All Tied Up: What exactly is Ankyloglossia?

Guest blogger Dr. Jordan Hubbard from Hubbard Dental sheds light on the topic of oral restrictions (also known as ankyloglossia). For the purposes of this blog post, we are speaking only about restrictions in newborns and infants. As a child gets older, additional therapies and different treatment modalities are sometimes required.

What is an oral restriction?

An oral restriction is an anatomical variation that causes a change in regular functioning of the person which usually leads to a show of negative symptoms. Some of these symptoms are more apparent than others. There are multiple locations for these restrictions or “ties” that can be present in the mouth, and a trained provider will check all of them to see if they are causing difficulties for the baby to perform regular movements and reflexes. Each area where these tissues are tethered can cause different symptoms, but the most common oral restrictions showing symptoms are tongue and lip ties. Lip ties can cause the common (but not normal!) milk blisters on babies lips, it can cause milk to spill out the sides of the mouth while feeding, and can also cause tension to be seen in the face. Tongue ties are most commonly associated with trouble breastfeeding as an infant as well as pain for the mother, but the elusive posterior tongue-ties, if not caught in infancy, sometimes don’t show symptoms until that child reaches adulthood.

Some signs to look for in your baby that could be a sign of a tongue tie include (but aren’t limited to):

  • Painful breastfeeding, hurt nipples, plugged ducts or mastitis
  • Excessive spit-up or vomiting after eating
  • Gassiness/colic
  • Noisy sleeping, mouth breathing, restless sleep
  • Poor weight gain
  • Baby feeling frustrated at the breast/bottle
  • Increased tension in the body
  • Constipation/irregular bowel movements

Some tongue-ties are easy to see with the untrained eye. The restriction looks almost like a string that is holding the tongue to the floor of the mouth. Posterior tongue ties are harder to spot, and only highly trained clinicians typically can diagnose them. The reason is because these tongues look “normal”, and the restriction is actually behind the tissue in the mouth, so that string-like appearance of the tie is hidden. A lot of the time, parents may only suspect a posterior tie based on symptoms present. While the posterior tie is harder to visually see, this type of restriction is typically the one that causes the most symptoms and the most issues, especially if it is not released, and improper functioning continues into adulthood. 

What does treatment look like?

If an oral restriction is suspected in a baby, the first step is to work with a trained IBCLC, or international board-certified lactation consultant, specifically one who is savvy with tethered oral tissues. A trained IBCLC will be able to recommend exercises to help improve movement, flexibility, and strength for the baby’s oral function. They can also help alleviate symptoms that the mother may have (sore nipples, improper milk supply, or pain with latching) until a release can be performed. Most of the time, the exercises that are recommended by the IBCLC are not only dealing with the mouth, but with the whole body, because an oral restriction can cause whole body tension in babies. The IBCLC may also recommend chiropractic care or other types of bodywork to help baby have the best outcomes from a potential tongue-tie surgery.

Once appropriate pre-operative care is complete, it is time to find a surgeon for the release of the tethered oral tissues. Finding a provider who has a lot of training (and good training!) can be challenging. Asking your IBCLC who they recommend is a good place to start. Checking the provider’s website to show what courses they have taken, who they have studied under, or other patient testimonials can be a good way to find a provider as well. The biggest thing is ensuring the procedure is performed with a CO2 laser. Not only does this type of laser ensure minimal bleeding and minimal post-op discomfort, but it also helps to ensure the best chance for a complete release for the baby. The laser procedure itself takes just a few seconds. The wound will be left open, and stretches will be prescribed in order to help the wound heal by secondary intention and not reattach. Reattachment can occur if stretches are not preformed adequately, and if this happens, symptoms can become worse than they were prior to release. The stretches prescribed are an extremely important aspect of treatment outcomes. You will likely see your release provider for a follow up appointment to ensure healing is taking place normally, and you will continue seeing supportive care (IBCLC, bodywork, chiropractor, etc) for additional support and exercises after the release to help baby function at their best. 

What if I choose not to get my baby’s ties released?

It is always your choice in what medical procedures are done for you and your family. However, an oral restriction is made with fascia, not muscle, and it will never “stretch” or “lengthen”. This means that it won’t get better on its own, and symptoms will not disappear, instead, the body will learn to compensate with the tethered tissues. These compensations can vary in how symptoms present, and compensations can lead to more issues later on. Some patients who are left to compensate can be left with orthodontic issues, airway issues like sleep apnea, and migraines or severe head and neck tension from ties that aren’t released. Tethered oral tissues that remain into childhood and adulthood can also cause speech and feeding issues as well. It is always easier to treat the problem early in life, because later on, many more steps are needed prior to release in order to have the best outcomes.

About the Author

Dr. Jordan Hubbard has always had a passion for the human body, how it works, and the physiology of how it is regulated. In high school, she found her passion for dentistry. She graduated from the University of North Carolina Wilmington’s Honors College with a BS in biology and minor in psychology in 2013. She went on to graduate from the University of Detroit Mercy School of Dentistry in 2017 and was awarded the AGD Excellence Award signifying she showed the highest excellence in general dentistry in her class. She also graduated with the ASDA Certificate of Excellence Award, received a Deans Circle Scholarship, and took additional courses to get her Certificate in Forensic Odontology upon graduation.

After graduation, she worked as an associate while taking continuing education courses in implantology, pediatric dentistry, and cosmetic dentistry. Once she purchased her practice in 2020, and had children of her own, she became fascinated with infant frenectomies and airway dentistry. She has spent the last 2 years studying her craft and has taken courses from leading experts in the field including Dr. Richard Baxter, Dr. Soroush Zaghi, Dr. Jared Poplin, and Dr. Erin Elliot. She has shadowed with Dr. Guy in Fayetteville to get mentorship on the frenectomy side of her practice and has worked with multiple other professionals in our area including myofunctional therapists, ENTs, IBCLCs, and speech language pathologists to help ensure patients have the best outcomes from their procedures.

Dr. Hubbard is passionate about functional dentistry, and getting to the root cause of problems to help ensure patients don’t just “get-by”, but truly thrive.



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