TONGUE & LIP TIES

A frenum or frenulum is a small fold of tissue which supports or restrains the motion of the part to which it is attached.  The lingual frenum is a fold of tissue beneath the tongue and a labial frenum is a fold of tissue between the lip and the gum.  Frenum is a normal part of the anatomy.  If there is a variation in the anatomy of the frenum causing restriction in the movement of the lip or tongue and altering the desired function and development, surgical intervention may be indicated to release the restraint.  For example, if a lingual frenum is too short, or attached inappropriately, it can restrict the movement of the tongue.  This is commonly known as tongue-tie or ankyloglossia.  In the upper lip, a thick or tightly attached frenum is known as a lip tie and it may be a contributing factor to restricted movement of the upper lip.

The tongue performs a wide range of movements that culminate in several functions. The symptoms of tongue tie can vary from mild to severe and may have multi-system impacts within the body. Literature has shown that untreated tongue tie may affect and contribute to problems in the following areas of development throughout life if left untreated:

Neonates and Infants

• Normal sucking patterns
• Normal swallowing
• Breastfeeding issues for the infant with latch, stamina, coordination
• Breast and breastfeeding concerns for the mother - nipple pain and trauma, blockages, supply issues
• Bottle feeding difficulties
• Growth faltering
• Gagging / choking
• Aerophagia
• Reflux and vomiting
• Pain and crying after feeding
• Excessive salivation or drooling of saliva
• Difficulty eating solids
• Sleep breathing disorders and sleep apnoea 
• Head and facial growth disturbances 

Children

• Ability to clean the surfaces of your mouth and teeth with your tongue after eating
• Normal eating / chewing patterns
• Avoidance of certain foods
• Speech difficulties
• Gaps in upper primary and permanent teeth
• Crowding of the teeth
• Malocclusion and improper jaw development
• Mouth breathing habits
• Sleep disordered breathing and sleep apnoea

Adults

• Posture
• Head and neck tension headaches and migraine
• Sleep disordered breathing and sleep apneoa
• Orthodontic malocclusions
• Long face syndrome
• Disturbance to speech and normal eating / chewing patterns.
• Difficulty with intimacy, e.g. kissing

At the time of writing there has not been a high-efficacy study investigating the functional consequences of an upper lip tie. 

Clinical experience and case studies indicate that upper lip tie may:

• prevent adequate eversion of the lip thus interfering with adequate or effective vacuum seal to the breast or around the bottle teat. A tight lip may have the potential to inhibit complete lip seal for eating and breathing.
• cause a gap (diastema) to develop between the upper primary and permanent incisors
• cause an increased risk of tooth decay due to accumulation of foods and difficulty cleaning around the frenum

Whilst the incidence and functional impact of upper lip tie remains relatively under-researched, it would be reasonable to assume a cautious approach in treatment and decision-making in infants, basing the approach on thorough individualised functional assessment. Labial frenectomy in the older child/teenager may be recommended and beneficial for dental/orthodontic reasons.