Tongue-Tie Tips #2

This week, we’re going to talk about symptoms a tongue-tie can cause. Did any of you check for restricted tongues on your patients last week? It’s crazy what you will find once you ask the patient to lift the tongue instead of stick out the tongue!

Many of these symptoms were determined after seeing countless patients report relief of these issues after a tongue-tie release, and these have now been reported in peer-reviewed articles on the subject, attached below. We use this form for screening children and adults (and it can work for screening infants as well). We will go into greater depth of infant issues, child issues, and adult issues in future pearls.

I used to think the main issues resulting from a tongue-tie were speech and difficulty licking an ice cream cone, as that’s what we were taught in school. That’s so far from the truth!

So to screen for the most common patient issues, we use this form, the Tongue Restriction Questionnaire. If a patient has one or two of these symptoms, and a Grade 1 or 2 tongue (from last week), it’s probably not a tongue-tie issue, and there’s nothing to do. If it ain’t broke, don’t fix it.

BUT if there are 3, 5, or 8 checkmarks of issues, and a restricted tongue, Grade 3 or 4, or even what appears to be a normal tongue at Grade 2, but they have lots of issues, it’s worth further evaluation. We’re submitting a paper on this new screening tool, and a revised version soon for publication, but I wanted to share it with you here first.

Here are the most common symptoms seen with a tongue-tie (tongue restriction).

Common Infant Issues:

• Painful nursing or shallow latch
• Difficulty bottle-feeding
• Slow or poor weight gain
• Reflux or spitting up often
• Excessive gassiness or fussiness as a baby
• Prolonged feeding time at the breast or on the
  bottle
• Milk dribbling out of the mouth when eating
  Clicking or smacking noise when eating

  Child to Adult Issues

• Frustration with communication
• Trouble with speech sounds, hard to understand, or
  mumbling
• Speech delay
• Slow eater or trouble finishing a meal
• Picky eater, especially with textures (e.g. meat,
  mashed potatoes)
• Choking or gagging on liquids or foods
• Spitting out food or packing food in cheeks
• Crooked, crowded teeth, or high arched palate
• Thumb or finger sucking or prolonged pacifier use
• Restless sleep (kicking or moving while asleep)
• Grinds teeth at night
• Sleeps with mouth open
• Snores (quiet or loud)
• Jaw joint (TMJ) issues (popping, clicking, or pain)
• Frequent headaches or neck pain
• Mouth breathing during the day
• Enlarged tonsils and/or adenoids
• Recurrent ear infections
• Frequent sinus issues/upper respiratory infections
• Hyperactivity or inattention

Again, just a child having enlarged tonsils, or lots of ear infections, probably not a tongue-tie. But many kids with tongue-ties do have a low resting tongue posture, predisposing them to mouth breathing, and subsequent tonsillar enlargement from microtrauma to the tonsils. The tongue rests down, so the palate is higher arched (the tongue provides support for the palate during development), and the septum is often deviated leading to sinus issues.

Tongue-tied kids have decreased tongue mobility, so the salpingopharyngeus muscle that connects to the Eustachian tube doesn’t have as much mobility (the muscle you use to pop your ears on an airplane) so it can’t drain as well, and they are more likely to be bottle-fed, both of which can increase ear infections. Hyperactivity (ADHD) is often related to airway issues and poor sleep quality. So is bruxism, it’s often related to sleep-disordered breathing in kids.

We will talk about these issues more in the future, but for now, check your patients with the TRQ. Have them elevate the tongue, and if it looks suspicious, and sometimes even if at first glance it looks normal, screen them for these common issues. Just let the form be a conversation starter and see what the patient says. 

In this way, you are helping your patients with total body health, and not just being a tooth mechanic!

You can download the TRQ and the rest of our forms for free on our website at www.TongueTieAL.com/professionals

Articles worth checking out: 

Article on infants, Ghaheri 2017: https://onlinelibrary.wiley.com/doi/10.1002/lary.26306

Article on Kids Baxter 2020: https://tonguetieal.com/wp-content/uploads/2020/05/Baxter-et-al-2020-Feeding-Speech-Sleep-Improvements.pdf

Article on Adults, Zaghi 2019: https://onlinelibrary.wiley.com/doi/full/10.1002/lio2.297