Tongue tie (ankyloglossia) and lip tie are congenital conditions where restrictive frenula impact oral functions, often leading to significant health concerns. These conditions frequently co-occur, affecting breathing, sleep, facial development, and overall quality of life. Understanding the connection between tongue tie and lip tie is essential for proper diagnosis and treatment.
Prevalence and Co-occurrence: What does the research Say About Tongue Tie and Lip Tie?
The prevalence of tongue tie is estimated between 4% and 10% of the population, though some studies suggest higher rates due to increased awareness and improved diagnostic methods. Lip tie often accompanies tongue tie, although exact co-occurrence rates remain under investigation.
Research suggests that both conditions have a genetic component and are more common in males than females.
While some research is considering the co-occurrence most focuses on the primary concern of tongue tie:
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Dydyk, A.; Milona, M.; Janiszewska-Olszowska, J.; Wyganowska, M.; Grocholewicz, K. Influence of Shortened Tongue Frenulum on Tongue Mobility, Speech and Occlusion. J. Clin. Med. 2023, 12, 7415. https://doi.org/10.3390/jcm12237415
This research supports the findings that when a tongue has restricted movement it will directly impact many functions. In the discussion, the authors stated:
“The present findings are consistent with previous studies referring to the influence of ankyloglossia on primary tongue functions, such as tongue mobility, eating, drinking, speech, as well as on malocclusion (including distal occlusion, mesial occlusion, crossbite, open bite and crowding) [20,27,28,29,30,31]. However, no relationship between short tongue frenulum and periodontal disorders in the region of the lower central incisors found in the present study is contrary to case reports published in the literature [32]”
However, a growing interest in the co-occurrence of both Tongue tie and lip tie is emerging in our infant and childhood populations:
Lip Tie
Here the authors look directly at lip tie:
https://www.sciencedirect.com/science/article/pii/S1761722722000304
They concluded, “Frenectomy is associated with cosmetic and oral hygiene benefits and, when performed properly, does not impede diastema closure and may aid closure.”
Diastema is the space created between the top two front teeth.
Do the Professionals Agree on Tongue Tie and Lip Tie Occurrence and Management?
The short answer. NO. Let’s take a look at this article in which some of the top Doctors in the profession of tethered oral tissue management dive into consensus or lack of.
Ghaheri BA, Tylor DA, Zaghi S. Lacking Consensus: The Management of Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020 Nov;163(5):1064. doi: 10.1177/0194599820937299. PMID: 33137275.
https://pubmed.ncbi.nlm.nih.gov/33137275
Even well-respected doctors still fight for acknowledgment of this very real condition. The review is summarized as follows:
“We would like to commend the authors on their effort to develop a Clinical Consensus Statement (CCS) on ankyloglossia in children.
1 It was necessary and important for the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) to recognize ankyloglossia as a significant medical condition that otolaryngologists should diagnose, treat, and study. The CCS is a description of the opinions of an invited expert panel of pediatric otolaryngologists, but it suffers from a high degree of confirmation bias.
We are concerned that most will come away with a skeptical view of a very real issue, much to the detriment of vulnerable mother-infant dyads and other patients who look to us for help and healing.”
Evidence-Based Wheel
To better understand the balance between patient experience and research we can view the Ven diagram of the evidence-based model. Notice the very real and important pieces of evidence on this wheel. We have practitioner wisdom, and family experience & insights.
When research begins it is in these two very important pieces of evidence. The therapy setting is the place where results, or lack of occur.
The whittling down of the patient’s experience and over-reliance on research papers may be a disservice to patients.
As there is an obvious gap in consensus on the topic of tongue tie and lip tie, is it any wonder so many people reach adulthood with tethers still intact?
Adults have now suffered years of imbalance and will require quite a bit more therapeutic intervention than an infant or young child.
Which makes it even more important to locate a preferred provider when launching yourself on this journey. We like the website Tongue Tie Life for its comprehension state-by-state list of providers who specialize in tethered oral tissues.
What signs and symptoms might you be experiencing as an adult with tongue tie and lip tie? Let’s check that out!
Symptoms and Signs of Tongue Tie and Lip Tie
- Speech articulation challenges/ Speech fatigue
- Mouth breathing
- Snoring and sleep-disordered breathing
- High, narrow palate
- Orthodontic issues, including malocclusion
- Frequent headaches and tension in the jaw or neck
- Teeth grinding
- Daytime sleepiness
- Poor focus
- Anxiety/ mood disorder
Impact on Breathing and Sleep
The tongue plays a crucial role in maintaining an open airway. When a tongue tie restricts movement, it may contribute to improper tongue posture, leading to mouth breathing and airway obstruction.
Meanwhile, lip tie prevents the lips from easily closing and resting together. This also adds to the open mouth position and mouth breathing.
Over time, this may result in conditions such as:
- Obstructive Sleep Apnea (OSA): Tongue restriction can cause airway collapse during sleep, increasing the risk of OSA. While lip restriction prevents closed lips.
- Snoring and Sleep-Disordered Breathing: Poor tongue/ lip posture and mouth breathing disrupt airflow, leading to fragmented sleep and reduced oxygen intake.
- Chronic Fatigue: Inadequate sleep due to airway obstruction may lead to daytime drowsiness, difficulty concentrating, and increased health risks.
The Link Between Mouth Breathing and Facial Development
Mouth breathing due to tongue tie and lip tie can significantly impact craniofacial growth. The continuous open-mouth posture can lead to what is commonly known as “long face syndrome.”
Characteristics of Long Face Syndrome:
- Elongated facial structure
- Dark circles under eyes
- Narrow dental arch
- High, arched palate
- Jaw misalignment
- Increased risk of temporomandibular joint (TMJ) dysfunction
- Open mouth posture at rest
- Recessed jaw
Myofunctional and Myofascial Interventions for Tongue Tie and Lip Tie
Myofunctional therapy and myofascial release are essential tools for addressing the dysfunctions caused by tongue tie and lip tie. These interventions can help correct oral posture, enhance breathing, and optimize post-surgical outcomes.
Myofunctional Therapy
Myofunctional therapy involves targeted exercises that strengthen the muscles of the tongue, lips, and face. Key benefits include:
- Retraining the tongue for proper oral posture
- Encouraging nasal breathing
- Supporting correct swallowing patterns
- Preventing reattachment after a frenectomy
Oral Motor Exercises for Lip and Tongue
According to research and resources from Lynn’s Tied Together Hub, the following exercises can help improve tongue and lip mobility:
Tongue Lifts: Gently lift your tongue including the back section to the roof of your mouth and hold for a few seconds. Build to a one-minute hold.
Tongue clicks – building up to 50 strong clicks making sure the back of the tongue is sucked up into the palate.
Tongue lateralization – touching back bottom molar with tongue tip alternate left-to-right building to 50 reps and increasing speed. The jaw should remain still and not rock side to side with tongue movements.
Tongue up and down alternating- touch just behind the front teeth top then bottom row, building to 50 reps and increasing speed. The jaw should remain still and not glide up and down with the tongue movements.
Tongue lift and hold -hold the tongue up squeezed into the palate while opening and closing the jaw -build to 50 reps and increase the width of the jaw opening.
Lip purse/smile – alternating the movements while holding the jaw still. Build to 50 reps.
Lip squeeze – hold a tongue depressor between the lips and pucker just a bit. Hold for 15-20 seconds repeat 3-5 times.
Lips on the straw tip -keep them pursed no rolling inward -drink 4-6 ounces without biting straw or rolling lips inward.
Myofascial Release
Myofascial release techniques can help alleviate muscle tightness and restrictions caused by tethered oral tissues. These techniques include:
- Gentle manual therapy to release tension in the tongue, jaw, and neck
- Exercises to improve tongue and lip mobility
- Integration with chiropractic or osteopathic care for holistic treatment
When we address the specific regions of the frenulum tethered at their site of insertion into the gum ridge, we release bound fascia.
Fascia is a thin layer of connective tissue that surrounds and supports muscles, organs, blood vessels, and nerves throughout the body. Think of it as a web-like network that holds everything together, providing both structure and flexibility. Fascia has three primary layers—superficial, deep, and visceral—each with different roles.
Fascia is key to healthy movement and stability, but it can become restricted or tight due to oral ties, injury, stress, or repetitive strain, leading to pain and limited mobility. For our purposes, we are focusing on superficial and deep fascia within the orofacial structures.
By providing myofascial input to the muscles and soft tissue we allow for better performance on an active exercise. The exercises listed above are considered active exercises. While myofascial technique would be a passive exercise, meaning there is no volitional movement demanded of the muscle.
The Role of Surgical Release (Frenectomy) In Tongue Tie and Lip Tie
When myofunctional therapy alone is relied upon to improve function, you risk eventually gravitating back into old patterns once the exercises are not performed regularly.
Therefore, we begin with a myofunctional program, then surgically release the frenulum in a Frenectomy or Frenuloplasty. This procedure involves releasing the restrictive frenulum to restore the full range of motion.
This procedure is quick, taking about 10-15 minutes in an office setting. Typically, a laser is used as this technique will seal as it cuts lessening healing times and reducing the chance of infection.
Post-Frenectomy Care
To ensure long-term success, post-surgical care must include:
- Myofunctional therapy to retrain tongue and oral muscles
- Active wound management to prevent reattachment
- Ongoing monitoring by healthcare professionals
Typically, the wound heals in 10-14 days. The first 2-3 days are the toughest for adults as there can be swelling and some slight difficulty with slurring of words.
Adults report a great sense of tension reduction post-release through their bodies and oral-facial structures.
Conclusion Tongue Tie and Lip Tie
Tongue tie and lip tie are interconnected conditions that can significantly impact breathing, sleep, and facial development.
Research hasn’t yet fully caught up with patient and therapist experiences in the treatment sessions.
It’s encouraging that more research is forthcoming and the links between tethered oral tissues, such as tongue tie and lip tie, are becoming more widely acknowledged and treated.
Addressing these issues through a combination of surgical intervention, myofunctional therapy, and myofascial release can lead to improved health outcomes. Early diagnosis and a multidisciplinary approach ensure that patients achieve optimal oral function and overall well-being.
For more information on tongue tie and lip tie please check out our other blog articles at https://lynnstiedtogetherhub.com/blog/.