I’m a speech and language pathologist, and also a mom of 2.  When my youngest son Miles wasn’t meeting speech milestones we started to explore contributing factors. It turns out he had a tongue tie and a lip tie! This topic hits close to home as a mom AND a speech therapist, and I want to share my experience with you.

My personal experience

My 17-month-old, Miles,  had not been making any ‘t’ or ‘d’ sounds and I never saw his tongue lift up. I had a speech therapist friend come evaluate Miles and see what she thought.  she recommended I take him to a pediatric dental specialist to get him evaluated for a tongue tie, Ankyloglossia. He had already been evaluated for a tongue tie at the pediatricians office and they said he did not  have one. He never had problems with feeding, sleeping, and he was not a fussy baby. I decided it never hurt to get him evaluated again. Before doing so, I had his 18-month checkup at the pediatrician’s office, where I had the pediatrician check him for ankyloglossia again. Yet again, she did not find a tongue tie.
I wanted to get a second opinion and my friend recommended Dr. Kirk Kollmann at Dentistry for kids. He was amazing. He was very gentle, well spoken, and knowledgeable. He examined Miles and sure enough he had a class 2-3 anterior posterior tongue tie and he also had a lip tie! Honestly, I was surprised, but not shocked. I was happy I took him for a second opinion. Kids Dentistry was great and said they could perform the frenectomy (tongue tie release procedure) on the same day.

The procedure

They wrapped Miles up in a swaddle, gave him some local anesthetic, and used a laser to clip his tongue and lip ties. The team was sweet and nurturing and took good care of him. He was given back to me a few minutes later, he hugged me tight, and then returned to his normal self almost instantly. We went grocery shopping afterwards and I gave him Ibuprofen for a couple of days and he was fine. I performed some oral exercises on the area that was clipped a few times a day and we went back a week later to get it re-checked.

The results

It is now November, 2018, and Miles is doing much better. He has more range of motion and coordination of his tongue. He is able to elevate his tongue and make consonants that originate at the alveolar ridge, the space right behind the two front teeth, like /d/,/t/ and /n/.  I am not quite sure how much the tongue tie set him back in his speech development. He never displayed any symptoms of the tongue tie except for the inability to make certain sounds and the inability to lift his tongue from the floor of his mouth, which was hard to notice in such a young child. I hope he continues to increase his ability to make sounds and gain tongue strength and coordination in the future.

What is a tongue or Lip Tie (restrictive frenum)?

A frenulum, a small frenum, is a narrow fold of mucous membrane connecting a moveable part to a fixed part. The lingual frenulum is generally under the mid-portion of the tongue. It can help to stabilize the base of the tongue. With ankyloglossia, the lingual frenulum has an anterior or posterior attachment. This causes adhesion of the tongue tip to the floor of the mouth and can result in restricted tongue movement.

Signs or Symptoms of Ankyloglossia
The diagnostic characteristics of ankyloglossia are not always easy to detect.

• Inability to stick the tongue out far.
• Because the tongue is tied down it becomes notched at the midline, and can result in a heart-shaped edge.
• The patient may be unable to touch the roof of the mouth with the tongue tip when the mouth is open.
• Excessive wetness or drool in the oral cavity or mouth.
• Attachment of tongue onto the tongue floor and/or floor of the mouth.
• A family history of ankyloglossia.
• Speech imprecision, they may have a lisp.
• Orthodontic concerns.
• Mouth breathing.
• They patient may have an interdental swallow, swallowing with the tongue in-between the teeth.
• While eating food, bolus, may be scattered due to reduced range of motion and coordination of the tongue.

Functional Effects of a Tongue Tie
• Feeding problems and difficulty with breastfeeding: Newborns with ankyloglossia may have trouble latching onto a nipple for sucking but the majority have no early feeding problems. As a child gets older ankyloglossia can cause difficulty with bolus control and clearing solids out of the mouth, which can lead to tooth decay and cavities.
• Speech: Ankyloglossia can cause speech deficits in articulation. If the movement of the tongue is restricted children may not be able to make all speech sounds and this can result in an articulation or phonological disorder.
• Dental: It can cause dental issues.
• Cosmetics and personal interactions: If someone looks different, talks different, and has breathing, swallowing, or dental issues it can take a toll on one’s self esteem.

Ankyloglossia and Speech
Whatever speech problem is occuring, it is being impacted by the ankyloglossia. The speaker is not being maximized to their best potential. If the movement of the tongue is restricted children may not be able to make all speech sounds and this can result in an articulation or phonological disorder. People with ankyloglossia may have difficulty with:
• Connected speech and rapid, loud, and whispered utterances
• Phrasing
• Voice quality
• Sentence length in spontaneous speech
• Consistency under different conditions of speed volume prolonged utterance
/l/, /s/, /z/, /th/, /n/, /t/, /d/, and /r/ sounds

What I learned: I learned that speech and language pathologists are the professionals responsible for diagnosing ankyloglossia. We are also the professionals who make recommendations to get them clipped. I have taken continuing education courses on ankyloglossia since Miles was diagnosed with one and I now feel comfortable diagnosing ankyloglossia and treating children who have had it. We are constantly learning!

I also had Ankyloglossia: I had ankyloglossia. I did not have a frenectomy until 7th grade. It did not affect anything! I could speak just fine. I could not stick out my tongue very far and my girl friends teased me and said i would never be able to french kiss. My dentist was the one who finally recommended I got it clipped. I remember going to see a dental specialist, had some local anesthetic, and it was done. I got to eat ice cream afterward and I was fine. Now, I can stick my tongue out pretty far and have full range of motion.

My stance on Ankyloglossia: Get a frenectomy, get it clipped. Why would you want your child to have reduced range of motion of their tongue? It is a simple outpatient procedure, babies require no anesthetic. Without a frenectomy many problems and symptoms may occur. These symptoms and problems are life lasting and can be avoided. Maximize your child’s potential by releasing their tongue.

What is a Lip Tie?

Upper lip-ties refer to the band of tissue, frenum, that attaches the upper lip to the maxillary gingival tissue (upper gums) at midline. Although most babies should have a frenum that attaches to some degree to the maxillary arch, the degree of restriction varies.

Functional Effects of Lip Ties:
• Breastfeeding and Bottle Feeding: Inadequate latch on a mother’s nipple. This can lead to fussiness, a callus on the baby’s upper lip, and painful nursing.
• Bottle Feeding: Inadequate Seal on the bottle nipple.
• Breastfeeding and Bottle Feeding a baby with a lip tie can cause other Symptoms to occur:
 Gassiness or fussiness, Treatment for gastroesophageal reflux disease, Fatigue resulting in falling asleep at the breast
, Discomfort for both baby and mother, resulting in shorter feedings
, Need for more frequent feedings, Poor coordination of suck, swallow, breathe patterns, Inability to take a pacifier.
• Lip ties can also cause increase difficulty with spoon feeding, finger feeding, and oral hygiene and dental issues.

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References:
1. Ankyloglossia: To Clip or Not to Clip? That’s the Question. The Asha Leader. December 01.2005.Volume 10. https://leader.pubs.asha.org/article.aspx?articleid=2278327)
2. Holtzman, Sandra, MS, CCC-SLP. (Northern Speech Services.)Tongue Tie 101 For SLPs: What Is Our Role?
3. Just Flip the Lip! The Upper Lip Tie and Feeding Challenges. (ASHA Leader.)March 10, 2015. Potock, Melanie MA. https://blog.asha.org/2015/03/10/just-flip-the-lip-the-upper-lip-tie-and-feeding-challenges/