• Megan Graham

Why “Clip and Go” Tongue Tie Releases Often Fail

You've heard the saying before: "If you want to go fast, go alone. If you want to go far, go together."

While that's true in many instances - the power of collaboration, though sometimes more cumbersome, will yield better long-term outcomes - it couldn't be more true when discussing the treatment of tongue ties.

Why A Multidisciplinary Approach Is So Important

First, let's think about the high-level needs in order to achieve a favorable outcome:

  1. Pre- and post-procedure exercises. While many people would love to show up, have a surgery and leave "cured," that is unfortunately not the case with tongue ties. Doing exercises before the surgery set you up for better success. Doing exercises after the surgery, much like physical therapy, retrains your oral muscles and prevents the tether from reattaching.

  2. The tongue tie release procedure. Called a frenectomy or frenuloplasty, a tongue tie release surgery can take many different forms. At Untethered, we use a CO2 laser on our babies. For big kids and adults, we follow The Breathe Institute's functional frenuloplasty approach.

  3. Ongoing maintenance and monitoring. After the tether is released, there is still work to be done. Not just a day's worth, or a week's worth, but ongoing and simple retraining over the long haul. During the time of the tongue tie, the body learns many bad habits and compensations for the physical deficiency. We need to make sure that we're overcoming those bad habits to ensure long terms health.

The point of this post is to point out the importance of all three of these needs, collectively.

Do the exercises and skip procedure? You'll probably be unhappy with your results. Do the procedure and skip exercises? Same deal. Choose to overlook the enduring nature of the issue? You're likely to deal with it again down the road.

So if you're bought in to the idea that there's much more to a release than the procedure itself, the next question becomes: who is on my multidisciplinary team? And the answer is that you should have three primary providers who are all talking and collaborating:

  1. A myofunctional therapist. Think of this person as a physical therapist for your mouth. They will give you the exercises for pre- and post-procedure as indicated in step 1 above.

  2. A proceduralist who is actively engaged with tongue tie research. Oftentimes an ear-nose-throat doctor, this person performs the release surgery. More commonly, this is something your dentist can do. They will conduct the wok described in step 2 above.

  3. A general dentist. This tongue tie stuff is not a one and done kind of thing. You'll need to use your regular cleanings and exams as a chance to check in and evaluate progress. Your dentists will conduct the work described in step 3 above.

There are additional multidisciplinary team members that could help with your release: a chiropractor, a sleep hygienist, and more. But the core team consists of the members outlined in the list above. Be judicious when evaluating your options, and bring up the value of each of these roles to any provider who claims that they are able to solve your tongue tie challenges as a party of one.

How We Measure a Tongue Tie at Untethered

Releasing a tongue tie is as much about pre- and post-procedure therapy as the procedure itself.

The tongue is a complex part of the body, some of which we can see with our own two eyes by simply looking in the mirror. But aside from the tip and apex of the tongue, there's a whole lot going on in parts that we can't readily see. Doctors estimate that upwards of two-thirds of the posterior (back part) of the tongue has been excluded in some modern metrics towards assessing a tongue tie.

In a report published earlier this year in the Journal of Oral Rehabilitation, a team of doctors challenged the notion that the tongue's mobility (referred to as the Tongue Range of Motion Ratio, or TRMR) could be accurately assessed without sucking the tongue to the roof of the mouth. By incorporating this lingual palatal suction (LPS) as part of the assessment, interventionists are able to determine treatment based on a more comprehensive understanding of the entire tongue.

Why does this matter?

Well, quite simply: this is complicated stuff! Tongue tie releases are getting more publicity lately, and there are some cases where patients are dissatisfied with their outcome. In a quick-fix society, many have become accustomed to visiting a proceduralist, receiving a treatment, and going about their lives pre-procedure. While we'd love for it to be that easy, the truth with tongue ties is that it isn't that simple. In order to accomplish a successful outcome, you'll be required to put in some work. Fairly simple work, yes, but work nonetheless.

What does that work look like?

Typically, both before and after a tongue tie release, you'll be required to do a variety of stretching and strengthening exercises. In some cases, your myofunctional therapist may work with you to retrain your natural habits. Or if you're the parent of a little one, the therapist will serve as a coach of sorts to help you facilitate the therapies at home.

The benefits of tongue tie release are many, but to reap those benefits requires a degree of diligence and commitment. This is complicated stuff. At Untethered, we want to help you get the best outcome possible. That requires a comprehensive assessment of the whole tongue, the latest and greatest in pre- and post-procedural myofunctional therapy, and the least invasive release procedure possible. We live and breathe this work and invite you to reach out with any questions!

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