First let’s start with the fact that the tongue is an important oral structure that affects speech, position of teeth, nutrition, swallowing, nursing/eating, speaking, periodontal tissue, and much more. 

We are just now discovering how important the tongue really is to our growth, development, and overall health.

What does it mean to be tongue-tied?

Ankyloglossia, the medical term for a (tongue-tie) is a congenital anomaly that is generally characterized by an abnormally short, thick lingual frenulum ( the band of tissue that attaches the tongue to the floor of the mouth) which affects the movement of the tongue. If it is tight, also known as tethered, the tongue will have limited mobility.

The term ‘functional ankyloglossia’ is used to characterize limitations of tongue mobility that may or may not be directly attributed to a structural restriction in the lingual frenulum.   

There are many other causes for impaired tongue mobility such as airway obstruction and lack of generalized movement, as well as inadequate tongue space and extraoral facial restrictions, among other factors that are often underappreciated where the tongue is concerned.

When the frenulum is restricted the other muscles of the face and neck compensate and take over function. Creating a myo functional disorder.

I was taught in school that you are only tongue tied if you have difficulty latching as a baby, could not stick your tongue out over your lower front teeth or have a speech issue. So we did not give the tongue much thought except for it made it difficult to do our job. 

Now we know so much more about the tongue and the gravity it has on our overall health. I tongue restriction is more than just those three things we learned back then they are now known as an anterior tongue tie or as a class four tongue tie and are only the tip of the iceberg in the myofunctional world. 

Restricted  tongue  mobility  has  long  been  known  to  impact speech, feeding , and oral hygiene. More recently restricted tongue mobility has been potentially implicated in facial development, mouth breathing, myofascial tension and even AHDA, sleep-disordered breathing, and sleep apnea.

The tongue is connected to a facia system that connects all the way down to your toes that can even have an effect on posture. 

Yes your tongue can have an effect on your posture and ability to stretch to your toes. I found this so fascinating. I had to know more. The more I learned the more I am thinking why and how I did not know this as a dental professional. We look in mouths all day long. After 35 years in the dental field how am I just hearing about this? This information could have changed my life, my daughter’s life and my nieces if I knew this information sooner. Think of all the people I could have helped.  So this is why I am sharing what I have learned and continue to learn.

If someone has a restricted lingual frenum where the muscles of the face and neck are compensating for the fact that the tongue cannot touch the roof of the mouth or the back teeth. They can experience symptoms like rolled shoulders where they slouch or don’t stand up straight, they can have neck or shoulder tension, they may have headaches, mouth breathing, teeth grinding or clenching, snoring and arousals at night when they sleep causing frequent urination at night or bedwetting. 

Who knew that this band of tissue under the tongue could be so influential from how we nurse as babies- to how our facial anatomy and airway develops as children and as adults and has an effect on breathing and how much oxygen we get.

When the tongue is positioned correctly in the mouth during rest posture, we can then develop good oral myofunctional habits which helps to facilitate better breathing and cranio-facial development.

So now that you know what a tongue tie is, lets see if you are:

A Simple Test For Tongue-Tie

Stand in front of the mirror and see how wide you can open your mouth- then place the tip of your tongue to the back of your upper front, and see what happens to your lower jaw.

  • Do you find yourself closing down significantly?
  • Are your neck or jaw muscles straining to make this movement?
  • Have you noticed other symptoms, such as being tired all the time or not having good breathing habits?

If so, perhaps it’s time to be evaluated by a provider who knows how to diagnose and treat tongue-tie. 

If you can not touch the roof of your mouth without closing down you or a loved one are very likely tongue tied. It is congenital so ask a parent or grandparent if they are tongue tied or have them do this test.

I’m so fascinated by the study of this field and the approach to treating sleep disordered breathing and ADHD in kids. It is not just one mode of treatment, but instead understanding how to take a multifactorial and collaborative approach to give patients the best outcome.

Until recently, the methods commonly used for screening and defining tethered oral tissues have been limited in their inclusion of “function” as a key variable in assessment.

Conventional definitions of ankyloglossia have been based on assessments of “free tongue length”. In the past decade, research advances have been made that examine mobility using the tongue’s range of motion ratio (TRMR) while the tongue tip is extended towards the incisive papilla (TIP). This measurement has indeed been helpful in assessing for variations in the mobility of the anterior 1/3 of the tongue (tongue tip to apex), however it can be insufficient to adequately assess the functional mobility of the posterior two-thirds of the body of the tongue. 

Measurements of tongue mobility using the validated Tongue Range of Motion Ratio (TRMR) were performed during two functional movements:

See the chart below from The Breathe Institute!

  1. with the tip of the subject’s Tongue on Incisive Papilla (TIP) – see fig. 1, and
  2. while the subject’s tongue was held in Lingual Palatal Suction (LPS) – see fig. 2.

In order to facilitate the ongoing spread of new tools and information, The Breathe Institute makes all of its research publications open-access.   The full length article can be read here —>


TRMR measurements were compared with subjective self-assessments of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate.

The advantage of the LPS (fig. 2) measurement is that it best describes one of the main functional outcome goals of myofunctional therapy: achieving tongue body to palate contact requisite for establishing ideal resting oral posture and swallow mechanics. LPS measurements have been used to track progress with tongue strengthening and rehabilitation in myofunctional, speech and swallow therapy protocols. These charts and measurements help us determine if a tongue tie release is needed or recommended. 

Myofunctional therapy before a tongue tie release helps a patient learn to control the tongue independently from the other muscles both before and after a release. It also helps prevent relapse.

Dr. Soroush Zaghi’s, patients often say that they feel a release in their body when they have gone through the procedure called a frenectomy (tongue tie release) and I believe it’s because the constriction they once had, is no longer there. You can see the videos on the breathe Institute web page!

No health journey is a straight path and in connecting dots. You have to be willing to deal with twists and turns.

Myofunctional therapy and its evolution as a fundamental aspect of articulation training Orofacial myofunctional disorders have been discussed in the literature for over 100 years.

In the late 1800’s, Edward Angle, D.D.S., also known as the “Father of Modern Orthodontics,” published Malocclusion of the Teeth. He recognized the influence of mouth breathing on the resting posture of the tongue and lips and viewed compromised resting posture as the primary hindrance to orthodontic treatment. In fact, he asserted that negative oral habits must be eliminated for successful orthodontic treatment to occur. 

Geoge Catlin,  wrote “Shut Your Mouth Save Your Life” in the 1860’s  A book detailing the effects on human life of poor respiration he traveled through North America to observe first-hand the effects breathing had on quality of life.

In the 1950’s , Dr. Walter Straub, a California orthodontist, developed a myofunctional therapy program for patients with ”perverted swallowing,” or tongue thrust. He trained dentists and speech pathologists to become future myofunctional therapists. Two of those speech pathologists, William Zickefoose and Richard Barrett, went on to push the movement even further with their development of therapeutic lessons, training courses, and the eventual formation of The International Association of Orofacial Myology. Zickefoose expanded Straub’s original program and established a training academy for myofunctional therapists. Since that time, mouth breathing, with associated low tongue resting posture and tongue thrust swallowing, have been linked to articulation disorders.

In recent years, increasing numbers of therapists have pursued additional education in myofunctional disorders, having seen the benefits that myofunctional therapy has on both speech and sleep disorder disorders. 

Are you noticing its more difficult to fall asleep since this time of COVID 19 hit?

Do you have difficulty falling back asleep if you wake up during the night?

If so, you are not alone. There are many perfectly good reasons why sleeping is more illusive right now.  And while many people struggled with getting quality sleep before the pandemic of coronavirus hit, wearing masks changed habits, heightened uncertainty  and  brought a new wave of mouth breathing and difficulty sleeping for people

In addition to increased  anxiety and stress that is present, there is also a range of things that are coming from this time of COVID 19 that further disrupts sleep.  

If you are experiencing a sleep disruption, snoring, teeth grinding, getting up to pee in the middle of the night, waking up with a headache or dry mouth. Evaluating your tongue and breathing is a good place to start. Are you tongue tied? If you are unsure I recommend having a consultation with a dentist or oral myofunctional therapist to find out. 

Sleep and breathing are two of the main elements we need not only to survive but to thrive. I offer a free 15 minute consultation or a $99 Evaluation where we can address your questions and concerns. If I cannot help we can find you the provider right for you or a loved one who can!