Untreated tongue ties can lead to a range of complications, affecting many aspects of physical and social development. Whilst it is a benign condition, restricted tongue movement caused by tongue-tie can impact essential functions from breastfeeding in infancy to speech clarity and jaw alignment in later life. 

Understanding the potential effects of untreated tongue-tie highlights the importance of early diagnosis and treatment. The following article explores these complications in detail. 

Introduction

Tongue-tie or ankyloglossia is a condition in which the piece of skin that connects the tongue to the floor of the mouth (the lingual frenulum) is too short or tight. This restricts normal tongue movement, making it difficult to lift the tongue or move it side to side. In itself, the condition is benign (meaning it does, by itself, cause any harm), however, if left untreated, it can cause various complications related to eating, speaking, sleep or facial development. 

Tongue-tie is a congenital condition and is present from birth. In the womb, the foetus’ tongue is fused to the floor of the mouth and the skin cells holding it in place usually die before birth, allowing babies to have full control of their tongue movements. In the case of tongue-tie, for various reasons, these cells do not die and the tongue is never freed. Tongue-tie is most commonly seen in newborns and infants, with a prevalence of between 4 and 11% in babies. In most cases, tongue-tie does not cause any symptoms for the baby or the mother and can resolve itself naturally.¹ However, there are also more severe cases of tongue-tie that can be responsible for the complications outlined in this article if not treated. 

Complications in infants and young children

Depending on the severity of the tongue-tie, infants with the condition can experience breastfeeding difficulties, speech issues, dental issues and challenges with eating solid foods. Below we will look into these complications in more detail. 

Breastfeeding difficulties

The main problem with tongue-tie is that it can make it more difficult to breastfeed, both for the child and the mother. Complications associated with breastfeeding include:²

• Poor latching
• Nipple damage or pain
• Slower infant weight gain
• Breastfeeding refusal
• Lower milk production due to poor feeding

Proper breastfeeding is important, as it provides the baby with all of its nutritional needs, promoting the development of not only the body but also the immune system and can provide a close bonding experience for the mother and baby.³ The complications that arise due to tongue-tie can lead to early cessation of breastfeeding and be distressing for both the baby and parents. 

Speech and language development issues

When tongue-tie remains untreated and fails to resolve itself, it can affect speech. Those affected with tongue-tie may struggle with the articulation of words and have difficulty pronouncing certain sounds, due to the limited mobility of the tongue. 

Whilst some studies have found no differences in the language development of those with tongue-tie, others have shown tongue-tie to have a negative effect.^4,5 It is important to note that language development is a complex process which relies on not only being able to physically articulate but is also influenced by other factors like the language being spoken, societal attitudes or cultural approaches to speaking.

Oral hygiene and dental problems

Untreated tongue-tie comes with its share of dental issues as well. Limited tongue mobility may lead to issues with clearing out food debris from the teeth, causing an increased risk of cavities and tooth decay.⁶ This increased risk is a result of the plaque build-up that forms due to uncleared bits of food-attracting bacteria. Plaque contributes to tooth decay, as it is acidic and essentially eats away at tooth enamel and the tooth itself. 

Tongue-tie can also be associated with unusual jaw development, in particular with the development of the upper jaw. Some studies have shown untreated tongue-tie to be linked with a narrow upper jaw width.⁷ 

Solid food challenges

Those with untreated tongue-ties may find it difficult to chew foods and swallow. Studies have shown that those with tongue-tie have signs of something called oral stage dysphagia.⁸ Oral stage dysphagia occurs when a person has difficulties chewing and moving chewed foods into the throat. This is because the tongue contributes greatly to food movement in the mouth. 

Food-related challenges faced in infanthood and childhood can develop into more serious food aversions later on in life. For example, selective food refusal or sensory food aversion can be linked to food refusal before the age of one.⁹ 

Psychosocial challenges

Living with untreated tongue-tie can not only pose physical challenges but may also come with social and psychological repercussions.¹⁰ Children may realise that they are different from their peers, leading to issues with self-esteem, which may follow them into their adolescence and adulthood. 

Complications in adolescents and adults

Complications that arise in those with untreated tongue ties in adolescence and adulthood are closely linked to those experienced in childhood. As many opt for treatment of tongue tie in infanthood, research on the complications associated with untreated tongue tie later on in life is limited.  

Orofacial Growth and Jaw Development Issues

The jaw stops growing at around age 15-18. Tongue-tie causes a narrow upper jaw, which if left untreated during development comes with a host of orthodontic complications. These include:

• Crooked or protruding teeth
• Impacted teeth - Teeth are stuck or cannot grow in due to crowding
• Mouth breathing
• Crossbite

Orthodontic complications can lead to physical impacts, like tooth decay or jaw pain, but can also have a severe impact on self-esteem and psychological well-being. 

Sleep and Breathing Disorders

Untreated tongue-tie can also be associated with sleep and breathing disorders like obstructive sleep apnoea. Obstructive sleep apnoea can lead to: 

• Fatigue during the day due to a disrupted sleep pattern
• Snoring
• Loud breathing

Compromised Oral Function

Untreated tongue-tie puts a limit on oral functions, hindering social milestones and greatly impacting confidence. Functions affected by untreated tongue-tie include:

• Articulating words
• Kissing
• Playing certain instruments 
• Whistling

Psychosocial challenges

The complications associated with untreated tongue-tie can be tied to psychosocial challenges in adolescence and adulthood. It is well known that difficulties with speech in adolescents have a negative impact on psychological health.¹² Furthermore, orthodontic and dental issues can also lead to decreased self-esteem, social anxiety, embarrassment and other forms of psychological distress. 

Importance of early diagnosis and treatment

Early diagnosis and treatment can aid in the prevention of the outlined complications associated with tongue-tie. Diagnosis and treatment in newborns can help to prevent difficulties linked to feeding, however, it is often a source of frustration for both doctors and the families of the affected.¹³ 

Treatment options

Treatment options depend on the severity of the condition. These include:

• Tongue tie release surgery (frenotomy or frenuloplasty)
• Consultation with a breast-feeding specialist
• Tongue exercises
• Speech therapy

Summary

Untreated tongue-tie (also known as ankyloglossia) can lead to an array of complications. It occurs when the tongue is bound to the floor of the mouth by a thin piece of skin (called a frenulum). As the tongue-tie is left untreated complications move from breastfeeding problems to difficulties with articulation of speech, eating foods and dental health. As children grow, tongue-tie can contribute to jaw misalignment and breathing issues, which contribute to detrimental psychosocial challenges like social anxiety and low self-esteem. Early diagnosis and treatment, including surgeries, speech therapies and tongue exercises, can aid in the prevention of these complications, thus improving long-term outcomes. Recognising and addressing tongue-tie in its early stages is crucial in ensuring proper development and overall well-being. 

FAQs

What syndromes are associated with tongue tie?

Tongue-tie is usually associated with genetics and can therefore be associated with some genetic syndromes. These include:¹⁴

• Pierre-Robin syndrome
• Oral-Facial-Digital syndrome
• Meckel syndrome
• Robinow syndrome
• and others

Is it worth removing a tongue tie as an adult?

Tongue-tie has many different severities, some of which do not cause any complications and others that significantly impact the quality of life. If the tongue-tie removal benefits outweigh the risks, it may be worth looking into tongue-tie treatment as an adult. 

Is it OK not to treat tongue-tie?

Tongue-tie is not a life-threatening condition. In some cases, tongue-tie is removed in newborns and in others clinicians prefer to wait for treatment. Either way, tongue-tie treatment can help to improve the quality of life in those who are impacted.