Should I Recommend Lingual Frena Release For Certain Patients?

Hello Sandra For some reason I am observing a fair number of cases of ankyloglossia in the dental office – I look at my hygiene patients with different “eyes” than a few years ago. I believe you have a fair amount of knowledge regarding ankyloglossia.  Is there any supporting research for the benefits to have a tight lingual frenum released without follow up OMT? My primary employment is in the dental office.  My dentist employer is slowly learning about OMD. 

I don’t think we are that far along yet with research.  Clinical experience and common sense can win out here:  If it is released and there is no follow up, then there is no reason for the resting posture to change by some miracle to be in a new and better position.  Also, depending upon the age of the patient and the type of release, we DO know that it can reattach.  With babies who receive release without the benefit of anaesthesia, there is a far greater number who have to be redone at a later time.  We DO have research showing that scenario.  My global group, IATP (International Affiliation of Tongue tie Professionals) is comprised of several doctors and lactation specialists as well as dentists….who are exploring the various types of post surgery treatments/exercises that might make the difference, especially with babies.  Most of them work in hospitals or elsewhere with babies, but the info they are gathering will help all of us. If you know that he definitely is ankyloglossic, then he DOES have an orofacial myology problem (certainly by MY standards and methods.  I put tongue tie into the orofacial myology category based on my program and teaching). So true, as I mentioned above. 

 Today I saw an adult patient who had previous orthodontic treatment. The lateral borders of her tongue were very callous and heavy scalloping on the right side and mild on the left.   Bi lateral linea alba was present and also extended to the inside of her lower lip.  She states that she rests her tongue on the mandibular teeth and she closes and bites her tongue – which eventually causes pain and she opens her mouth.  She has stopped using a c pap machine.  She could not tell me if she was having effects from sleep apnea – such as drowsy (although she was yawning a great deal and it was midafternoon).  I briefly explained what I am doing with OM.  She asked me if having the ankyloglossia addressed would be of benefit for her major complaint of a “big tongue”.    I did tell her that having the procedure would not be of major benefit without doing formal therapy. I did suggest she try researching on the web for more information.  Not sure if this was the correct response or not. Later I did ponder how OMT would work well with re-patterning the muscles to alleviate some of her oral habits.  But I do realize how limiting the tongue would be in this situation.

I feel from my clinical experience that there IS a connection, despite the presence of research at this time to back my theory.  In some cases, where it is significant as this case you have described, it seems obvious to me that a connection is highly likely.   I had an acromegaly patient who presented like this.  Are you certain this lady does not have any other underlying issues?  Is her palate sufficiently wide and not too vaulted?  No other symptoms or etiologies that you know about?  Upon evaluation she has a restricted lingual frenum.  Restricted can mean many things from a slightly embedded frenum that is a bit anterior to a severe situation where normal function is compromised related to both the lingual and mouth floor attachments?  Did you use the Quick Tongue Tie Assessment (ROM)?  If so, what were the measurements?  If not, how did you determine that she is tongue tied and can you detail it a bit more for me?    Her tongue might merely be forward due to some of the same conditions that cause the sleep apnea, or perhaps for other reasons.  With this type of patient, I immediately check their ability to do the normal alterations and excursions with the tongue, thus demonstrating to them that is isn’t the “size” of the tongue but rather the “function” that must be addressed.  I don’t know if you have the Myo Manual or not.  If so, see Proficiency Exam #1 for these lingual shapings and excursions.  If not, let me know and I will try to explain them to you and direct you to our videos on our website and YouTube that demo some of the exercises (they will give you a better idea of the “goals” of the exercises).  It is good that you didn’t make any promises, but depending upon the type and severity of her lingual restriction, release can only be a benefit in any circumstance…over having restriction.  I consider lingual frena release as the most basic starting point for any patient.  That way we level the playing field in the patient’s favor.  If they are seeing us, they have a problem most of the time.  Allowing a tongue tie to exist will place a barrier up to successful treatment, probably close to 100% of the time.