Introduction

Do you know tongue-tie can affect someone beyond their physical health? Have you ever wondered how tongue tie can bruise an adult’s self-esteem and confidence? This article will tell you about the pyschosocial effects related to iadults with tongue-tie.

Ankyloglossia (ankylos-tight; glossa-tongue) or tongue tie is a medical condition where the band of tissue called the frenulum that connects the tongue to the floor of the mouth is shorter or tighter than normal. It could be partial or total ankyloglossia.¹ It is more common in males than females, with a ratio of 3:1. Its prevalence in the general population ranges from 4% to 10.7%.^2,3

Although this is frequently identified and treated in infancy because of failure to thrive due to improper latching on the breast during nursing and bottle-feeding, it also affects speaking, eating, oral hygiene, and breathing during sleep by unnaturally limiting tongue movement; it can also persist in adulthood, leading to various challenges.³  

Understanding tongue tie in adults

The tongue is an essential muscle needed for feeding, speaking, maintaining good oral health, swallowing, breathing, and body language.⁴ Most tongue-tie cases are detected early in infancy due to poor feeding, leading to failure to thrive. For the missed cases that grow till adulthood, the situation goes far beyond feeding properly. The struggle of eating and swallowing can persist into adulthood, added to other challenges. They struggle with speaking properly; mispronouncing consonant sounds "t," "d," "s," "z," "l," "r," "th," and "n". Their oral health also suffers greatly due to the inability to sweep food particles from the teeth. This promotes poor oral health such as gum inflammation, tooth decay, and edentulism. They also struggle with performing other oral activities which we may take for granted such as licking an ice cream, playing with a windpipe, licking the lips, and kissing.⁵ Another challenge they have is low self-esteem and confidence, which we shall be talking about at length in this article.

The psychosocial effects of tongue tie

Psychosocial well-being is closely linked to self-esteem and self-confidence. Whilst self-esteem involves one's overall sense of worth and value, self-confidence reflects belief in one’s abilities and competence, shaped by psychological traits and social reinforcement.^6,7 They all play a role in determining if someone plays a productive role in society and has a ripple effect on how they view their abilities and person.

Self-esteem issues linked to tongue tie

Speaking is essential in that it facilitates the expression of desires, needs, and ideas, promoting relationships and effective communication. These are the cornerstones of forming bonds, interacting with others, and contributing to society.⁸ Verbal exchanges are the main mechanism via which social interactions, an essential component of self-esteem,translate into how one is viewed and regarded by others.⁹ Self-esteem tends to decline following a series of unfavourable social encounters.

As adults with tongue ties have trouble pronouncing words correctly or producing certain sounds, their peers and audience may make fun of them. This causes a fear of speaking in front of an audience or striking up a conversation.⁵ Their intellectual capacity is frequently questioned due to their ambiguous speech, which further embarrasses them. When combined with poor oral health, these factors can cause them to internalise shame, which lowers their self-esteem and results in the individual avoiding situations requiring verbal communication or any kind of interpersonal interaction.

Impact of tongue tie on confidence

In a world where fluent speech is a marker of competence, while assertiveness and networking play a key part in career and societal progress, adults with tongue ties have a unique challenge due to low self-confidence. This is due to how a tongue with limited motion impacts their articulation, eating, and self-perception. Difficulties with pronunciation may lead to anxiety and depression in social or professional settings,. This affects their ability to be productive in society as they will have limited career opportunities, especially those needing extensive verbal communication and human interaction.¹¹

The restricted tongue mobility makes it difficult to move and produce food boluses in the mouth, hindering appropriate chewing and swallowing. Food becomes dispersed around the mouth, making chewing more difficult and time-consuming and making feeding uncomfortable. As a result, people shun particular foods and are afraid to eat in public, which lowers social interactions.¹²

Physical characteristics brought on by tongue tightness can cause self-consciousness. Poor dental health can result in tooth infections and gum inflammation that can lead to bad breath and loose teeth.^13.14 These contribute to exacerbating social anxiety and depression. Other factors that might cause insecurities include the inability to stick out the tongue, a heart-shaped tongue, or changes in jaw or face structures owing to excessive tongue tightness.

Management

At this point, you might be wondering what the necessary steps could be to mitigate the psychosocial effects of the tongue on adults. Management can either be conservatory or surgical.

People who decide against having surgery can use a variety of coping strategies to enhance their daily lives, which will boost their confidence and sense of self. Despite tongue tie, speech clarity and articulation can be improved by using compensatory speech procedures. This will call for working with a speech pathologist, doing certain tongue exercises to slow speech, and deliberately practicing challenging sounds. Oral health can be improved with regular dental checkups combined with adjusted mouth care using the right devices. Making dietary changes like selecting food that is softer and easier to chew, consuming modest portions, and drinking enough water can also be beneficial. Reducing frustration and enhancing psychological health can be achieved by participating in activities that do not primarily rely on tongue movements.¹⁵

If surgical intervention is decided, frenotomy, which is the procedure that entails cutting the frenulum, is the most common procedure. Added to speech therapy, it has been proven to improve tongue mobility, consonant pronunciations, articulation and overall speech abilities.¹⁶ The importance of psychotherapy counseling and speech therapy cannot be understated in adults with tongue ties.^17,18

Summary

A tongue tie is a condition in which the tongue’s movements are limited by a tissue under it. This distorts the normal functions of the tongue, such as chewing, speaking, swallowing, and keeping the mouth healthy. This leads to several challenges, such as poor oral health, poor swallowing, and poor articulation, that have a ripple effect to affect an adult’s self-esteem and confidence, and hence their professional growth, productivity in society, and intimate relationships. The availability of non-surgical and surgical treatments associated with psychotherapy gives a gleam of hope for the psychosocial well-being of all those adults with tongue ties.