Tongue function and its role in dental health is a hot topic at the moment.
Infant tongue-tie and its impact on dental, breathing, and sleep health have seen a recent spike in attention. The symptoms of an undiagnosed tongue tie can link to mouth breathing, poor sleep, sleep apnea, neck pain, digestive issues, and anxiety.
Many parents are seeking tongue-tie releases for their newborns to help a child to breastfeed. But what about those of us who didn’t get released earlier in life? Adult tongue-ties are a much less talked about procedure. There is now a growing group of health practitioners performing this procedure.
Adult tongue-tie release can be undertaken by dentists, oral surgeons, and ENTs.
Research in this field is limited due to it being a relatively new area of clinical focus. There is a need for clinical trials to measure outcomes vs risk of procedures. However, knowledge and experience of the potential health benefits of tongue-tie release is growing and far outweighs risks when carried out by an experienced practitioner. Many people are seeking adult tongue-tie release and seeing benefits.
I’ve written this blog to give you an overview of your options for oral restriction release.
I recently came across a case study on adult tongue-tie release. It’s useful because it describes the set of symptoms I often see in adults with tongue-tie. The patient is a Certified Practicing Speech Pathologist trained in orofacial myofunctional therapy.
Michelle’s story is one that many people may relate to and she has kindly shared her before and after tongue-tie experiences.
Tongue tie problems in adults
For one reason or another, tongue-ties became a lost part of the pediatric dentistry assessment. Midwives were known to clip a newborn’s tongue-tie at birth if spotted with a sharp fingernail. Retired pediatricians have reported a ‘thrive or die’ approach early in their careers. If newborns were found to have feeding or other issues they were routinely checked for tongue tie.
The second half of the 20th century saw a movement away from the practice of breastfeeding. It may have been caused by the rise of formula and bottle feeding, which together, made diagnosing a tongue tie as a long-lost art.
That means there are two to three generations that grew up with tongue-ties. It’s a large group of adults and could mean that you unknowingly have a tongue-tie.
Your tongue is such a crucial part of your body. The neuromuscular system is intertwined with the brain, digestive system, neck, spine, and teeth. To get an understanding, I recommend reading this blog on its role in breastfeeding and preventing braces.
Symptoms of tongue tie before surgery
Tongue tie symptoms in adults may be similar to those found in kids. But in adults, a tongue-tie may be underlying a broader set of conditions and diseases.
Let’s look at the tongue tie symptoms Michelle experienced.
Michelle had suffered symptoms all her life that may have been due to her life-long tongue-tie.
“I had a debilitating lack of energy. It was difficult to get through the work week. It would mean afternoon naps, and craving sugar to give her energy.
I was always a bad sleeper. This culminated in a diagnosis of snoring and obstructive sleep apnea. The sleep study showed an AHI (apnea-hypopnea index of 30).
I began CPAP treatment three years ago, of which brought my AHI down to 1-2. But it still didn’t make me feel rested.
CPAP helped a little bit, but I was still so tired that I could not entertain the idea of socializing through the week out of fear of losing sleep.
For most of my life, I had chronic neck and back pain. It would focus at a point on the right scapula and spread through the shoulder and thoracic area.
The pain also included my jaw joint. I had TMD which meant my jaw would open to the left and would click on the right 3 times and left 2. I’d wake in the morning with a sore jaw joint and I had chronic migraines.
The morning jaw pain was probably due to my teeth grinding at night. The daily mouth breathing seemed to give me sensitive teeth. I would often have a rush of tooth pain when I would drink cold water. I would go through a stick of lip chap in two weeks, on bad weeks it would be one because my lips were so dry during the day to which I now realize was due to mouth breathing.
In general, my sleep was light. I would wake with acid reflux and the feeling of ‘pressure.’ It would always be a struggle to get back to sleep, and this made a horrible cycle of being scared about being tired, and unable to sleep.
I was seeing a psychologist for anxiety.”
Michelle’s story is powerful because the symptoms are so common.
Here’s a summary of her symptoms before tongue-tie release:
- Brain fog, tiredness, lack of energy
- Frequent dry lips on a daily basis even though she used lip balm
- Waking up tired
- Afternoon naps
- Grumpiness and irritable
- Lisp as child
- Sleep apnea
- Chronic neck pain, back, and shoulder pain
- Jaw pain and audible jaw click and
- TMD on her right-hand side – she would wake up with sore jaw joints
- Childhood lisp
- Diet – food craving sugar
- Sugar cravings for energy
- Tooth sensitivity – rush of pain with water consumption
- Mouth breathing (air coming in on teeth)
- Teeth grinding
Am I Tongue Tied? How to identify oral restrictions
Does any of the above sound familiar? If you suffer any of these conditions, let’s go on to see a simple test that may reveal a tongue tie.
- Do a finger swipe under your tongue, is there a catch? It should be a smooth transition.
- Is there a visible flap of skin under the tongue? There should be no flap.
- Do you experience a strong gag reflex?
- Stick your tongue out, straight, now can you lift the tip without moving the rest of the tongue? You should be able to move the tip independently of the rest of the tongue.
- Open your mouth, as wide as it goes. Without moving or closing the jaw, can you reach the tip of your tongue to spot behind your upper front teeth? Your tongue should reach the spot behind your front teeth at FULL jaw opening.
- Can your tongue comfortably wipe across the outer sides of your upper and lower back teeth and reach where the gums connect with the cheeks?
- Can you move your lips side to side (lips closed) without moving the entire jaw? The lips should be able to move independently to the jaw. This may indicate a lip tie, which is a slap of skin between the lip and the gums inside the mouth. It’s similar to a tongue tie in that it can restrict full lip movement.
*There are other signs on the face and body that a well trained professional can assess as well as several related issues that stem from tongue restriction. These include airway, posture, and sleep and a practitioner can assess you beyond just appearance of the tongue.
Adult Tongue Tie Surgery Before and After
Before Tongue Tie Surgery
As a trained Orofacial Myofunctional Therapist, Michelle completed her own 8-week myofunctional therapy program surrounding her laser release. She worked under the guidance of Sandra Coulson from the Coulson Institute who she trained under. She then connected to the great team at Enhance Dentistry in Brisbane. The plan was that she would complete a further 2-week myofunctional therapy program before the release.
The general goals of myofunctional therapy are:
- Develop a nasal breathing pattern
- Correct rest posture of the tongue
- Guide closed lips resting position
The therapy includes using a sticky spot to help train the tongue to sit at the top of the mouth.
She reported the following benefits before tongue-tie surgery at week 4 of myofunctional therapy.
“I still found it uncomfortable to hold correct tongue posture. I was wearing four spots (spot, central upper, lateral) to encourage tongue posture on the roof of mouth but it was far too tight at the base of tongue and floor of the mouth.”
- Within 48 hours, she could perform nasal breathing comfortably while keeping the tongue to the spot
- Sleeping better, alert and better rested.
- Using less lip chap during the day as a result of using the spots indicating she breathing through her nose
- She had gained jaw stability and lip posture to keep the mouth together
- She reported waking up with tongue up with mouth open. Her lips and jaw didn’t have the strength to maintain a closed position, but she felt nasal breathing was occurring with the tongue up.
- She reported a soreness down the neck at the base of the skull. She attributes this to the tongue muscles straining to push the tongue up while her mouth posture was open.
- The rough rugae at the top of the mouth appear to have expanded. The skin appeared new due to tongue contact.
After tongue tie surgery
Michelle opted to have her oral restrictions released by laser.
“I had three releases (tongue, upper and lower lip ties) under the care of the amazing Dr. Marjan Jones (Dentist and director and The Tongue Tie Institute Australia) and her team. My 4 ties were submucosal tongue tie, clean-up of previously busted upper lip tie, lower lip tie and laser behind bottom front teeth. I chose to have a local anesthetic [as some patients choose topical anesthetic only]. I have since been under the Myofunctional guidance of the amazing Sarah Beach.
Of most interest to me was during the procedure, I could feel what I can only describe as ‘pings’ of muscle release as my TMJ tension, right middle scapula knife like pain, right side neck and middle of neck and shoulder right side pain all disappeared. Also noted immediately post release, TMJ has one small dull click, and my usual left deviation on opening was gone. My lateral neck twists extension could go past my shoulder (previously slightly in front of the shoulder.)”
Measurements before and after surgery
Before tongue-tie surgery:
Opening with tongue suctioned to palate: 20mm
Tongue on roof of mouth: 35mm
Max jaw opening mouth: 50mm
Lower lip measure: 16mm
Upper lip measure: 20mm
After tongue-tie surgery:
Opening with tongue suctioned to palate: 29mm
Tongue on roof of mouth: 43mm
Max jaw opening mouth: 60mm
Lower lip measure: 14mm
Upper lip measure: 21mm
Lisp and speech pathology:
As an experienced speech pathologist, Michelle was able to do a self-assessment of her lisp. She produced a dentalised /s/ whereby her tongue pushed downwards on the lower front teeth and a slightly muffed /s/ sound was produced as the airflow was directed forward.
Usually, an /S/ sound should mean the tip of the tongue just comes off the top of the palate. Michelle was unable to correctly produce /s/ sound in this position prior to the tongue tie release. A tongue-tie may result in not being able to achieve correct tongue placement resulting in a ‘lisp’.
There are four types of lisp: Michele identified here own lisp. As an example here is two types of lips.
Interdental: ‘TH’ sound, where the tongue pokes through the teeth.
Lateralized lisp: where air flow comes out the side of the teeth.
Michelle’s own analysis describes the lack of control of the tongue’s side muscles. These are important hold the tongue in position whilst slightly releasing the tip of the tongue for correct airflow to make a /s/ sound. A tight lingual frenulum pulls the tongue and changes the shape of it for an /s/ production.
Four weeks after tongue-tie surgery – The remarkable recovery
Michelle’s life changed significantly after her tongue-tie surgery.
“My sleep length time improved straight away. I can now sleep 7 ½ hours to 8 hours on CPAP. There are still waking periods but can get straight back to sleep. Before I could never get to sleep.
I notice I can keep my mouth closed through the day. I use less paw-paw ointment on my lips because I’m not mouth breathing during the day. There is no longer need for afternoon naps, and I have plenty more energy and feel alert in the evenings. I can socialize through the week which I had not done for years.
My gut issues decreased, reflux has settled which I think was contributing to my night time waking.
I feel the front part of the tongue fits into my palate. At the back feels a bit crowded. My posture has improved; I can now get myself into straight posture before my neck begins to hurt. The back and neck pressure released almost immediately after the tie. My teeth clenching appears to have stopped (I need to confirm this) and my tooth sensitivity has ceased.
There have been no headaches or migraines, since the release. They have completely resolved.
I feel much calmer as a person. For instance, I burnt my hand, instead of panicking I put my tongue up and felt calm. I no longer feel anxious, and I have postponed my psychology sessions.
I’ve also lost 5 kg since the procedure. I don’t feel the cravings and dependence on sugar for energy.
My life has changed significantly since having the release. I would recommend anyone who thinks they may have a tongue-tie to investigate further.
I am continuing working with Sarah from Enhance Dentistry with an Orofacial Myofunctional Therapy program to achieve my goals. Most excitingly I can now produce /s/ and /z/ sounds with tongue in correct position.”
Tongue tie surgery recovery time
Generally, the wound can take between 2-7 days to heal. Post-op pain is common after the surgery. Michelle reported very little post-op pain. She took a course of codeine-panadol painkillers before treatment, 6hrs after and 6 hours after tongue tie surgery.
Some patients report significant soreness post op for weeks after surgery.
Tongue tie surgery types for adults
This treatment can be carried out without needing to have General Anesthetic and options are:
- Release of the frenum by laser with local anesthic or with topical anesthetic (gel) only
- Release of the frenum with scissors and local anesthetic.
- Release by electrocautery using a local anesthetic.
Tongue tie surgery complications
- Recurrence of lingual frenum can occur, especially in growing children. This may mean a revision is necessary in certain cases.
- Damage to surrounding structures of the floor of the mouth may end up in vessel or nerve damage. Always consult with your practitioner regarding potential risks and complications before surgery.
What is the cost of tongue tie surgery for adults?
Prices generally vary between $300-1200 for depending on the level of support and lead up treatment. A general anesthetic will increase the procedure cost significantly.
You can watch an adult tongue-tie release video with the team at Enhance Dentistry Brisbane below:
Do you have a question regarding adult tongue-tie release? Have you had the procedure performed? Leave your experiences in the comments below.
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