and surrounding muscles for release. There will be a significant amount of tension in the floor of the mouth where the frenulum attaches. There are muscles here supporting the tongue muscles.
Myofascial release is one technique under the myofunctional heading that helps to alleviate tension and pain. At Lynn’s Tied Together Hub, we recommended a general pain scale of 1-10 be assessed at each appointment.
When the patient can consistently report pain under 2/3 they are ready for a surgical release. We find that through a course of 6-8 weeks, pain typically reduces to zero or one on the scale.
Performing myofascial release is considered a passive exercise, one that is done to the muscle. It requires no volitional participation of that muscle. Active exercises are those that require the muscle to move on its own.
These exercises are best completed after myofascial release is performed. Exercises may target the tip of the tongue or the posterior tongue. They may require simple up-and-down patterns or more complex posterior side spread patterns.
Your therapist will determine the most beneficial exercises for you and provide a home program for daily completion.
Next, it prevents scar tissue formation and reattachment after surgery. It is important to keep the wound open if there are no sutures/stitches. Reattachment is a concern and scar tissue is a concern after surgery. Being confident in your exercise program will ensure that recovery is successful.
Finally, Myofunctional exercises help to improve breathing, swallowing, and oral posture. When optimal tongue placement and movement are achieved the impact on health is tenfold.
Combining surgical release with Myofunctional therapy ensures long-term success.
Summary Anterior vs. Posterior Tongue Tie
The distinction between anterior vs. posterior tongue tie is the location of the tether under the tongue. Either located anteriorly, close to the tip, or posteriorly located midway back.
A tongue tie, regardless of location, goes beyond visual appearance and directly impacts oral function and overall health.
From swallowing and digestive problems to TMJ dysfunction and headaches to sleep disorders such as airway obstructions and apnea.
Releasing a tongue tie, whether anterior or posterior, offers numerous physical, emotional, and functional benefits.
From enhanced speech clarity and confidence to relief from chronic pain, such as neck and jaw tension.
As well as improved breathing and sleep quality along with better digestion and reduced reflux symptoms.
By addressing anterior vs. posterior tongue tie, adults can unlock a better quality of life and live untied!
Tongue ties might be tethered oral tissues, but they don’t have to tether your life. Understanding the differences between anterior vs. posterior tongue tie and seeking the right interventions can lead to a world of improvement.
For more expert insights, visit Lynn’s Tied Together Hub and take the first step toward untangling your health.