Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 35

Let's Talk About That

PT: It seems as though every journal on dental
sleep medicine has an article on the use of lasers
to do lingual frenectomies. What is the relationship of tongue-tie to sleep breathing disorders
(SBDs)?
CQ: Because research has shown that tongue
posture can play a role in SBD, such as obstructive sleep apnea (OSA), it is not surprising to find
many of the same symptoms present in patients
with SBDs.
Suggestive of an even higher degree of intimacy
between sleep concerns and a restrictive lingual
frenum is the finding by Camacho et al4 that
myofunctional therapy alone can reduce the
apnea-hypopnea index for adults and children
with mild to moderate OSA by 50% and 62%,
respectively.
PT: How do you evaluate a tongue-tie anatomically and functionally?
CQ: Every new patient exam includes the Brodsky
tonsil classification and Kotlow grading classification for the lip and tongue frenums in addition to
all dental and orthodontic findings. The soft-tissue findings are used as a springboard for further
investigation with the parents on possible sleep
and/or airway concerns. Questions such as the
presence of snoring, enuresis, night terrors, active
movement in bed, or somnambulism would
identify whether there were possible sleep issues.
Follow-up questions related to the frenums
would be the following: Did the patient have a
difficult time nursing (painful, prolonged)? Were
they fussy or gassy? Did they have problems with
reflux? Problems with speech? Were they picky
eaters (texture sensitive)? Did they have problems
with choking (unable to manage a bolus of food)?
Were they messy eaters (lack of seal)?
Often as a result of the answers to these questions, a pattern would emerge, and we would
move into a " reconnaissance " phase for more
detailed observation and documentation by the

Spring 2021    PCSO Bulletin	

family before referring the patient for additional
care or follow-up. While I began studying the procedures or techniques used to release the frenum,
my interest was in prevalence and impact.
PT: How does your management of older children
and adults differ from your management of infants?
CQ: My training and approach to working with
children, adolescents, and adults on restrictive
frenums parallel those of the infants; however,
instead of a lactation specialist, I consult with a
myofunctional therapist (MFT), who serves as the
primary care coordinator. As such, the patient
works with the MFT on tongue positioning and
strengthening exercises prior to the surgical
procedure. In an ideal setting, the patient is not
scheduled for surgery until the MFT feels that the
patient is compliant and ready. The patient will
continue with the MFT after surgery. Work with
an MFT both before and after release is a critical
component in the outcome of the release.
PT: Is ankyloglossia or tongue restriction associated with specific malocclusion?
CQ: Tongue-ties can be found across the gamut
of malocclusions. Although tongue activity and
function clearly affect the occlusion, you will see
tongue-ties in open-bite as well as deep-bite
cases in all Angle classifications.
PT: It seems like the orthodontist is a critical
member of the team and even perhaps the professional to make the initial diagnosis. Can you
tell us a bit more about the other members of this
multidisciplinary team?
CQ: Depending on the specific needs of that
patient, a number of specialists may be called on
to provide care. Although some pediatric dentists
are competent to perform frenectomies, in certain areas surgery may land in the hands of the
ENT [ear, nose, throat specialist] or oral surgeon.
Successful outcomes hinge on the work patients
do before and after surgery with a speech thera-

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Pacific Coast Society of Orthodontists Bulletin Spring 2021

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