Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 34

Let's Talk About That

requires assessing lingual frenum alterations and
tongue movement limitations in newborns in all
Brazilian hospitals and maternity wards.
PT: What are some of the clinical manifestations
of having a restrictive tongue?
CQ: The influence of the restriction does not
subside between infancy and orthodontics.
Symptoms of a lingual restriction in a child, an
adolescent, or adult can include any of the following, and the orthodontist can evaluate them at
the initial exam:

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Mouth breathing
Dry mouth
Myofascial tension
Dental clenching, grinding, or sleep bruxism
Speech and articulation issues
Acid reflux
Nutritional malabsorption
Sleep issues such as snoring
Selective or picky eating
Swallow dysfunction and tongue thrust
Messy eating
Postural maladaptation
Low resting tongue position
Neck and shoulder tension
Headaches
Heartburn or other digestion issues

What I found interesting was that the presentation of the tie did not always coincide with
my expectation as to their related symptoms.
Specifically, I found children and adolescents
who presented with severe lingual ties extending to the tip of the tongue, but who had no
history of nursing, eating, speech, or sleeping
concerns. Often the mother reported that the
patient had nursed well and for several years.
Speech and eating effects would be noted
on others, however, once again, contrary to
problems that might be expected based on the
significance of the restriction. This observation
has in turn fueled a conservative approach
to prophylactic releases as I continue to gain
knowledge in this area.

34	

I recently treated one of my staff members with
an open-bite malocclusion and a tongue-tie. After
myofunctional therapy, the frenectomy was performed. Immediately apparent was not only the
freedom of tongue movement but a release of
tension in the neck and chest. We are beginning
to appreciate the connections mediated through
the fascial system. A release of a tongue-tie can
be felt remotely throughout the body as years
of compensatory habits find freedom. It is not
surprising to see the tongue-tie implicated in
myofacial pain dysfunction (temporomandibular
disorders).
PT: How did you gain your knowledge and experience in managing patients with tongue-tie?
CQ: I began studying, training, observing, and attending a number of symposiums on tongue-tie,
airway, tethered oral tissues, and myofunctional
therapy. What was evident to me right away was
that a multidisciplinary approach to treatment
gave the most predictable successful outcomes.
It also opened my eyes to the possibility that a
patient can have a tongue-tie and have nursing
difficulties that are not related to the tongue. Examples could be torticollis, birth trauma resulting
in muscle imbalance, and tightness of the muscles in the mouth, head, and neck, all of which can
create challenges to nursing, including latch and
suction. Performing a release surgery on a patient
with other compounding issues will not improve
the feeding process.
Partnering with a lactation specialist (international board-certified lactation consultant
[IBCLC]) and bodywork specialist allowed me to
tease out the nonfrenum contributing variables to poor nursing. For some patients, these
therapies were all that was necessary, and the
babies responded to treatment without requiring surgical intervention. For those patients
whose symptoms did not resolve and who had
a tongue-tie, a frenum release or frenuloplasty
was completed with follow-up feeding guidance by the IBCLC.

PCSO Bulletin    Spring 2021



Pacific Coast Society of Orthodontists Bulletin Spring 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2021

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