Tongue tie and the anatomy of craniofacial development explained by dentist in Turlock, CA
A tongue tie is a condition that a child can be born with (also called a congenital condition) that results in their tongue being attached to the floor of their mouth instead of being free to move in various directions. The condition can result in breastfeeding difficulties and speech problems, but a simple surgical procedure is often all that is needed to treat it. Dr. Ramsin Davoud in Turlock, CA is skilled at identifying tongue ties and performing procedures to correct the issue in people of all ages. Here, he explains tongue ties and the anatomy of craniofacial development so you can better understand the condition if you or your child has it.
Anatomy of craniofacial development
The craniofacial complex in the human body consists of the head, face, and oral cavity. The features in the human craniofacial complex are the most distinguishing aspects of our whole body, and each person’s unique facial patterning enables us to recognize loved ones or even people we have seen just once or twice. Craniofacial evolution in both humans and other mammals has long been studied to not only understand our overall anatomy and how our facial structures are formed, but also how to treat abnormalities should they occur.
The development of our craniofacial structure begins early on in the womb, and continues throughout our lives, even into adulthood and later ages. In humans, the bulk of the initial facial development is complete between the fourth and eighth weeks of gestation; after that, the rest of the baby’s face development in the womb occurs slowly and is mostly comprised of changing the proportions and relative positioning of the facial structures and features. After birth, as a child grows, their profile changes so that their jaw moves more forward, their forehead becomes smaller in comparison to the rest of their face, and the shape of size their nasal bridge grows. The chin, jaws, and teeth also undergo several changes throughout childhood and adolescence, and the overall facial height increases.
Craniofacial abnormalities are the most common type of birth defect – in fact, over half of all congenital defects are related to the craniofacial structures. Several factors can contribute to these types of malformations, including genetic issues, environmental exposures, and deficiencies in maternal vitamins during pregnancy, such as folic acid. Across the globe, the infant mortality rate for babies with some types of craniofacial congenital defects is much higher than for babies who do not have a defect. For example, infants with oral clefts have been shown
to have nine times the odds of dying within their first year.
One very common type of congenital defect is a tongue tie. Fortunately, it is possible to seek intervention early on for a child with a suspected tongue tie so that their development is not negatively affected.
Overview of tongue ties
A tongue tie is formally known as “ankyloglossia.” It is a congenital condition, which means that it is not something that develops as you age, but is instead present at birth. In a normal tongue, there is a thin fold of tissue called the frenulum that connects the tongue to the bottom of the mouth. Its purpose is to anchor the tongue in the mouth while also allowing it to move freely for speech, tasting food, and chewing properly. It also allows the tongue to help thoroughly clean out your mouth after eating.
In a tongue tie, the frenulum is abnormal in one of several possible ways that cause the tongue to be unable to freely move around in the mouth. The frenulum can be:
- Too thick
- Too short
- Too tight
- Attached in the wrong location under the tongue – in a normal tongue, it attaches at around the mid-point
When a child has a shortened frenulum, or one that is too tight or attached in a way that doesn’t allow their tongue to move properly, it can have several negative effects on their growth and development, including:
- Breastfeeding difficulties: In order to breastfeed correctly, children need to be able to use their tongue to latch on to the breast. The tongue is used not only to take the nipple and a portion of the areola into the mouth, but also to latch on and perform the squeezing motions necessary take in the milk. When they are unable to stick their tongue out or perform the proper sucking motion, their ability to remove milk from the breast can be hindered. Some infants with a tongue tie are unable to breastfeed at all, whereas others may have a slight impairment or no difficulty at all.
- Insufficient weight gain: Because babies who have tongue ties are frequently unable to take in sufficient calories from breastfeeding, they may not gain weight as rapidly and consistently as they should for proper development.
- Irritability: When a child is frustrated by an inability to breastfeed and is hungry due to insufficient milk intake, they may cry a lot and frequently be irritable, as well as have sleeping issues.
- Problems with eating and swallowing solid foods: As a child gets older and begins to eat solid foods, they may have issues with moving food around in their mouth to properly chew and swallow it. This is because the tongue cannot perform the motions necessary to move food left and right or to the back of the mouth. Some foods may be easier to eat for children with a tongue tie than others, which can result in children refusing foods that they unconsciously learn are difficult to eat.
- Speech issues: A tongue tie does not affect a child’s ability to learn and say words (also known as speech delays), but it can negatively impact the way they are able to form speech sounds and articulate words, making them difficult to understand or have a lisp.
- Other mechanical issues: In addition to the problems discussed above, a child with a tongue tie can have several other issues with mechanical motions of their tongue, including licking their lips, sticking their tongue out (such as to eat an ice cream cone or just to be goofy), using their tongue to keep their teeth and mouth clean after eating, and playing wind instruments.
How is a tongue tie diagnosed?
Tongue ties are classified by the location that the frenulum is attached to the tongue. Typically, classes 1-2 are considered anterior tongue ties, and classes 3-4 are posterior tongue ties.
- Class 1 tongue ties occur when the frenulum is attached to the very tip of the tongue; this is the classic type of tongue tie that people think of and often results in the tongue being heart-shaped
- Class 2 tongue ties are a bit further back on the tip of the tongue
- Class 3 tongue ties occur when the frenulum is attached near the base of the tongue
- Class 4 tongue ties are more difficult to diagnose because they may be located underneath the mucous membrane and can only be felt, not seen; it results in the inability for the mid-tongue to elevate but the front and sides can be raised
While a baby may have a visible anterior tongue tie, those ties typically also have a posterior component to them as well that must be treated appropriately to fully address issues such as breastfeeding difficulties.
A highly trained and skilled dentist like Dr. Davoud can accurately diagnose the type of tongue tie your child has. Dr. Davoud examines each child that comes into his practice for any signs of craniofacial abnormalities or birth defects that can affect their health, including tongue ties. In addition to looking for visual cues that a tongue tie is present, Dr. Davoud performs a physical examination by swiping his finger under the child’s tongue to feel the size, shape, and attachment location of the frenulum, as well as checking the frenulum from each side of the child’s mouth to determine if a posterior tongue tie is present.
Tongue tie treatment options
Based on the type of tongue tie and the impact it has on your child, different treatment options may be available. Some children have few negative symptoms related to their tongue tie and may eventually grow out of it as the frenulum loosens, in which case a “wait-and-see” approach may be the best option.
In other cases, the tongue tie may be causing several negative effects on the child’s health and happiness, and a surgical treatment may be recommended. The right tongue tie surgery age depends on several individual factors, and Dr. Davoud can discuss your child’s unique needs with you to determine the best age for treatment. Two types of surgical procedures can be done to treat tongue ties:
- Frenotomy: this is a simple surgery where the frenulum is snipped; it is a quick procedure with minimal discomfort, and can often be done without anesthesia
- Frenuloplasty: this is a more advanced procedure that is done to release the frenulum; it is typically done if the frenulum is too thick for the simpler frenotomy or if a frenotomy was unsuccessful, and either local or general anesthesia is used depending on the age, size, and cooperation of the child
Tongue tie expertise in Turlock, CA
Dr. Ramsin Davoud is highly trained in the diagnosis and treatment of tongue ties. If you think your child may have a tongue tie or other craniofacial development issues, we encourage you to call Dr. Davoud’s practice in Turlock, CA at
to schedule an appointment today.