FAQ
1) Can a tongue tied baby/child or adult stick their tongue out past his/her lips?
Absolutely yes! The tongue needs to have a normal motion in ALL directions. The most important movement for the tongue during breastfeeding is UP and DOWN not OUT.
2) How often does a tongue tie accompany a lip tie?
In my experience, >70% of cases a tongue tie accompanies a lip tie. Only after a functional assessment, we decide whether the tongue or lip tie needs to be released.
3) If a tongue-tie is left untreated, can it have an effect in childhood and adulthood?
Untreated tongue ties in infants can lead to difficulty chewing and swallowing firmer foods, altered jaw and dental development including a high palate and narrow facial structure, poor sleep patterns, mouth breathing, and increased gas and bloating resulting from poor tongue coordination and corresponding swallowing of air. Also, when tongue movement is restricted, the tongue cannot sweep across tooth surfaces and spread saliva, both crucial to oral cleansing and may increase the risk to cavities. Tongue ties in childhood present itself as affecting jaw growth, speech, picky eating, thumb sucking, clenching, mouthbreathing, snoring or disturbed sleep. In adults it progresses to affect the TMJ, breathing, sleep(mouthbreathing, snoring, UARS, Sleep apnea), anxiety, posture and a quality of life.
4) Can a tongue tie cause speech problems?
Significant ties may result in delayed speech development due to the tongue being restricted in movement. There are articulation problems with letters like R, S, L, Z, D, CH, TH, and SH in some kids. While some kids can make these sounds in isolation, stringing the sounds together during speech can be very difficult.
5) Are tongue tie stretches/exercises necessary to prevent reattachment?
Stretches are most the important and necessary post operative care measure to prevent reattachment for the lip and a released tongue tie. The opposing raw edges of the wound are too close, and will stick together to some degree without stretching.
6) Is there always a posterior tie behind an anterior?
Yes. The real restriction of a tongue tie is typically at the fascia which is present posterior to the anterior component.
7) Is there a tongue tie release provider/ dentist near you?
Dr. Ankita is the only Indian Ambassador to be trained by Dr. Soroush Zaghi of The Breathe Institute. In our practice we use the Functional Frenuloplasty procedure to release tongue ties for toddlers, children and adults. Dr. Ankita Shah is also Laser Certified by the Global Laser Oral Health, LLC to perform laser frenectomies for infants and babies. We work as a team and believe in a holistic, conservative and overall approach. Sometimes there may be reasons other than a tongue/lip tie which may be giving you similar symptoms. We like to give a holistic approach and give you a pleasant journey through your treatment.
8) Can a baby outgrow a tongue tie? Will the tongue tie disappear with age?
A tongue tie can bever disappear on its own. The Tongue tie is fascia that is enveloping the muscles beneath the tongue. Some Tongue ties show symptoms and some do not. Only the symptomatic tongue ties need attention. A tongue tie cannot be corrected without a small surgical intervention.
9) I have no difficulties with breastfeeding but it looks like my baby has a lip/ tongue tie. What should I do?
Enjoy your normal breastfeeding journey 🙂
10) Does a tongue tie need to be fixed?
Untreated tongue ties often show some signs and symptoms at different ages. Upon diagnosing the existence of a tongue tie, having a lingual frenectomy/ functional frenuloplasty/ tongue tie release performed can yield fantastic results. The earlier it is released the better. Better late than never!
11) Can tongue ties be corrected in adults?
Tongue-tie in adults may be found when looking for causes of a TMD/orofacial pain, clenching of teeth, snoring, disturbed sleep and breathing and poorly developed jaw growth and teeth alignment. There are also several related issues stem from a tongue restriction that include the airway, posture, and sleep, which is why a comprehensive functional assessment of the tongue is essential. A functional frenuloplasty is a straightforward outpatient procedure that can be completed in office without the need for general anesthesia. It is a quick, safe, non-invasive and relatively a painless procedure.
12) Can tongue tie cause sleep problems?
In some cases the tongue rests low in the mouth because of a tongue tie, low muscle tone, mouth breathing, or inadequate space in the mouth. This can cause the posterior part of the tongue to fall back and narrow the airway causing Airway function disorder. Airway function disorder involves Mouth breathing, Noisy Breathing, Snoring, UARS, Sleep Apnea and oral muscle dysfunction. This may affect children as well as adults.
13) Can tongue ties cause TMJ problems?
When there is a tongue tie, some of the muscles are typically tight, pulling on the tongue when it attempts to function, but cannot because it is anchored to the floor of the mouth. This restricts the tongue from normal movement and function. The movements of the ‘tied’ tongue are then accompanied by many compensations like unfavorable movements of the TMJ, lower jaw, tension in the floor of the mouth, neck, face and head which can result in TMJ disorders.
14) Is Tongue Tie Release painful?
This is probably the most concerning question everyone has. A functional frenuloplasty is a straightforward outpatient procedure that can be completed in office without the need for general anesthesia. For infants after the application of the numbing gel in infants or local anaesthesia, we ensure there is zero to minimal discomfort to the baby during the laser frenectomy procedure. If a release is recommended, the treatment takes less than an hour. Dr. Ankita will apply an effective anesthetic that wears off approximately 60 minutes after the procedure is completed. For the first 5-6 days following surgery, mild pain is expected. This can usually be controlled with the help of some pain killers.
15) Which is better – laser or scissors?
BOTH instruments have proven to be successful in long-term treatment. What is important is that your provider must be skilled and trained.
In our opinion, a laser yields a more precise and complete result than scissors when treating an INFANT. Laser treatment limits the amount of bleeding as it cauterizes the tissues within your child’s mouth, minimizing risk of infection. We use proper laser settings and protective eye wear is worn by the team.
For adults we have seen a more precise fascial tongue tie release using the Functional Frenuloplasty Procedure. Dr. Ankita Shah is the only Zaghi trained provider in India.
16) Is Myofunctional Therapy Necessary before and after a tongue tie release?
Pre- and post-operative myofunctional therapy is essential and critical for optimal recovery and success of the frenuloplasty procedure. Our tongue-tie release procedure is based on precision: releasing the appropriate extent of tissues for maximal relief; not too much, and not too little. The success of our practice is based on our ability to provide a complete and effective release of tethered oral tissues by incorporating a multidisciplinary protocol that integrates myofunctional therapy (and sometimes physical therapy) both before, during, and after surgery. You also need to undergo physical therapy rehabilitation after the surgery for your muscle-balance-posture is retrained.
1) What is Myofunctional Therapy?
2) At what age can Myofunctional Therapy begin?
- Choking/ Gagging
- Mouth breathing
- Picky eating
- Finger sucking
- Lip biting
- Snoring
- Pencil Chewing
- Drooling
- Tongue thrusting
- Noisy Breathing
- Pacifier habit
- Nail Biting
- Poor Posture
- Teeth Grinding
- Bottle feeding habit
3) How can Myofunctional Therapy help in correcting crooked teeth?
4)Can Myofunctional Therapy help for tongue thrusting?
5) Can Myofunctional Therapy help for speech?
6) Can Myofunctional Therapy help for sleep apnea and mouth breathing?
7) Can Myofunctional Therapy help for TMJ?
8) Why is Myofunctional Therapy used for tongue tie?
9) Can adults do Myofunctional Therapy?
- Mouth breathing
- Sleep Apnea
- Before and after Tongue Tie Release
- Lip incompetence
- Tongue thrusting
- Facial esthetics
- Headaches
- Gastroesophageal reflux disease (GERD) or heartburn
- Temporomandibular joint (TMJ) pain
- Neck, shoulder and back pain
- Orofacial pain
- Posture correction
10) What are the goals of Myofunctional Therapy?
The goals of myofunctional therapy are as follows:
- To better understand the importance of proper tongue position (i.e to rest in the roof of the mouth) which is the ideal oral rest posture. ​A low tongue position can contribute to improper muscle functioning and can lead to airway obstruction.
- To better understand the importance of proper tongue position (i.e to rest in the roof of the mouth) which is the ideal oral rest posture. ​A low tongue position can contribute to improper muscle functioning and can lead to airway obstruction.
- To better understand the importance of establishing lip seal.
- To better understand the importance of continuous nasal breathing.
- To swallow correctly
- To clearly identify and illustrate the importance of pre/post operative Myofunctional therapy exercises as part of a successful tongue-tie (Frenuloplasty) procedure.
- To help strengthen the tongue and orofacial muscles through myofunctional therapy exercises and pattern retraining to help resolve issues associated with sleep, breathing, posture, orthodontic relapse, cervical neck tension, and jaw pain, among others.
11) Is myofunctional therapy supported by research? Is it Legit?
12) Who performs myofunctional therapy? Is there anyone in India?
13) How much does myofunctional therapy cost?
1) Are TMJ and TMD same?
The Temporo Mandibular Joint (TMJ) in the jaw is one of the most powerful and complex joints in the body. It is located on either side of the face in front of the ears and connects the jawbone to the skull. The joint also has a disc of cartilage that serves as a cushion, and protects the top end of the jaw (condyle) and the socket into the skull from hitting each other. The TMJ is also connected to several nerves like the trigeminal nerve and head and facial muscles, like the pterygoids and masseter muscles.
The conditions that affect the TMJ are broadly classified as Temporo Mandibular Joint Disorders (TMD). TMD disorders may be with or without articular disc reduction.
2) Can TMJ cause headaches and migraines?
We believe the inflamed muscles from clenching put pressure on the nerves and this pressure contributes to headaches. Typically those who have chronic headaches also have other issues related to muscle dysfunction that is neck pain, jaw pain, worn off teeth due to grinding, postural imbalances from jaw all the way down to the feet. Patients having forward neck and shoulder posture due to mouth breathing, tongue ties or other causes show a rotation in the upper cervical vertebrae especially C1(Atlas) that can contribute to headaches as well.
3) How is TMJ caused?
There are many causes of TMJ like Physical Injury, Arthritis, Teeth Grinding & Clenching, Mouth Breathing, Malocclusions & Improper Bite, Tongue Ties, Narrow Airways, Obstructive Sleep Apnea and Anxiety & Stress.
4) Are TMJ and lock jaw same?
Lockjaw and TMJ are two very similar terms. Jaw lock is the term used to describe a locked jaw caused by the temporomandibular joint disorder. Patients with jaw lock typically can’t predict when their jaw will become stuck, either opened or closed, and most of the time there’s a lot of pain when trying to move it. TMJ is the name of the jaw joint and TMJ disorders vary from jaw clicking, popping, arthritis to jaw deviations.
5) How does TMJ affect the entire body?
Studies have shown that when treating TMD patients their symptoms across the body are an explanation to the polyvagal theory. They are oftentimes shocked to hear that the eyes, mouth, throat, ears, jaw, and neck are all associated with TMJ disorder. While some symptoms of Temporo Mandibular Joint Disorder (TMD), such as facial pain and headaches, seem self-explanatory, there are other symptoms that are not as apparent like ringing in their ears, anxiety, vertigo, sleep disorders, or chronic neck and back pain. This is why patients suffering from TMD, at times, may be misdiagnosed with pyschosomatic disorders.
6) How is TMJ treated?
If we know WHY, we know HOW to treat it? There are many non invasive treatment modalities that have shown great success like Myofascial release technique is the Functional Neuro Myofascial Massage Technique (FNFT) with Low Level Laser Therapy (LLLT), Myofunctional Therapy, Tongue tie Release, Magnesium Glycinate Supplements, Moist heat, Dietary Regulation and Orthotics.
7) How does TMJ affect the eyes?
The bad bite affects the jaw muscles and the TMJ (TMJoints) which triggers the trigeminal nerve causing referred pain that eventually makes your eyes hurt. The Trigeminal Nerve goes to the teeth, the jaw muscles, the jaw joints as well as to the sinuses especially directly behind the eye. Retro-orbital or behind the eye pain is mediated by the Trigeminal Nerve. The result is that you feel pain behind the eyes and sometimes they cause swelling and twitching because of the pain.
8) Can TMJ cause ear stuffiness and tinnitus?
The temporo-mandibular joint is located extremely close to the ear canal and middle ear. The muscles, especially the lateral pterygoid that surround the temporo-mandibular joint, the fascia and discomalleolar ligament that hold the bones in place are intricately connected with the ear and the nerve that supports the ear. If there is any strain or stretch on these structures or the disc becomes dislocated or there is muscle dysfunction, that could cause the lancing or dull pain in the ear, ear stuffiness, ringing or ear tinnitus, vertigo or dizziness.
9) What does a TMJ pain feel like and where is it felt?
Patients suffering from TMJ usually have fatigued & spasming facial muscles resulting from trauma, stress, clenching or the inability to find a proper bite, incorrect swallowing and breathing dysfunction. The pain can ranges from a dull aching to acute to a referred pain. The pain is felt raging from the eyes, mouth, throat, ears, jaw, neck, headaches, ringing in their ears, anxiety, vertigo, sleep disorders like snoring, UARS or sleep apnea, or chronic neck and back pain. This is why patients suffering from TMD, at times, may be misdiagnosed with pyschosomatic disorders. It is important to note that TMD affects overall health and well being, due to the intricate structures involved with this joint.
10) What is the relationship between TMJ and orthodontics?
The way the teeth fit together not only influences the position of the jaw and the resting position of the temporomandibular joints but also has a major impact on breathing and sleep disorders. The narrowing of the upper jaw naturally pushes the lower jaw back and further compromises the airway. To compensate one begins clenching and grinding their teeth which causes muscular dysfunction and articular disk displacement, causing TMD. This can also present itself in symptoms like anxiety, poor sleep, fatigue and a multitude of metabolic and cardiovascular diseases. Jaw muscles can also compress nerves, causing more TMD symptoms. Traditional orthodontics extracts teeth to relieve overcrowding and create space for teeth alignment, this is another possible cause of TMD. Removing teeth rather than expanding the jaw will alter the entire structure of the oronasal airway, which will leave no room for the tongue to rest on the roof. Hence one must consider Airway Orthodontics.
11) Can a tongue tie cause TMJ?
A tongue tie restricts the tongue from normal movement and function. The movements of the ‘tied’ tongue are then accompanied by many compensations like unfavorable movements of the TMJ, lower jaw, tension in the floor of the mouth, neck, face and head. The tongue performs many functions including keeping the airway open (in compensation to which one starts mouthbreathing, snoring, clenching and grinding their teeth), assisting with chewing, swallowing, and most importantly facial and jaw development, speech and digestion. An open mouth, incorrect bite, clenching and grinding or constant compensations of the muscles while swallowing and speaking can result in Orofacial pain and TMJ dysfunction.
12) Can sleep apnea cause TMJ?
Sleep Disordered Breathing is a common cause of TMD. These disorders give rise to muscular dysfunction and postural imbalances which in turn worsen the sleep disorders. In some cases restricted (tongue tie) or low tongue posture may cause the tongue to sit on the floor of the mouth rather than the optimal roof position that causes the upper jaw to become narrow. This throws the orofacial system off-balance and narrows the airway. The narrowing of the upper jaw naturally pushes the lower jaw back and further compromises the airway. To compensate one begins clenching and grinding their teeth (sleep bruxism) which causes muscular dysfunction and articular disk displacement, causing TMD. This can also present itself in symptoms like anxiety, poor sleep, fatigue and a multitude of metabolic and cardiovascular diseases.
13) Whom should I see to treat my TMJ?
Temporomandibular joint disorders (TMD) are complex medical conditions that can be caused and compounded by numerous other conditions and underlying causes. TMJ disorders can impact a number of areas, including pain in your jaw, teeth, face muscles, neck, ears, headache, and more. As a result, many patients are confused who they should turn to when suffering from a TMD. Most often, an airway focused dentist who specializes in TMJ disorders is actually your best choice. There are multiple forms of TMJ disorder treatment.
14) Will TMJ heal on its own and will it ever go away?
In the majority of cases, TMJ syndrome is self-limiting. Most of the acute symptoms disappear in two weeks once the jaw is rested That said, the main causes of TMJ flare ups are sleep apnea, snoring, stress; which can lead to jaw clenching or bruxism (teeth grinding) while you’re asleep or awake; hormonal changes, hard and chewy foods, which can strain the already stressed TMJ. Some people who have TMD develop long-lasting (chronic) symptoms which need attention and may take 1-2 yrs to get cured depending on what treatments are required for the patient.
