Is It Worth Removing Tongue-Tie in Adults?

Most people think of children when they talk about tongue-ties. However, about 25% of adults also have a tongue-tie, and this condition may be overlooked or well-managed. It is possible that people can adapt to this condition, but even mild cases can have lifelong implications in adulthood and become more challenging to deal with over time.

What is a tongue-tie?

The tongue is a highly motile organ involved in speech, swallowing, and taste. The tongue can be divided into two parts — the pharyngeal part, which sits at the back of the throat, and the oral part, which is at the front of the mouth and is connected to the floor of the mouth by soft tissue called lingual frenulum.

Abnormalities in lingual frenulum development result in movement and function limitations of the tongue, causing ankyloglossia, or in simple terms — tongue-tie. Tongue-tie is a congenital (present from birth) anomaly common in babies, but it can carry through to adulthood and can often be misdiagnosed or overlooked. You can recognize common signs of tongue-tie and improve your overall health by receiving appropriate treatment or, with the right support, you can learn techniques to cope with this condition.

Tongue-tie vs. normal tongue

Tongue-tie is a condition with an unusually tightened, thickened, and shortened frenulum. Normally, the frenulum stabilizes the tongue and provides support while speaking, eating, and swallowing. In the case of tongue-tie, physiological tongue position and movement are affected, causing a spectrum of severity cases (from mild to severe).

What are the typical symptoms of tongue-tie in adults?

Anatomical symptoms of tongue-tie can vary depending on the severity of the condition, but they may include:

• Shortened and thickened frenulum
• Heart-shaped or notched tongue
• Limited tongue mobility
• Difficulty elevating the tongue
• Inability to extend the tongue
• Tongue curling

Side effects of a tongue-tie in adults

Tongue-tie can cause a lot of problems related to your overall health. The most common symptoms of tongue-tie in adults are:

• Speech problems. Difficulties articulating sounds like ‘s, z, t, d, l, j, zh, ch, th, dg’ and especially difficult to roll an ‘r.’
• Poor oral health. Due to the tongue’s limited mobility, it becomes difficult to remove food and debris after eating. People with tongue-tie will need to take more precautions with dental hygiene. As a result, they may have a higher risk of gum inflammation, gum disease, bad breath, frequent cavities, and similar.
• Temporomandibular joint (TMJ) dysfunction. TMJ are two joints connecting the lower jaw to your skull. Due to tongue-tie, speaking, swallowing, and eating may cause extra work for the jaw muscles. In addition, in tongue-tie, the positioning of the tongue may be unnatural, which could also contribute to jaw pains.
• Abnormal alignment of teeth. According to dental research, tongue-tie has been associated with an anterior open bite, where the upper and the lower teeth are slanted outward and don’t touch when the mouth is shut.
• Poor sleep quality. Untreated tongue-tie can cause changes in the craniofacial-respiratory complex — bones, muscles, soft tissues, and nerves involved in breathing, chewing, speaking, and swallowing. Therefore, people may start breathing through their mouths, which prevents the brain from experiencing deep sleep.
• Snoring. When the tongue is tightly tethered due to tongue-tie, it may not rest properly during sleep and cause blocking of the airways. However, snoring can be caused by various reasons — not everyone who snores has a tongue-tie, and people who have a tongue-tie do not always snore.
• Sleep apnea. Due to tongue-tie, the palate can develop poorly, causing a smaller airway. People with a smaller palate have a higher risk of sleep apnea. Sleep apnea can cause daytime sleepiness, difficulty concentrating, morning headaches, memory problems, and similar.
• Quality of social life. Some everyday activities that are common for healthy adults, like kissing, licking lips, or playing a wind instrument, can be impacted by tongue-tie.

Treatment of tongue-tie

Treating tongue-tie depends on various factors, including the severity of the condition and its impact on the overall quality of life. For example, if an individual experiences speech difficulties, oral hygiene issues, limited tongue mobility, chronic oral health problems (like TMJ dysfunction), or any psychological impact, tongue-tie treatment could help improve the health of this individual. In such cases, surgical intervention should be considered.

However, not all cases in adults require treatment. If the conditions are mild or asymptomatic (symptoms do not impact their daily activities) or individuals have effective coping strategies, therapy may be the most suitable option. Myofunctional therapy focuses on the muscles of the face, tongue, and mouth. During the therapy, improper muscle function, particularly related to breathing, swallowing, and speech, can be improved.

If you have any doubts about having this condition or would like to seek advice, it is best to speak to a healthcare specialist such as a dentist or ear, nose, and throat (ENT) specialist.

Tongue-tie treatment options for adults

The most common way to treat tongue-tie in adults is surgical intervention, such as frenotomy, frenectomy, and frenuloplasty (Z-plasty), coupled with myofunctional exercises before and after the procedure.

Frenotomy

Frenotomy is a simple procedure that can be carried out with a typical cold-blade scalpel or by the use of a laser. During the procedure, a simple horizontal cut is made to release some tension on the tongue. Frenotomy is a quick, minimally invasive procedure. No general anesthesia is needed during the operation.

Traditional frenectomy

Frenectomy is a more extensive surgical procedure because it involves partial or complete removal of the frenulum membrane and the underlying tissue. Therefore, frenectomy is used in more severe cases of tongue-tie patients.

A frenectomy can be performed by using a scalpel, laser, or electrocautery (a surgical needle that uses electrical heat), or the traditional way is to use the scalpel. Traditional frenectomy procedure usually involves general anesthesia and suturing; after the procedure, analgesic and/or anti-inflammatory drugs are required.

Laser frenectomy

Surgical laser treatment appears to be a more effective and promising method for children and adults. Usually, local infiltration anesthesia (numbing only the targeted area by injecting the drug directly into the tissue around) is used; in some cases, only topical anesthesia is enough. Additional sedation with nitrous oxide can be also done.

The need for anesthesia depends on the laser type, but compared to traditional frenectomy, the amount of anesthetic administered can be significantly reduced. Moreover, after the laser frenectomy, the requirement for stitches is very low compared to traditional frenectomy. Therefore, this treatment method is simpler and shorter.

Electrosurgery frenectomy

Electrosurgery frenectomy is a surgical procedure used to release the frenulum by using high-frequency electrical currents to cut the tissue. This procedure is recommended for patients with bleeding disorders because the device simultaneously seals blood vessels as it cuts, so there is no need for stitches following the procedure.

Z-plasty frenuloplasty

Z-plasty is a surgical technique that involves creating Z-shaped incisions, which allows for the rearrangement of the tissue and the redistribution of tension. This procedure is performed in cases where the frenulum is thick. Z-plasty surgery is done under general anesthesia, it requires stitching, and scarring is possible after the procedure.

How to choose the right treatment

If you are experiencing any of the tongue-tie symptoms mentioned above and need support or are considering treatment options, you should speak to your healthcare provider. For mild cases with no severe symptoms, surgical procedures may not be required. Myofunctional therapy with exercises could help you to manage your condition.

In severe cases, surgery should be performed. Your doctor will decide on the best one for you. The cost of the surgery may differ depending on whether the frenectomy is performed by scalpel, laser, or electrosurgery. Laser and electrosurgery prices are higher due to the price of the equipment and expertise. Also, if anesthesia is necessary, it can impact the cost.

Insurance coverage for the surgery depends on the health insurance plan. Some insurance plans may cover frenectomy for certain indications, while others may consider it a cosmetic procedure. You should check with your healthcare provider for further specifications. On average, surgery can cost about $2,000, which will cover the exam and the surgery fees.

Recovery

Following the procedure, some painkillers can be prescribed for the first one to two days as needed. Antibiotics are usually not required. Most people can go back to work the next day after the surgery. You should stick with soft foods for a few days and start some exercises for better recovery.

Tongue-tie condition should be managed during newborn screening. Nevertheless, if this condition was overlooked or previously well-managed, you can still improve the quality of your life as an adult. If you are experiencing the symptoms listed above, don’t hesitate to contact your healthcare specialists. It is never too late to improve your health, especially when it is that easy.