How dangerous is tongue-tie? - BBC

Awareness of tongue-tie, and its hidden impact on children's health, is rising around the world. Here's how it can be spotted and fixed.

By Kamala Thiagarajan

13th April 2022

Purna Parmar had been looking forward to breastfeeding her son, Janav, after his birth in 2011. But whenever he latched on to her breast, she felt a searing pain. Soon, her nipples were sore, raw and bleeding. "I found it excruciatingly painful," says Parmar, a customer care executive in Mumbai, India. "And yet, I was wracked by guilt that I couldn't even do this basic thing for my child."

Everyone around her was dismissive of the problem, suggesting it was natural for new mothers to face some breastfeeding issues. Her pediatrician suggested she switch to formula. Instead, she put up with the pain and kept up with the feeding routine as best as she could. But as time passed, Parmar realised something was wrong. At parties, her son could never play with the other kids, because he was always the last to finish his meal. At home, mealtimes were draining. Janav lingered over his food, taking up to two hours to finish.

"At first, I thought he was a sluggish eater," says Parmar. "Even his walking was slow and unsteady. And he just couldn't balance on a bike." Rushing him only created more stress. Eventually, she pureed his meals, as he couldn't chew and swallow most foods. He was constantly exhausted.

In 2019, when Janav was eight years old, the mystery was finally solved: he was diagnosed with a severe case of ankyloglossia, also known as tongue-tie, a genetic condition now gaining attention from medical experts and families around the world.

The first signs of tongue-tie can be problems during breastfeeding. Later, children may struggle to chew and swallow food (Credit: Getty Images)

In babies born with tongue-tie, the thin strip of tissue that connects the underside of the tongue to the mouth is unusually tight. This means that instead of resting on the roof of the mouth, the tongue is tied to the floor of the mouth, which can prevent the babies from feeding properly.

The condition is thought to be genetic, and has been known for millennia, but can be hard to diagnose. In the United States, about 8% of children under one-year-old suffer from it, according to a review published in 2020.

In some countries, tongue-tie cases have increased 10-fold

Experts say that awareness of it has been rising around the world in recent years, and some countries have seen a more than 10-fold increase in diagnosed cases. In the US, both the number of tongue-tie diagnoses, and tongue-tie surgeries, have soared.

However, there are still families like Parmar's suffering through years of pain and stress caused by undiagnosed tongue-tie. In developing countries like India, healthcare providers may focus on fighting more immediate threats to babies' health, such as infections, and as a consequence, leave tongue-tie unnoticed and untreated for years. Even in countries where the condition is more frequently diagnosed, it can be overlooked.

Some years ago, Kate Canavan, a mother-of-two living in Raleigh, North Carolina, noticed her younger daughter Anna's speech was not very clear. Anna was only two years old at the time, Canavan had not had any breastfeeding issues, and her pediatrician told her not to worry about it. It wasn't until Anna was four that another pediatrician said something could be amiss and referred them to a speech therapist.

"The speech therapist told us that she had a lip-and-tongue-tie and if those weren't addressed, the speech therapy really wouldn't be very effective because her mouth anatomy was limiting her articulation," says Canavan, meaning, her daughter couldn't move her lips and tongue freely enough to speak clearly.

Trapped

The first signs of tongue-tie can be problems and pain during breastfeeding, as in the case of Parmar and her baby son.

"Children with tongue-tie can't extend their tongues beyond the tip of their lips. This results in ineffective latching, sucking and swallowing, all actions that are so essential for breastfeeding," says Ju-Lee Oei, a senior neonatologist at the Royal Hospital for Women in Randwick, Australia.

As the baby tries to move the trapped tongue and clamps down on the breast to try and feed, the result can be extremely painful for the mother.

For others, like Canavan's daughter, the problems emerge later.

Many children enjoy moving their tongue, which helps strengthen it. Tongue-tie can make those activities difficult or even impossible (Credit: Getty Images)

"Many children with tongue-tie will not have symptoms," says Amulya K Saxena, a consultant pediatric surgeon at Chelsea Children's Hospital, Chelsea and Westminster Foundation Trust and president of the European Association of Pediatric Surgeons, in an interview over email.

The tethering of the tongue itself can be hard to spot. The lingual frenulum is a strip of tissue extending from the back of the mouth to the midline of the tongue. If this tissue is restrictive, the tip of the tongue can't extend beyond the lips, the tongue-tie can be quite evident. However, there is a more hidden kind of tongue tie, located deeper in the mouth, which requires a health professional to detect and diagnose, Saxena says.

Children living with tongue-tie may find it hard to use their tongue freely, be it to play a wind instrument, lick their lips or an ice cream, or use their tongue to help clean their teeth during the day. "In some children, it may cause cuts under the tongue if the lingual frenulum gets trapped between the lower incisor teeth," Saxena says.

The tongue's awkward position, and weaker tongue muscle as a result of the lack of movement, can cause problems beyond the mouth.

"One of the biggest issues with tongue-tie is that the air-pressure balance in the mouth is affected, and this can cause nasal breathing that disrupts sleep," says Ankita Shah, a pediatric dentist and director of the Tongue Tie and Sleep Institute in Mumbai, who diagnosed Parmar's son's case.

Children with tongue-tie often contend with open-mouth breathing and snoring, she says, which affects the quality of their sleep. They wake up frequently with a congested nose, and tend to clench or grind their teeth while asleep, leading to neck and shoulder stiffness, and headaches. The constant discomfort, even if quite subtle, can affect their posture and overall wellbeing.

"We don't realise how much the alignment of the teeth, tongue and the jaw can influence an entire range of body functions," says Shah.

A quick fix?

In milder cases, the problem may resolve itself, says Saxena, the London-based surgeon. The connecting strip stretches as the baby feeds and moves her tongue, and over time, the tongue is less restricted. Advice on the right breastfeeding technique, massaging the frenulum, and exercising the tongue can all help resolve such mild cases, in his view. But if that doesn't work, or if the tongue-tie makes breastfeeding very difficult, he recommends the release procedure. This involves a small cut into the frenulum to help release the tongue.

However, all of these problems – struggling with feeding, eating, breathing, sleeping and speaking – can have other causes. And while in countries like India tongue-tie may be under-diagnosed, some doctors in other countries see a risk of over-diagnosing it.

We went from 10 cases of tongue-tie a month, to 10 per week - Ju-Lee Oei

"In 2017, when we had a huge surge in cases, we decided to look into it," says Oei. The Royal Hospital for Women in Randwick, Australia, where she works, records 4,500 births on average each year. Until that year, they usually had only 10 requests for tongue-tie surgery every month. "We went from 10 a month, to 10 cases per week," says Oei.

Cases at other hospitals in the area had risen too, and some practitioners were charging steep rates for the procedure. "We realised that the surgery was in high demand because it was seen as a quick-fix to correct breastfeeding troubles. However, cutting the frenulum to release the tongue doesn't magically solve all problems," she says.  

The results of their global study, published in 2018, noted that the diagnosis of tongue-tie had risen more than 10-fold in some countries, varied considerably around the world and that greater efforts to standardise care were needed.

Since then, the guidelines at their hospital have changed, says Oei. Every child struggling to breastfeed because of suspected tongue-tie must now be assessed by a breastfeeding consultant. Surgery is recommended only after two-to-four weeks of trying to solve the breastfeeding issues with the consultant's support.

As Oei and her colleagues note in their research paper, even the relatively simple surgery used for tongue-tie should not be carried out lightly, as "subjecting infants to a surgical procedure, no matter how minor, causes pain, stress, possibly longer-term neurological harm".

Surgery and 'tongue yoga'

Saxena, the pediatric surgeon in London, has noticed that families are growing more aware of tongue-tie. "Patient support groups and professional bodies are now offering information on social media," she says.

In India, Shah has also observed a rise in the number of families seeking help, including those with older children. But she, too, advises against resorting to surgery too quickly.

Out of 10 patients who walk into her clinic, roughly only half will need surgery, says Shah. It depends on the severity of the tongue-tie, and its impact on the body, including the airways. "We evaluate the varying symptoms each patient has with this condition, and we ask ourselves if the problem is only because of the tongue-tie? We try to correct other associated problems first before opting for surgery."

While older children may need general anaesthesia, cases in younger children tend to be treated with local anaesthesia, Shah says. In the case of newborns, anaesthesia isn't used at all, as the risks would outweigh the benefits.

However, surgery is not the end of the treatment, says Carmelle Gentle, an independent midwife and breastfeeding consultant based in London. Gentle, who has set up a donation-based tongue-tie centre in South London, recommends that parents help the baby use and strengthen their tongue after the snip, through various exercises.

"We support babies to use their tongue in a new way," she says. "It's a bit like yoga. You may not be able to touch your toes at the beginning of the session, but regular, gentle practice helps you get there."

I was just so relieved that there was a name for what we were going through – Purna Parmar

For some, the growing awareness – and right diagnosis – can be life-changing.

Kate Canavan's daughter, Anna, was helped by surgery. "Because her frenulum was so thick and muscular, and she was so young, the speech therapist and an [ear, nose and throat specialist] recommended that the procedure be done with a surgical scissors and under general anaesthesia. That way, they would be careful to not damage surrounding tissue while releasing the tongue," says Canavan over email.

After the 15-minute procedure, Anna didn't need any pain medication and was able to eat and drink without any problems. She even went to pre-school the next day. Within a month of surgery, her speech improved dramatically.

Purna Parmar in Mumbai, whose son had suffered from tongue-tie for so many years, burst into tears when her doctor told her about the condition: "I was just so relieved that there was a name for what we were going through."

It then took her two years to convince her family that an operation was necessary, but it was worth it, she says. He had the surgery, and it helped. Today, Janav enjoys experimenting with different foods, can finish his meal in 20 minutes – and is then off to ride his bike. 

https://www.bbc.com/future/article/20220322-how-dangerous-is-tongue-tie

Stick out your tongue and find out how healthy you really are

Open your mouth and stick out your tongue. It may show if you have a serious disease. This practice is usual examination in traditional Chinese medicine.

AUGUST 18, 2017

The tongue is closely linked to the brain and other internal organs via nerve pathways, so when something in the body is amiss, the tongue shows it. Photos: dpa

Illnesses have been diagnosed by the tongue’s appearance for millennia, one reason being that people used to be too embarrassed to undress in front of a doctor.

This has changed, of course, but to this day, even mainstream Western physicians make use of tongue diagnosis.

The tongue is closely linked to the brain and other internal organs via nerve pathways, so when something in the body is amiss, the tongue shows it.

The agile appendage reflects a person’s state of health, says Dr Dirk Esser, medical superintendent of the Department of Otolaryngology at Erfurt Helios Hospital in Germany.

Normally, the tongue is a pale pink colour, with a somewhat rough surface and slight coating. A tongue that looks much different from that, even for a few hours, could be a sign of illness.

If it’s black more than periodically, leukaemia may be to blame, while a strong, constant, yellow discolouration could indicate liver or gallbladder problems.

A brown tongue points to possible digestive tract trouble, a greyish one to anaemia, and a blue one to lung disease.

A cold or gastrointestinal disorder often gives the tongue a thick, white coating.

“The biochemical processes in the body behind tongue colouration haven’t yet been scientifically explained,” remarks Rene Graeber, a traditional practitioner in Germany.

He says acid levels in the body could play a role. If an illness causes an imbalance of bile – a yellowish-brown alkaline fluid that’s stored in the gallbladder and aids in digesting fat – acid levels are disrupted as well.

“This could explain a yellow tongue coating, which is linked to the gallbladder,” Graeber says.

The colour of your tongue may be a good indicator of your health.

A study in 2015 found that changes in the formation and breakdown of amino acids could play a role in a brownish tongue coating in cases of gastritis.

Discolouration isn’t the only way the tongue indicates health problems. “Smooth tongue”, known medically as atrophic glossitis, is marked by a smooth, glossy appearance of the muscular organ.

“This occurs due to deficiencies of vitamins or minerals,” notes Dr Andreas Filippi, an oral and dental implant surgeon at the University Centre for Dentistry in Basel, Switzerland.

A burning sensation or inflammation of the tongue could also be a sign of a vitamin deficiency.

If it’s continually red, called “raspberry tongue” or “strawberry tongue”, scarlet fever is a likely cause.

Coating on just one side of the tongue may be due to a nerve disorder or middle ear infection.

A swollen, brown-tinged tongue could be a sign of kidney failure.

And “geographic tongue”, characterised by uneven patches resembling smooth red islands, indicates a digestive tract disorder, Graeber says.

A temporary tongue coating or discolouration is generally no cause for concern, however. Eating blueberries, for example, will turn the tongue blue for a while.

Dr Esser advises everyone to regularly check the appearance of his or her tongue at home in front of a mirror, preferably in daylight and immediately after getting up in the morning – before the tongue has been coloured by food or beverages.

If something appears abnormal, he says, it should be addressed during a visit to one’s family doctor.

Sometimes, the tongue is infected with a fungus. This typically happens to people with a weakened immune system or during therapy with antibiotics.

Oral thrush, as the infection is called, can be treated with antifungal lozenges. Some over-the-counter mouthwashes may help too, Dr Esser says.

Dr Filippi recommends cleaning the tongue regularly, “ideally with a tongue brush and not a tongue scraper”.

Since most of the bacteria in the mouth are on the tongue, cleaning it helps to prevent tooth decay and bad breath. The tongue brush should be used with a special paste or toothpaste.

Graeber has another tongue-cleaning tip – oil pulling, in which you swish around in your mouth a mixture of one teaspoon each of coconut oil and sesame seed oil.

“This doesn’t harm the oral flora and helps guard against infections in the mouth,” he said. – dpa

http://www.star2.com/health/wellness/2017/08/18/stick-your-tongue-out-disease/

The Secrets Hidden In Your Tongue

8 February 2013

by Frank Ervolino, N.D., L. Ac

The tongue is a truly versatile part of your body. It helps you communicate with the outside world, maintain the integrity and health of the mouth and, of course, it helps you nourish yourself. The tongue also holds information about your physical and emotional health, which it keeps secret to those who take it for granted.

Simple knowledge of the tongue can give you a few clues on how your diet, lifestyle and environment can affect your health. By learning a few simple aspects of the tongue and how it relates to the rest of the body, you cannot only learn secrets about yourself, but also about others! In fact, talking to people may never be the same.

Tongue Anatomy 101

The tongue is a muscular organ. It is covered with a moist and pink tissue called the mucosa. The tiny bumps on the surface of the tongue are called papillae. Embedded within the papillae are several thousand taste buds that are responsible for detecting sweet, salty, bitter and sour tastes. Interestingly, there is also a fifth taste, called umami, which can detect glutamate-type of tastes, such as those found in green tea.

The tongue is a unique part of the body in that it is composed of all three of the embryonic layers of the body: endoderm, ectoderm and mesoderm. It also has its origins in the four embryonic arches of the fetus, which make up much of the components of the ears, head, neck, throat as well as fetal cartilage, nerves, muscles and arteries.

This means the tongue represents a large part of the various tissues of the body. There has been research showing that parts of the body, which come from the same origin, can communicate with each other even when they exist in separate regions of the body! From this, one can conclude that the tongue is able to communicate with regions of the head, neck and upper torso. That’s not to say that the tongue is “talking” per se to other areas within the body. Rather, it suggests that what happens in one part of the body may be reflected in another related part of the body.

This makes for some very interesting possibilities. For example, the thyroid, which is in the throat, could have some pathology, such as a hyperthyroid storm as seen in Hashimoto’s disease, and by looking at the tongue, you may be able to see the state of the thyroid tissue reflected in the tongue even before the thyroid symptoms become a clinical symptom.

Reading the Tongue

In addition to expressing and nourishing us, our tongues can provide us meaningful and fascinating information about our state of health.

The bulk of knowledge about the diagnostic aspects of the tongue comes from ancient Chinese medicine, which clinically observed the tongue for over a thousand years. (And most of us would agree that 1,000 years is a luxury few medical systems have to reach a conclusion.)

Chinese medicine uses three main factors when “reading” the tongue: tongue coating, tongue color and tongue shape.

Tongue Coating

The tongue has a coating, which represents the state of digestive function in your body. The coating of the tongue is actually made up of bacteria that reside on the tongue. It is interesting in that most people think they can scrape the coating off of the tongue. In fact, scraping the coating does very little and the bacteria will grow back immediately.

The fact that there are bacteria on the tongue should not be surprising in light of the fact that bacteria reside throughout our entire digestive tract. As such, you cannot actually remove the bacteria from your tongue just by scraping it.

The ideal tongue coating consists of a thin, white film on the surface of the tongue. A thin, white coating indicates that the stomach and digestive system is healthy and functioning in the process of transforming and digesting food.

In Chinese medicine, the white coating represents the residue leftover from indigestion, so a thin, white coating is considered normal and healthy.

If there is a thick coating on the tongue then there is an imbalance to the point where it has impacted the body’s physiology. This imbalance could be pathophysiological or it can be due to other factors such as lifestyle choices or aging.

A thicker, white coat means there is a predominance of cold in the body. Cold is the Chinese term that describes a weakness of physiological function in the body, so a heavy white coat would mean that some system in the body is not able to perform its physiological role in maintaining health, or may represent a viral infection.

A thick, yellow coating on the tongue indicates a predominance of heat in the body. This could correspond to inflammation or a bacterial infection.

A geographic tongue is one where the coating is peeled in areas and easily removed. This type of coating indicates a person who has pushed their body to the brink of exhaustion. This type of tongue is also associated with allergic disorders and autoimmune diseases, but these are severe manifestations. If you have a geographic tongue, it is a sign to slow down and regain your health.

Tongue Color

Tongue color takes a long time to change and therefore reflects the state of one’s health over a longer period of time.

The ideal color of a healthy tongue should be pale-red, which indicates good circulation of blood in the body. This is because, in Chinese medicine, the tongue is an extension of the heart and the color of the tongue is said to represent the health of the blood. Since the blood is what nourishes and maintains the body, the tongue color also shows the overall health of the body and its organs.

A tongue that is nearly white or extremely pale can be a sign of a problem. An extremely pale, “wet” tongue indicates a weakness in the digestive system. This can be accompanied by loose stools, extremity coldness, heavy fatigue and abdominal distention.

An extremely pale, dry tongue can also indicate a blood deficiency, which can affect women more than men, and is frequently marked by anxiety, dizziness, impaired memory, insomnia, chapped lips and eventually anemia.

A bright red tongue almost always indicates a pathological condition. In acute situations, the red tongue will indicate an infection. At the start of the infection, only the tip will be red. As the condition progresses, the redness will advance to eventually cover the whole tongue body.

The tip of the tongue is also known as the heart area. Given this, a red tongue tip without any signs of illness can indicate emotional turmoil.

If there is a red tongue with a yellow coating, there is a chronic inflammatory condition in the body.

A red, shiny tongue with no coating usually indicates a loss of the body’s ability to regulate and offset thermogenic hormones in the body. This is often seen in women who start menopause and men who use Lupron®.

Red dots can also appear on the tongue. These indicate heat or inflammation in the blood. In children this can represent an immune response to infection. In adults, this can indicate what is called heart fire, which can result in insomnia and anxiety.

If only the sides are red, this is called liver fire and can be the result of long-standing anger or resentment. This can also be aggravated by over-consumption of spicy or greasy foods and alcohol. A tongue with red sides can also be seen in people with irritable bowel syndrome.

A tongue with a purple hue indicates long-standing inflammation. This color can be seen in women
who have very difficult menstrual cycles or in people who are experiencing chronic pain.

Tongue Shape

Tongue shape addresses a Chinese medicine concept of deficiency or excess, which addresses physiological strength of the systems or processes of the human body. Take the immune system for example. If there is a deficiency of immune response, such as that seen in mononucleosis, there will be increased illness. If there is an excess of immune response, then there could be asthma, allergies or autoimmune disease.

The ideal shape of the healthy tongue is full, yet not so full as to press on the teeth and leave a serrated edge. There should be no cracks in the tongue body.

A tongue that is thin and pale indicates a deficiency of blood or fluids. Anemia, fatigue, dry skin and lips are often seen here.

A swollen tongue indicates general overall weakness and an inability to recover from this state.

Basically it means the body is weak and losing ground. It is an indicator of gradually worsening overall health.

If the tongue gets so swollen as to have a serrated outside edge to it, this indicates that your energy is getting so low that the tongue will rest against the teeth. This is often a sign of a digestive disorder.

When it comes to cracks in the tongue, this could be a sign of a yeast infection, as well as a biotin deficiency. A cracked tongue is also a symptom of Sjögren’s syndrome. This would be accompanied by a dry mouth, fatigue, joint pain and burning or itching of the eyes.

Healthy Tongue, Healthy You

As you can see, your tongue does so much more than just help you chew your food or lick a stamp. It can be a roadmap to what is going on in your body. You just need to know how to read the signs.

The Secrets Hidden In Your Tongue