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From Trisha's Desk Trisha E. O’Hehir, RDH, BS, Hygienetown Editorial Director

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Checking Lingual Frenums
– by Trisha E. O’Hehir, RDH, BS, Hygienetown Editorial Director

You might have heard in dental school or from medical colleagues that tight lingual frenums go away by themselves and are not a problem.

Don’t believe it. It’s not true.
There are major consequences linked directly to tight frenums including problems with eating, swallowing, digestion, speaking, kissing, snoring and OSA. Look closely at your patients’ frenum attachment and decide for yourself.

Ankyloglosia occurs in approximately five percent of the population and it is three times as prevalent in males than females. When I started looking, I found three males in my immediate family who had tight lingual frenums. My five-year-old grandson was having difficulty saying certain sounds and speech therapy hadn’t helped. The first pediatrician said the frenum was fine, despite speech problems. A year later my grandson saw a new, younger pediatrician who agreed there was a problem. Within a week, my grandson’s frenum was treated by an ENT in the hospital under general anesthesia. I would have preferred that he was treated by a dentist with a laser.

My nephew’s six-year-old son has the classic heart-shaped tongue, due to the tight frenum pull and as an infant was unable to latch on and breast feed successfully. At the time, his mother asked about his tongue, but was told it was not a problem. At six years, his maxillary jaw is very narrow, his teeth are crowded and he can’t lick an ice cream cone. When brought to the attention of his dentist, the mom asked if he treated tight frenums or referred to an ENT. Mom was told emphatically that it was not a problem. As mom and son walked out of the dental office, the six-year old asked, “Why can’t he see it’s a problem? I know I have a problem.”

Adults with tight frenums don’t know they have a problem since it’s never been diagnosed. They’ve adapted to the tight frenum and think it’s normal. After diagnosis and release of the tight frenum, these people are amazed to have a tongue that is free to move as it should.

The reluctance of dentists or physicians to treat tight frenums is more likely due to legal rather than medical reasons. Imagine this scenario: The doctor performs hundreds of successful frenotomies that no one hears about. Then one day a baby moves suddenly and a muscle or blood vessel is cut. This might involve complications and a lawsuit and the news of this one case spreads like wildfire, written up in journals and dentists and physicians agree the procedure should never be done for fear of a lawsuit. Sadly, the hundreds of successfully treated cases will be ignored.

To understand the implications of a tight lingual frenum, hold the tip of your tongue against the lingual of the lower anterior teeth. Now try to talk, eat, or swallow without moving your tongue. Who would want to live like that?

The natural rest position for the tongue is in the palate. If the tongue is tied down to the floor of the mouth, it can’t rest in the palate, exerting passive pressure on palatal development. The result is a narrow, high-vaulted palate with crowded teeth. Early intervention to treat tight frenums can assure natural development of the oral structures, allowing for correct chewing, swallowing, speech and breathing. Have patients stick their tongues out as far as they can and see if the tip is pulled by the tight frenum. With a five percent incidence, you’re likely to see this condition in at least one patient within the next week.

Many thanks to Brian Palmer, DDS, an expert on ankyloglossia and tight frenums.

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