The tongue, the lips and the cheeks have anatomical attachments, which are made up of connective tissues, known as the fascia (it is like the skin inside the body). An oral attachment is also known as frenulum, or frenum.
In a small percentage of the population (between 1% and 35%, based on various research papers), the attachment of the tongue can be too short, or too thick, restricting the tongue from its ability to function optimally. This functionally restrictive tongue attachment is commonly known as a tongue tie, or ankyloglossia.
The labial (lip) and buccal (cheek) frenulum can also be too tight, commonly referred to as lip and cheek ties. Collectively, tongue, lip and cheek ties are known as oral restrictions, or tethered oral tissues.
The tongue, the lips and the cheeks themselves are muscles. It is the functions of these muscles that get affected when the attachment tissues are too tight and restrictive.
Example of Tongue Tie
Example of a Lip Tie
Restricted movement of the tongue, lip and cheek can cause difficulties with the key functions of the mouth, including:
Breast and/or bottle feeding
Sucking and swallowing
Eating and chewing
Jaw and teeth development
The fascia that is directly involved with a tongue tie is the deep frontal line. This line is the myofascial core of the body, extending inside the front of the upper body, down the thighs, twisting around to the calves, then to the soles of the feet. Inevitably, restrictions in any part of the deep frontal line can affect the overall posture of the individual.
Symptoms of oral restrictions may include:
- Difficulties with chewing and swallowing
- Difficulty managing certain textures of foods
- Fussy eating
- Digestive issues – reflux, indigestion, tummy upset, problems with bowel movements
- Mouth breathing, snoring, sleep apnoea
- Poor sleep, disturbed or non-restorative sleep
- Difficulty settling or relaxing
- Frequent illness, particularly involving the ears, sinuses and tonsils
- Frequent headache or migraine
- Chronic jaw, neck or shoulder pain / postural issues
- Poor oral hygiene
- Dental cavities affecting certain teeth that are directly related to the particular restriction
- Dental crowding
- Teeth grinding
As you can see, oral restrictions can affect individuals of any age, with the infants tending to have difficulties in breast and/or bottle feeding.
It is believed that oral restrictions begin to develop at 12 weeks in utero (at 3 months of age when the baby is growing inside the mother’s womb). Hence, at birth, the affected individual usually has had the restrictions for around 6 months.
When these restrictions affect the optimal functions of the associated muscles, other muscles tend to compensate in order to allow the individual to continue to go by their day to day living. The compensations are usually the ones demonstrated by the symptoms.
This also means the longer the individual has had the oral restrictions for, the more compensations are likely to be occurring. Consequently, managing these restrictions involves more intensive and longer therapies when the patient is older.
Ultimately, releasing these oral restrictions is indicated when they are impacting on functions negatively. Nevertheless, the release is only one part of the equation, because the affected muscles also require retraining to learn how to function optimally.
The decision to release always comes down to the patient and/or the parents. Our role as the providers is to evaluate, diagnose, provide treatment options and make recommendations.