Restricted Oral Movement: The Tongue, Tongue-Ties & Breathing
Today we are going to talk about the tongue, its structure, and functions. We will review tongue-ties, and the integral role the tongue has in jaw development, maintaining nasal breathing, and optimizing sleep.
The tongue is a collection of 8 paired muscles that are integral in
Breastfeeding
Swallowing
Speech
Pre-digestion
Chewing
Development of the upper jaw
And maintaining one of three components that optimize nasal breathing and sleep quality.
Tongue-ties are a polarizing topic within the medical community. Let me explain this a little further.
There is little understanding of oral function and mechanics when it comes to the tongue’s role with breastfeeding, sucking, swallowing, and oral anatomy in general within the general medical community. There is little focus on oral function, let alone breastfeeding in medical school.
There are really only a handful of reasons a baby would not breastfeed well. Some are the mother’s milk supply, the nipple shape, baby’s function, or the anatomy of the tongue not allowing the baby to use and function with it properly. It is a matter of survival to breastfeed; it should be simple and should not hurt.
The literature is inconsistent. There is minimal literature surrounding tongue-ties. Of those, the sample sizes were small. There was no consistency in assessment protocols, surgical technique, or skill level. In addition, post-op care, the restoration or long-term follow up with milestones have not been reviewed. The concrete evidence is two-fold: a short frenzy (tongue-tie) is associated with maxillary hypoplasia (small upper jaws) and positively correlated to obstructive sleep apnea.
Physicians and most allied health professionals are not trained in the assessment of infant tongue-ties, or in the functional assessment of tongue function. So if a proper diagnostic ability is missing, one cannot identify the structural restriction. The tongue needs to be able to elevate in addition to stick out. This vertical movement is the key.
The results of tongue-tie surgeries are inconsistent. Surgeons of the mouth should be the only providers performing oral surgery (unless otherwise specifically trained in the technique). This group of providers includes dentists (with proper training) and ENTs (ear nose and throat doctors). The skill, experience, and technique are of the utmost importance, not so much the tool.
Aftercare is s significant factor for proper wound healing. Proper care of the wound is needed to allow the wound to heal without contraction of the tissue. Primary or units, wound healing takes 30 days in every human, no matter the size.
The team approach — the surgery is only as good as the rehabilitation of the function of the tongue. This means for babies that following cranial osteopathy or craniosacral therapy is needed. These therapies help to loosen and align the fascia and release the oral tension and overused muscles of the face and lips as well as a follow-up lactation visit. Surgery alone will not help the child.
And for developing infants and children, what is poorly understood in the medical and even dental communities is that the tongue is the architect of the upper jaw. This issue means the architect for the nasal complex. The optimal and proper growth of the upper jaw is directly correlated to the tongue’s ability to position against the palate. This results in the ability for it to function with no compensations, lips remain sealed, and continuous nasal breathing.
If the tongue cannot elevate because it is tied to the floor of the mouth, the tongue cannot create optimal jaw architecture. This will in most cases result in small jaws, narrow nasal passages, deviated septums, crowded teeth, mouth-breathing, breathing-disordered sleep, high risk of asthma, respiratory infections, and chronic ear infections. Truly, the list goes on and on.
A tethered tongue can also not swallow optimally. This results in a thrust, difficulty swallowing, even choking at times, and not being able to clear the Eustachian tubes (this is the ear infection piece).
And, lastly for speech. Think of how you need to use your tongue; it has to move in the mouth and into the palate to create s, sh, t, th, n sounds. If the tongue cannot elevate because it is tied to the floor of the mouth...how can those sounds be produced if the tongue cannot elevate? The tongue needs a full range of motion to be able to create all of the sounds in each respective language.
The bottom line is:
Are the function and anatomy optimal for the human to grow, function and thrive optimally?