Introduction

Definition of tongue-tie (ankyloglossia)

Tongue-tie, also scientifically known as ankyloglossia, is a congenital condition that restricts the movement and function of the tongue, because of a short or tight lingual frenulum. Lingual frenulum is the fold of tissue that connects the bottom of the tongue to the floor of the mouth.¹ Tongue-tie is common, and it is more common in males than in females, with a ratio of 3:1, affecting 4%-10.7% of the population worldwide.²

You may have tongue-tie in adulthood because it may have never caused issues in your childhood and therefore was never corrected. However, in adulthood it may start to affect your daily-life and limit you in your basic tasks.¹

Symptoms of tongue-tie in adults

There are many symptoms of tongue-tie that you can experience as an adult, that you did not experience in childhood.^1,3,4

Physical symptoms

Because of limited tongue mobility, adults with tongue-tie often have difficulty with:

• Tongue mobility
• Sticking out the tongue or touching the roof of the mouth
• DIfferent tongue appearance - short lingual frenulum and or heart-shaped lip

Functional impact

Other common signs and symptoms for adults with tongue-tie, include:

• Speech difficulties - slurring, difficulty with certain sounds
• Difficulty in eating - chewing, swallowing and licking
• Oral hygiene issues - difficulty cleaning teeth with higher risk of cavities

Associated issues

• Jaw pain 
• Jaw tension
• Snoring 
• Sleep apnoea
• Impact on confidence 

Diagnosis of tongue-tie in adults

When it comes to diagnosing tongue-tie, it is usually done after birth, however, it may not require treatment until adulthood. There are several ways in which you can get diagnosed, either by a self-assessment or by looking for signs and symptoms of tongue-tie in adulthood. However, to have an appropriate diagnosis, it is best to talk with your doctor. The doctor, will perform different assessments, such as:^1,4,5

• Examination of tongue looking at the shape and mobility of the tongue 
• Speech assessments
• Swallowing assessments
• Frenulum assessment scales - measures the lingual frenulum function 

Treatment options for tongue-tie in adults 

There are different ways to treat tongue-tie in adults. In most cases your doctor will choose the treatment that is best for you.^1,5,6

Non-surgical approaches

Tongue-tie exercises are usually recommended to reduce the symptoms before surgery. Exercises can help to gain control over the tongue and correct its wrong use and that of the mouth. With the help of a therapist, you can choose the type of exercise that suits you. These include:

• Oral kinesthesia - assesses the part of the tongue that you move and how you move it. May involve physically touching the tongue
• Diadochokinesis - involves changing the movement of the tongue. The process is repetitive to ensure increase in muscle memory

Surgical interventions

You are never too old for a tongue-tie surgery, but the sooner it is carried out the less the chances of side-effects. Surgical ways include:

• Frenotomy - cutting the lingual frenulum, usually a very quick and simple procedure, with minimal recovery time 
• Frenuloplasty - done in very severe cases, such as having a very thick frenulum. Usually done under general anaesthesia and requires stitches

Post-treatment care

Complications after surgery are often rare, but there is always some risk, such as bleeding, scarring and the possibility of infections. However, your doctor will always monitor it and make sure everything is fine and comfortable for you. 

Alternative treatments

In more recent times, orthodontists have been using a new technology to treat tongue-tie in adults. This is called CO2 lightscalpel laser treatment which uses scissors to visualise the restriction. This allows selective removal of the connective tissue and fibres that keep the tongue restrictive. It is painless and only requires local anaesthesia. 

Potential complications and considerations 

If you have tongue-tie as an adult and choose not to have treatment, there are a few complication that you might experience in the future, these include:^1,4,5

• Poor oral health - reduced tongue mobility can lead to food and debris being accumulated in your teeth. Other condition you may experience are cavities, gum disease, inflammation and bad breath 
• Mouth breathing - having a tongue-tie can prevent the upper palate from developing larger, resulting in a smaller nasal breathing airway
• Reduced quality of life 
• TMD dysfunction leads to incorrect swallowing, misaligned teeth and incorrect development of the jaw. You may experience migraines, jaw, neck and back pain, clicking and or popping jaw

Summary

Tongue-tie is a very common condition that is often diagnosed in childhood, however, you may not always require treatment then, but may need it in adulthood. Those with tongue-tie in adulthood, usually adapt by using their tongue atypically, which can give you short-term relief from symptoms, but it can cause side-effects and complications, such as TMD dysfunction, mouth breathing and poor oral health. If your tongue-tie is interfering with your health or your quality of life, it is best to seek medical help.