What is Tethered Oral Tissue? Tongue-tie & More
Tethered oral tissue is a condition characterized by the presence of a piece of connective tissue that restricts the normal range of motion of the tongue, lips, or both.
This connective tissue, known as a frenulum, is usually present in everyone but may be abnormally short, thick, or tight in individuals with tethered oral tissue.
There are three main types of tethered oral tissue:
Tongue tie
Labial (lips) tie
Buccal (cheeks) tie
Let’s review each type of tethered oral tissue.
TONGUE-TIE
Tongue tie, also known as ankyloglossia, is a condition in which the thin piece of tissue that connects the underside of the tongue to the floor of the mouth (called the lingual frenulum) is shorter or thicker than usual, which can limit the movement of the tongue.
This can affect facial development, feeding, breathing, and speech in different ways.
Facial Development - Tongue tie can affect facial development by hindering the tongue's ability to rest on the roof of the mouth, leading to a high and narrow palate. The absence of static pressure on the palate can impact jaw and face growth, resulting in airway and dental problems.
Breastfeeding Difficulties - Tongue tie can cause difficulty with breastfeeding because it can interfere with the baby's ability to latch on properly and transfer milk sufficiently, leading to pain and frustration for both the baby and mother. This can result in poor weight gain and inadequate nutrition for the baby. The restricted movement of the tongue due to the tight or restrictive frenulum can prevent the baby from forming a good seal around the nipple and properly stimulating milk production. Tongue tie can also cause the baby to tire easily during feedings and may require frequent feedings to get enough nutrition.
Chewing Difficulties - Tongue tie can cause difficulties with chewing because it can limit the mobility and range of motion of the tongue. The tongue is an important muscle that helps move food around in the mouth, mix it with saliva, and position it for swallowing. When a person has a tongue tie, the frenulum (a piece of tissue that connects the tongue to the floor of the mouth) is too tight or restrictive, which can prevent the tongue from moving freely and fully. This can make it difficult to chew and break down food properly, leading to digestive problems and potentially malnutrition. Additionally, people with tongue tie may compensate by using their cheeks or lips more during chewing, which can cause excessive wear on the teeth and lead to dental problems over time.
Speech Difficulties - The tongue plays a crucial role in speech production by shaping sounds and controlling the flow of air through the mouth. When a person has a tongue tie or other tongue-related issue, it can impact their ability to properly articulate certain sounds, resulting in speech difficulties. For example, a person with a tongue tie may have difficulty producing certain consonant sounds that require the tongue to be raised, such as "t," "d," "n," and "l." This can lead to a lisp or other speech impediment. Additionally, a person with a tongue tie may have difficulty with more complex sounds that require more intricate tongue movements, such as the "r" sound.
TMJ Difficulties - Tongue tie can also have an impact on the temporomandibular joint (TMJ), which is the joint that connects the jawbone to the skull. When a person has a tongue tie, it can cause the tongue to rest in a low position, which can cause the jaw to be held in an incorrect position. This can lead to tension and stress on the TMJ, potentially resulting in pain, clicking, or popping sounds when opening or closing the mouth, and even headaches. Additionally, compensatory movements of the jaw, such as excessive clenching or grinding of the teeth, can also contribute to TMJ issues.
LABIAL TIE
A labial tie is a condition where the tissue connecting the upper lip to the gums is too tight or restrictive, causing limitations in lip mobility. This can have a negative impact on oral resting posture and feeding.
When the labial tie is present, the upper lip may be pulled inwards and downwards, making it difficult to maintain proper oral resting posture with the lips resting together. This can lead to an open mouth posture and cause the tongue to rest in a low and forward position, leading to a cascade of negative effects on the growth and development of the jaw, airway, and face. Inadequate lip closure can also lead to mouth breathing, which can further exacerbate these issues.
Feeding can also be affected by a labial tie. Infants may have difficulty latching onto the breast or bottle, leading to poor weight gain and inadequate nutrition. This can cause frustration for both the infant and the caregiver. Additionally, a labial tie can interfere with the infant's ability to create and maintain suction while feeding, leading to further feeding difficulties.
Lastly, a labial tie can impact chewing and swallowing by restricting the mobility and range of motion of the lips. The lips play an important role in chewing and swallowing by helping to keep food in the mouth, positioning it for proper chewing, and sealing the mouth during swallowing. When a person has a labial tie it can limit the ability of the lips to move and function properly. This can make it difficult to chew and break down food. Additionally, a labial tie can cause a person to compensate by using other muscles in the face, such as the cheeks, to help with chewing and swallowing, which can lead to overuse and strain on these muscles and contribute to the development of OMD.
BUCCAL TIES
Similar to labial ties, buccal ties can also contribute to OMD. Buccal ties occur when the tissue connecting the inside of the cheek to the gums or teeth is too tight or restrictive. This can limit the mobility and range of motion of the cheeks and lips, which are important muscles involved in chewing, swallowing, and speaking.
In order to compensate for the restricted movement, a person with a buccal tie may alter their oral resting posture or use other muscles in the face to complete oral tasks. This can lead to improper positioning of the tongue and teeth, causing dental problems such as malocclusion and teeth grinding. It can also impact the development of the jaw and airway, potentially leading to breathing difficulties and sleep apnea.
Additionally, buccal ties can impact feeding, as it can make it difficult for babies to form a proper seal around the nipple while breastfeeding, causing pain and frustration for both the baby and the mother. It can also lead to poor weight gain and inadequate nutrition.
