A tongue tie or ankyloglossia is when the small string of tissue under the tongue (frenum) doesn't degrade properly during development and is tighter or shorter than it should be. With this restriction the tongue loses its mobility, is unable to move freely to function properly, and is forced to sit low in the mouth. The body does its best to compensate for these lingual restrictions in order to chew, swallow and speak as well as possible, despite the reduced mobility. Ultimately, tongue ties will contribute to OMDs and can result in the symptoms listed above.
Tongue Posture: (One of the main indicators of OMDs)
A low-resting tongue occurs when the tongue sits low in the mouth, either in the front or back. Three factors typically contribute to a habitual low-resting tongue: genetic abnormalities (tongue-tie), habits (finger/thumb sucking), or airway issues (chronic congestion). Anything that forces the tongue low can contribute to the following symptoms:
- mouth breathing
- tongue thrust swallowing patterns
- ear infections
- stomach aches
- crowded teeth
- narrow dental arches and facial features
- sinus issues
- speech problems
- orthodontic relapse
- jaw pain
- headaches or migraines
- neck pain
- sleep disordered breathing or sleep apnea
When the tongue is low in the mouth, the head tends to rest in a forward position and the shoulders tend to roll forward affecting the cervical spine and posture. Ideally, the tongue should rest in the roof of the mouth providing support for the upper jaw, which is the floor of the sinus. Because a low resting tongue posture becomes habitual in nature, just removing the source of the problem (fingers, tongue tie or tonsils and adenoids, for example) doesn't solve the problem in entirety. This is the goal of myofunctional therapy: to eliminate habits and restore proper muscle function so muscles of the lips, tongue and jaws rest and work together correctly.
Tethered Oral Tissues: (TOTS)
Lips and cheeks also have frenulum that can be tight or short, consequently affecting speech, chewing, and swallowing. If any of the frenula in the lips, cheeks or under the tongue are restricted, they are considered a tethered oral tissue.
What is the Treatment for Tethered Oral Tissues? (TOTS)
Treatment for tethered oral tissues depends on the degree to which functions are restricted and the severity of symptoms. When myofunctional therapy alone cannot retrain the tongue and brain so the muscles of the tongue can function and rest properly, surgery is recommended. Releases of TOTs can be done with a laser or with scissors, and both require exercises before and after surgery so the tissue does not reattach. Wound constriction is a normal process of wound healing, and myofunctional therapy helps prevent long term constriction.
Oral Habits (Such as Thumb/Finger Sucking)
Sucking on fingers, thumbs, clothes, or hair and biting on nails, pencils and other items can all either indicate or contribute to an existing myofunctional disorder (as can extended and frequent use of bottles and pacifiers). These habits force the tongue into a low position, creating a low resting tongue posture, thus contributing to the previously listed symptoms. The goal of OMT is to retrain the tongue to sit on the roof of the mouth and achieve complete closure of the lips so the jaws can form properly. This allows the teeth to come in normally.
A tongue thrust occurs when the low resting posture and other dysfunctional muscle movements of the lips and cheek cause the tongue to push forward against the teeth during the swallow. A tongue thrust can affect the position of the teeth during development, complicate orthodontic treatment, or cause orthodontic relapse. A tongue thrust can also be a symptom of underlying airway problems. Often times, open mouth resting posture and mouth breathing go hand-in-hand with tongue thrust swallowing patterns. Signs of a tongue thrust include:
- mouth breathing
- forward tongue that is visually resting between the front teeth
- front teeth that do not come together (open bite)
- excessive lip and chin movement or head bobbing during the swallow
- sucking habits (which cause the tongue to rest low in the mouth and subsequently stay habitually low during the swallow)
Correct oral resting posture is critical to the function of the tongue and proper development of the sinuses and airway spaces. Therefore, it is important to address any factor that results in mouth breathing. Cold, unfiltered air enters our bodies when we bypass the nose and breathe through the mouth. This can disrupt the homeostasis between oxygen and carbon dioxide, contributing to further health problems. Chronic mouth breathing can contribute to the following:
- development of long and narrow facial features (long face syndrome) in children
- gingival inflammation
- periodontal disease
- bad breath
- dry mouth (which can lead to decay)
- enlarged tonsils and adenoids
- sleep disordered breathing (snoring and sleep apnea)
Nasal breathing is essential. It naturally humidifies, filters and warms the air entering our bodies. Nasal breathing also creates nitric oxide, which is a potent vasodilator, natural antimicrobial, and blood pressure regulator. Other health benefits of nitric oxide include improved oxygen absorption and blood vessel maintenance, reducing the potential for cardiovascular disease and stroke. If nasal breathing is impossible or reduced, the benefits of nitric oxide can be missed.