Ties in Older
Children & Adults

As research on the effects of Tethered Oral Tissues (TOTs) continues, studies are showing more and more links between TOTs and multiple health conditions, including obstructive sleep disordered breathing (such as sleep apnea and upper airway resistance syndrome), migraines, neck tension, speech impediments, and ADHD.

SLEEP DISORDERED BREATHING

At rest, your tongue should be lifted against your palate, your lips should be closed, and you should be breathing through your nose. Nasal breathing is healthy breathing. However, when there is a restriction in the mouth that prevents the tongue from resting against the palate, this often leads to mouth breathing, with the tongue sitting farther back in the mouth, obstructing the airway. 

When the airway is obstructed, it takes much more effort to maintain oxygen levels throughout the night. As a result, the body is in a heightened state of stress throughout the night, bouncing between light and deep sleep, in an effort to keep oxygen levels stable. This results in poor sleep quality, frequent night wakings, waking up feeling unrefreshed, and can progress to more severe sleep disorders, such as sleep apnea.

This lecture from Dr. Soroush Zaghi explains the connection between tongue tie and sleep disordered breathing:

FASCIAL TENSION AND PAIN

When the tongue's mobility is restricted due to a short frenum, other parts of the body will lend some of their mobility to help increase the tongue's movement. This often means the neck, jaw, shoulders, and floor of the mouth will compensate to allow for improved tongue function. This can lead to tension in these other parts of the body. We often see patients with tongue ties complain of headaches, migraines, forward head posture, cervical neck and shoulder tension, jaw fatigue, and even speech difficulties (especially when speaking for long periods of time.) Here is a video featuring Timothy King that explains how restricted fascia can affect the whole body:

SPEECH

When the tongue is unable to move freely, a child may have difficulty producing certain speech sounds. The most common letters affected are R, S, L, Z, D, CH, TH, and SH, but other sounds are also difficult. Furthermore, stringing multiple sounds together may also present a challenge. Most children learn to compensate and are still able to produce normal-sounding speech, despite limited movement of the tongue. Lip ties are not known to cause any speech problems.

There is no guarantee that a tongue tie will automatically create speech problems, just as there is no guarantee that a frenectomy will solve existing problems. Delayed speech is not a symptom of a tongue tie. There are, however, recent studies that show speech improvements after frenectomy. 

Working with a speech-language pathologist or speech therapist is an important step towards helping your child learn to produce proper speech sounds, regardless of whether there are tongue restrictions or not. 

ORTHODONTIC ISSUES

Tongue ties can lead to a wide range of dental issues. The tie may pull on the jaw bone, resulting in teeth shifting out of position, or it may prevent the teeth from closing together, causing a large gap between the front teeth. 

Furthermore, the tongue is nature's palate expander. In utero, the tongue begins to press against the palate to help create a rounded, wide arch. A tongue that cannot lift upwards and press against the palate results in a high, narrow palate. An elevated palate may negatively impact nasal breathing, and may also cause orthodontic problems such as malocclusion and crowding. 

Removing restrictions of the tongue and lips can allow the teeth to erupt in a more ideal alignment, which may help reduce the need for future orthodontic treatment.