You see, everyone has a lingual frenum, which is a piece of tissue under the tongue that connects it to the floor of the mouth. In some people, it’s shorter than it should be, and this is what’s called a tongue-tie (also known as a “restricted lingual frenum” or “tethered oral tissue”).
This is a physical limitation, not one that can be corrected by changing habits or oral exercises alone.
This is a very real medical condition that can have serious effects on oral development and dental health. Most people understand that when the tongue’s movement is restricted and it’s resting low in the mouth, speech can be impacted. But more importantly, as we’ve seen above, a low or restricted tongue can also be a contributor to sleep apnea symptoms.
The position of the tongue is so important! This is because it’s meant to rest on the roof of the mouth, providing an internal support system for the upper jaw. A properly placed tongue is a sign of strong muscles and a healthy airway.
But when the tongue is low in the mouth, it’s a sure sign that the muscles aren’t functioning properly. A low tongue can contribute to airway obstruction, which is a major factor when it comes to general airway and breathing related issues, including sleep apnea.
If you or your child are mouth breathing at night, this can be an indicator that these problems are occurring.
The tongue can be resting low in the mouth simply due to habit and weak muscles. This is something that can be corrected by changing those habits and strengthening the muscles with a targeted exercise program. This treatment will have noticeable positive effects on sleep apnea symptoms.
But what if there’s a physical reason that the tongue is resting in a low posture? This is often the case when a tongue-tie is present, especially in children.
A 2015 study published in the International Journal of Pediatric Research titled Short Lingual Frenulum and Obstructive Sleep Apnea in Children looked at children aged 2-17 years of age.The study demonstrated that a short lingual frenum (or tongue-tie) is a clear risk factor for the development of sleep disordered breathing, including sleep apnea.
The study recommended that parents and healthcare providers need to be aware that if children are tongue-tied, then they should be monitored while they sleep to make sure that their breathing is healthy.
In my practice, I screen all children and adults for the presence of a tongue-tie, and I often recommend that a frenectomy is performed. This is a simple surgical procedure to release a tongue-tie that takes only about 15 minutes in a dental office.
The study agreed, stating that this procedure should be performed as early as possible but noted that exercises also needed to be done. These exercises strengthen and re-pattern muscles, while teaching the patient to breathe properly through their nose, especially at night.
My treatment programs for tongue-tie releases are exercise-based, easy to follow, and I get great results with my patients.
When it comes to braces, orthodontists have to look beyond the actual position of the teeth. The tongue and other factors are also major considerations.
The tongue can have a dramatic impact on the development of the mouth and teeth. Ideally, the tongue should rest in the top of your mouth and provide an internal support system for the upper jaw. When someone has a tongue thrust or a mouth breathing problem, the tongue rests in the bottom of the mouth, which means that the support system simply isn’t in place.
At the same time, the tongue is constantly resting against the front teeth, and every time we swallow, it pushes forward. These two factors can cause the teeth to move.
When we lose our baby teeth, and the adult teeth are growing in, the position of the tongue can cause the adult teeth to grow in crooked. Specifically, when a child has a tongue thrust, the adult teeth tend to grow in more widely spaced, angled towards the lips and in what dentists call an open bite (where the top and bottom teeth don’t overlap).
Once a child is ready to have braces, the dental problems caused by a tongue thrust will be a concern during and after the orthodontic treatment. This is because the muscular issues haven’t actually been addressed.
A tongue thrust and mouth breathing will:
Myofunctional therapy can address all the issues caused by a tongue thrust and mouth breathing that make orthodontic treatment more challenging.
Children’s faces, jaws, teeth and bodies grow and change at such incredible rates. This means that myofunctional therapy will have optimal results if done during this growth phase rather than later in life.
The ideal time to start a therapy program is before the braces are put on. However, myofunctional therapy can significantly improve the results of orthodontic treatment at any time, even when the braces are on the teeth.
After the braces have been removed and the teeth have started to shift, it’s still not too late to start myofunctional therapy. Many of the adult patients I see come to me for this exact reason. They would like to have braces for a second or third time but their orthodontist says they need to fix their tongue thrust first.