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Tongue Tie

The lingual frenulum is a band of connective tissue that covers the floor of the mouth and undersurface of the tongue. It is most obvious when you lift the tip of your tongue to touch the roof of your mouth. In the womb, most of this frenulum is supposed to dissolve, leaving just enough to cover the structures underneath. When the frenulum doesn’t dissolve and tethers the tip of the tongue to the floor of the mouth it is called “tongue tie.”

Tongue tie is a specific diagnosis that occurs in at least 4-10% of the population. It looks like a string or band of tissue that connects 75-100% of the tongue to the floor of the mouth, often resulting in a heart shaped tongue tip. Despite what you may have been told, tongue tie never stretches. In fact, it gets thicker. And because of its intimate relationship with the other structures of the head, it can permanently affect the shape of the palate, tongue, jaw, and teeth if it is left in place.  It can therefore result in a whole slew of issues, including speech problems, trouble moving food around, dental crowding, difficulty sticking out the tongue, jaw tightness, quiet speech, etc.

Very often, tongue tie causes gape restriction, which results in painful nursing and poor milk transfer. Releasing the tongue tie improves the gape and therefore improves nursing. All tongue tie should be corrected as early as possible.

But not all tongue tie causes gape restriction. In other words, there are some babies with obvious tongue tie who seem to nurse just fine while others with very little frenulum cannot nurse. This has lead to a coining of the term, “posterior tongue tie” in the breastfeeding community.

Posterior tongue tie

“Posterior tongue tie” has been described as a thick band of tissue that tethers the tongue in the same way as a more visible anterior frenulum. However, this type of description has led to a lot of confusion for several reasons.

  1. Simply looking in a baby’s mouth, you cannot diagnose posterior tongue tie because everyone has a frenulum. The diagnosis was created to account for babies who have the same symptoms as those with tongue tie, but without the tongue tie.
  2. The tongue is not the only factor. There are many other structures involved in the baby’s ability to gape, such as the jaw, palate, oral muscles, esophagus, and larynx.
  3. The real issue is the baby’s inability to gape normally. The relative position and tethering of the tongue is just one factor. Correcting the gape releases the baby’s head and neck structures and resolves the symptoms.