The Tell Tale Tongue

April 30, 2014

Your tongue is a major player in your facial appearance and dental alignment. The tongue’s form and function should be part of a holistic mouth checkup.

Natural beauty is bone deep. Wide smile and straight teeth are unlikely with tongue tie preventing full development of upper jaw and mid-face.

Natural beauty is bone deep. Wide smile and straight teeth are unlikely with tongue tie preventing full development of upper jaw and mid-face.

A normal tongue is agile, and free to move upward and backward to serve Nature’s palatal expander. An unrestricted tongue is a best-kept secret to a fully-developed face with high cheek bones and naturally straight teeth.

What Is A Tongue Tie?

On the other hand, tongue tie is a handicap restricting the tongue to the floor of the mouth, keeping it from expanding the palate. Ankyloglossia, the medical term for tongue tie, means the tongue is anchored to the floor of the mouth by a stiff cord (lingual frenum).

Example of tongue tie and resulting dental arch deformities. Note: diagnostic signs: heart-shaped tip and inability to touch the back of upper front teeth.

Example of tongue tie and resulting dental arch deformities. Note: diagnostic signs: heart-shaped tip and inability to touch the back of upper front teeth.

The length and flexibility of the frenum cord determines a tongue’s resting posture, which counts more than its action in creating malocclusion (1). Low tongue posture is linked to class III malocclusion with crescent-moon facial profile (2).

A 2014 study found tongue-tied patients to have a tendency toward Class II Malocclusion characterized by weak chin (3), while another study confirmed long frenum leads toward class III malocclusion with excessive chin(4). “Studies which are being done on the association of lingual frenum and orofacial musculature are still in infantile stages.”

Why Does Tongue Tie Matter?

The tongue plays a big role in life from very start. If you are an exhausted mother (or know of one) with an restless and inconsolable baby, consider the tongue as a possible cause.

69% of lactation consultants believe tongue tie in a newborn can interfere with breast feeding (5). A new 2012 protocol is now available to evaluate tongue tie in newborns relative to “feeding fatigue” which is characterized by: less than one-hour between feedings, fewer sucks, and longer pauses between sucking groups (6).

If the tongue tie condition is recognized and treated early with Myo-Functional Therapy, the tongue is free to follow The Law of Form and Function. Then normal dental-facial development can resume, usually with few medical-dental or orthodontic problems.

If allowed to persist, however, tongue tie can lead to nursing and weaning difficulties, tongue thrusting, weak lips, mouth breathing, dysfunctional swallows, which in turn can impair ideal dental-facial development and create medical-dental complications with many whole body symptoms.

Left untreated, tongue tie forces other muscles to over-compensate. Imagine a hockey or soccer team playing with one-man down. What if the penalty lasts a life time instead of 2-5 minutes?! Long term consequences of tongue tie can contribute to:

  • Malocclusion, crowded/crooked teeth and facial disharmony requiring braces, surgery, or regular chiropractic or massage treatment
  • Under-development of the upper jaw and a flat mid-face
  • Over-development of the lower jaw contributing to a “crescent moon” profile
  • Progressive crowding or spreading of the upper and/or lower front teeth
  • Relapse after orthodontic treatment (braces)
  • Facial disharmony: flat mid-face, long-and-narrow “horsey” face, squat bull-dog face
  • Snoring, sleep apnea, teeth grinding, and associated medical-dental costs

You can tell Tongue Tie from Tongue Shape during crying

Tongue Tie Tongue

Top left: Round or square means no tongue tie
Top middles: V-notch at tongue’s tip suggests tongue tie
Top right: heart-shaped tongue shape means strong tongue tie

Source: International Journal of Orofacial Myology;2012, Vol. 38, p104

How do you know if you have tongue tie?

Here are a few clues:

  • When you point your tongue straight out and upward, does it show a heart- or fan-shape? “Yes” means tongue tie.
  • Can you click your tongue and make a POP sound? A tied tongue cannot click.
    With your mouth wide open, can the tip of your tongue touch the back of your upper front teeth without strain? “No” suggests a tongue tie.
  • With 2 fingers’ space between your upper and lower front teeth, can your whole tongue (front-middle-back) make contact with the entire palate — front, middle, and back? “No” suggests tongue tie.
  • Where is your tongue right now — on the floor of your mouth, behind your upper front teeth, on the roof of your mouth (palate)? Any place other than full contact with the whole palate points to a tongue handicap.
  • When you swallow, do you have lines and wrinkles around your mouth and/or chin? “Yes” suggests tongue restriction associated with a dysfunctional swallow.

Tongue Tie Solutions

In a nutshell, tongue tie in children can negatively affect dental-facial development, speech, posture, social acceptance, and possibly entire life. Tongue tie in adults represents incomplete development, which carries a price in and around the mouth, and throughout the body. It means your fullest health has been short-changed.

The good news is that tongue tie is readily treatable at any age.

The best way to confirm a tongue tie is to consult with a dentist trained in Oral-facial Myo-functional Therapy (OMT), which is physical therapy using exercises to reprogram and rebalance the tongue and swallowing muscles in and around the mouth.

In milder cases, doing Myo-Functional Therapy (7) can get your mouth and head back to better balance and fuller health. Some tongue ties are too severe for OMT to be effective. That’s when a lingual frenectomy may be needed in combination with Oral-facial Myo-functional Therapy.


1. Proffit WR, Mason RM.Myofunctionaltherapyfortongue-thrusting: background and recommendations. J Am Dent Assoc 1975;90: 403-11.

2. Hopkin GB. Neonatal and adult tongue dimensions. Angle Orthodontics,1967;37:132-3.

3. Meenakshi S, Jagannathan N, Journal of Clinical and Diagnostic Research. 2014 Mar, Vol-8(3): 202-204.

4. Jang SO, and others, Am J Orthod Dentofacial Orthop 2011;139:e361-e367.

5. Messner AH, Lalakea ML (2000). “Ankyloglossia: controversies in management”. Int. J. Pediatr. Otorhinolaryngol. 54 (2–3): 123–31. doi:10.1016/S0165-5876(00)00359-1. PMID 10967382.

6. Martinelli R, et al, LINGUAL FRENULUM PROTOCOL WITH SCORES FOR INFANTS, International Journal of Orofacial Myology;2012, Vol. 38, p104.

7. Orofacial Myofunctional Therapy

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