Jj is for Jottings 141.  Tongue Tie Side Effects.

Following on from the previous article on tongue tie, we now turn to discussion of side effects of tongue.  Even professionals dealing with tongue tie often overlook or are unaware of many of these side effects.

SIDE EFFECTS OF TONGUE TIE.

Cosmetic Appearance.

I have covered some of this in the previous article, in the section What Does a Tongue Tie Look Like?  But there are other elements affecting a person’s appearance.  These include:

• Sometimes there is too much saliva slushing around in the mouth. This is due to poor coordination of swallowing during speech.  (This can happen for other reasons, not just as a result of tongue tie.)  Obviously we can see too much saliva, but also we can hear it, as I said “slushing” around in the mouth.  Younger children may dribble profusely. At least you’re less likely to have conversations long enough to need an umbrella when conversing with younger children!

Older patients might deal with the excess saliva in different ways.  They might purse their lips when speaking in an effort to keep the saliva in. This is likely to make their speech less clear. Some will shorten their utterances; others may slurp loudly.

• The child with tongue tie can also develop habits of mouth breathing, swallowing air (aerophagia) and, perhaps surprisingly, forward tongue position. Once again, all these factors depend on the nature and extent of the tie.  Aerophagia isn’t all that cosmetic – more auditory than visual – but consistent mouth breathing actually changes face shape.  There have been many times when I have taken one look at a child and thought “mouth breather”.  And then verified it with observation and asking the parents questions.

Mouth breathing, I now realise, it worthy of an article on its own, so more details about how it changes face shape etc. are for another time.

• The appearance of both the tie and the tongue may become more conspicuous as the child grows older. They are also more easily noticed and less excused in teenagers or adults.
  

  Tongue Tie Side Effects. Not a tongue thrust, but a piece of orange peel.

Oral and Dental Hygiene.

Limited tongue mobility and/or incorrect tongue position frequently lead to messy eating habits.  This may result in bits of food staying on the lips and teeth, which can cause decay.  And it’s not a very appealing picture, is it?

Tongue tie can cause misalignment of teeth (malocclusions), which may require orthodontic treatment.  Pressure of the tongue on the front teeth when there is a tongue thrust swallow will push front teeth forwards.  And there can be pressure on the teeth at the sides because of an unusually wide tongue.

Bottle Feeding.

When tongue tie (or anything else) interferes with an infant’s ability to latch on to the breast and suckle efficiently, it is natural to resort to bottle feeding.  And often necessary.  However, lactation consultants have found that bottle feeding never has the same effects as breastfeeding, despite claims made by bottle manufacturers.

The sucking patterns required for bottle feeding are different from those used when breastfeeding.  Bottle feeding requires a strong up and down action of the tongue, like a piston.  This may produce a high, narrow-arched hard palate (roof of the mouth) and sometimes a tongue thrust swallow.  If the teat has too large a hole, the tongue may be used as a “stop” to reduce the flow of milk.

On the other hand, breastfeeding results in the soft and hard palates being moulded into a gentle curve.  This is because the malleable breast tissue distributes pressure over the entire palatal region.

The alpacas have high, narrow-arched hard palates, even when they haven’t been bottle fed.  I guess there may be other factors at work here!

Feeding Difficulties.

Sometimes feeding difficulties resulting from tongue tie aren’t actually recognised as feeding difficulties.  Mothers can incorrectly attribute difficulties with breastfeeding to their own inadequacy as breastfeeders.  Other feeding difficulties which may (or may not) be a result of tongue tie include:

• Slow, picky eaters.
• Fast, untidy eaters who don’t chew their food properly.
• Children who prefer soft foods or who swallow air when they eat.
• Inability to clear food off the teeth with the tongue.
• Even adults with tongue tie may not be able to chew meat or bulky mouthfuls of food.
• Acute malnourishment. This applies to infants, and hopefully diagnosis and remediation occur quickly.  But even adults, while not malnourished, may be quite limited in the range of foods they can handle.

Tongue Mobility.

As mentioned in the previous article, difficulty of movement varies from person to person, and usually relates to the degree of tongue tie.  But touching the tongue tip to the upper teeth and poking out the tongue tend to be consistent hallmarks of tongue tie.  This is due to the pull of the tight frenulum on the tongue and the floor of the mouth.

Other movements, whether related to speech or not, can often be achieved only under optimal conditions: when concentrating, when talking slowly, or after prolonged speech therapy.  And of course, the longer the utterance, the more movements are involved, and the more difficult it is to articulate all the sounds.

Oral Kinaesthesia.

“Oral”: relating to the mouth; kinaesthesia: the ability to know where the parts of your body are and how they are moving.  (Late 19th century from Greek: kinein ‘to move’ + aisthēsis ‘sensation’.)

Underdeveloped oral kinaesthesia results from a poor sense of the geography of the mouth, due to having a limited range of tongue movements.  Resulting speech problems can be difficult to correct because the child can’t memorise correct speech sound movements.  And if they sometimes get them correct, they can’t always be sure of achieving them.  Many people are able to develop ways around making speech sounds the conventional way if the tie is not too severe.  I have seen children produce /s,z,t,d,n,l/ sounds using the blade of the tongue behind their top front teeth rather than their tongue tip. And /l/ is even more complicated than the other sounds.  It’s amazing what children do unconsciously to compensate for what their tongue can’t do.

Other Factors.

Poor confidence and self-esteem can be a result of tongue tie and all that comes with it in terms of speech, eating and cosmetic appearance.

Adults have sought to have their tongue tie released to address the following:

• headaches
• to increase tongue and jaw mobility
• poor sleep
• swallowing
• a combination of reducing pain, improving sleep and improving swallowing

Most of the adults in a study reported improvements in all these areas following tongue tie release.

The other factor which may not occur to parents of young children because it is not relevant until they are much older is what the study referred to as “future intimacy”.  Think kissing for starters, and I’ll delicately leave the rest to your imagination!

Check out the Facebook page: Aa is for Alpacas