Debunking Myths About Tongue Ties

Debunking Myths About Tongue Ties

Among those familiar with holistic health/medicine, tongue ties (ankyloglossia) are becoming quite a hot topic.  As knowledge of them begins to spread, there has been some inevitable push-back, and the circulation of a number of myths.  I’d like to tackle some of those myths here.

Before we do that, let me point something out.  Because tongue ties — apart from the most severe/obvious ones — have gone largely unnoticed for much of recent medical history, there hasn’t been a lot of research done on them of the variety modern medicine has come to rely on.  In that sense, there is “no evidence” for some of the things I’ll be pointing out.  None of these ideas, however, is pulled out of thin air; there is basis for making some pretty solid conclusions about some things based on fairly widespread clinical practice/observation and on logical connections between known biological facts.

Now, let’s get down to it, shall we?

Tongue Tie: The Myths

Myth #1: The pediatrician/family doctor said my child doesn’t have a tongue tie, so he must be okay.

Truth: Although some pediatricians or family practice physicians are likely knowledgeable about tongue tie, most are not.  Many can recognize the most visually obvious tongue ties, but will miss less-apparent ties, because they don’t know what they’re looking for and/or how to check correctly.

Myth #2: If the child can stick his tongue out, he doesn’t have a tie.

Truth: Some ties are so severe the tongue-tied individual cannot stick his tongue out.  However, the ability to extend the tongue forward is not evidence that a tie is not present, because the forward movement of the tongue is not the primary concern.  Rather, the primary concern with a tongue tie is an inability (or inadequate ability) to lift the tongue up — particularly in the back of the mouth.

(In fact, the compensatory, incorrect, swallowing motion that often develops is called a “tongue thrust,” precisely because in this process the tongue thrusts forward when it should be moving up and back.)

Myth #3: A tongue tie with an appearance that is lesser in degree is less significant.

Truth: The reason tongue ties are important is function.  Consequently, the degree to which the tie interferes with function is what truly determines its severity.  There may be a correlation between more visually-significant ties and more functionally-significant ties, but this is not necessary a direct linear correlation.  Some people manage to function quite well with fairly (visually) significant ties, while others have ties that are difficult to even identify with the untrained eye but which greatly interfere with function.

Myth #4: If my baby can breastfeed okay, he can’t be tongue-tied (or his tongue tie doesn’t matter).

Truth: Perhaps not.  Certainly everyone doesn’t have a tongue tie!  However, ties can impact more than just breastfeeding, and some babies with ties manage to breastfeed just fine but develop other problems.  Many of these problems have, for decades, been common problems that people don’t realize may be connected to tongue ties.  Besides breastfeeding problems, these may include other feeding or swallowing issues, excessive gag reflex, dental problems and/or the need for orthodontics, airway issues and/or allergies (including asthma, swollen tonsils or adenoids that require removal, and/or sleep apnea), and recurrent ear infections.

There is some preliminary indication that ties could also be related to some far-reaching issues, such as back and neck problems, digestive issues beyond the mouth and throat, and even neurological issues/learning difficulties and/or migraines.  (I’ll explain why later in the post.)

Myth #5: Tongue ties are new.

Truth: Actually, tongue ties are not new at all!  They aren’t even newly-discovered…just newly re-discovered.  “Back in the old days,” midwives checked babies for them at birth, and severed them with a fingernail.  (I know — gross!  And not very sanitary.  I’m glad we have better methods today!  But the point is, they used to know about them and know to address them, and that knowledge was lost.)

There are some questions that remain unanswered.  What did they do — if anything — about posterior tongue ties?  Why was the knowledge lost?  Perhaps because doctors largely took over delivering babies, so the midwives’ knowledge fell by the wayside?  Perhaps because breastfeeding fell out of vogue, so people didn’t think to look, because breastfeeding problems weren’t a common issue?  We’re not really sure.

Myth #6: If tongue ties were really an issue, we can’t have gone the past several decades without knowing about them (because they would have caused problems, so we wouldn’t have missed them).

Truth: As previously noted, tongue ties can be the root cause for a variety of health problems that most modern Westerners simply take for granted.  It’s likely that many people today have tongue ties and they are causing them problems — they just don’t know it.

Do you know anyone who has had tonsils and/or adenoids removed?  Tubes put in the ears?  Anyone who uses a CPAP machine for sleep?  (I’ve been asking for years what causes sleep apnea — a question nobody seemed to be attempting to answer.  After all, we can sell someone an expensive machine, so why should we get to the bottom of the problem?)

Do you know anyone who quit breastfeeding because of difficulties?  Had a child who struggled with “textural issues” with foods?  Needed braces?

Chances are at least some of these problems have their roots in tongue ties, but if we don’t know to make the connection, we don’t.

There also seems to be a possibility that tongue ties are appearing with greater frequency than they did in the past…

Myth #7: MTHFR causes tongue ties.

Truth: Sort of.  This one’s a little complicated.  There does seem to be a connection, that explains — at least in part — the apparent genetic component of tongue ties.  However, tongue ties don’t seem to be directly inherited, and MTHFR doesn’t directly cause them.  Here’s the deal:

MTHFR is shorthand for the presence of genetic polymorphisms in the genes that code for the enzyme methylenetetrahydrofolate reductase.  (I know that’s a mouthful.  For more information, see this post; here I’m just giving the minimal information necessary for context.)  These polymorphisms, commonly called “mutations” (‘though, strictly speaking, that’s not accurate) result in less of the enzyme, and this enzyme is necessary for the body to use vitamin B9, better known as “folate.”

Now, we know that a folate deficiency* during pregnancy can result in midline birth defects, such as cleft lip or palate, congenital heart defects, and spina bifida.  (I’m avoiding links here by choice, because most of the links I can find include outdated information about folic acid supplementation that I believe is dangerous.  But this connection is well-established; feel free to search on it.)  Observation and logic, in combination, suggest that tongue ties are a minor form of midline birth defect and, therefore, probably result from subtler folate deficiencies during fetal development.  Since MTHFR mamas are more likely to be folate-deficient, they’re also more likely to birth tongue-tied babies.

So…WHY Do Tongue Ties Matter?

Oral Posture: Get in Shape

It’s a matter of oral posture — the way you hold your mouth — especially during the developmental years.  The tongue may be small, but it’s actually a very strong muscle.  The muscles of the jaw/in the cheeks are strong, too.  The muscles in the cheeks constantly exert a steady inward force on the teeth and palate.  What is supposed to happen is that the tongue, when not in use, rests against the upper palate.  There’s a hollow that it should simply settle into.  When this happens, the tongue also exerts a constant steady pressure — upward.

The result is that the tongue’s pressure provides a balance for the cheeks’ pressure.  Imagine if you took a small rubber ball — the kind you can hold in your hand — and pressed in on it from the sides.  It would “smoosh” into a shape that becomes taller and narrower, right?  Now what if you pressed in on the sides but also pressed up from the bottom and down from the top at the same time?  The shape would remain more balanced, wouldn’t it?

Form Affects Function

That is exactly what happens with our mouths.  When the tongue is allowed to drop instead of resting against the roof of the mouth to apply that counterbalancing pressure, the dental arch grows narrow and the palate grows high and narrow.  Although tongue ties aren’t the only cause of poor oral posture, when the tongue is not able to rest comfortably in place, this dropped-tongue posture is inevitable.

Some of the potential effects of this raised, narrowed palate are fairly obvious or unsurprising.  Dental problems or the need for braces clearly are related.  Airway problems are related because we’ve now narrowed the whole mouth and the floor of the nasal passageway.

Other problems are a little less obvious, but still not shocking.  Recurrent ear infections can become an issue, for instance, because the ear canals have been pulled into the wrong angle and no longer drain efficiently.

Still other problems seem completely unconnected at first blush, but may be related to the altered shape of the face and jaw, and/or the restricted muscles of the tongue.  Reflux and other digestive problems can occur because the rippling movement of the digestive tract should begin all the way up at the tongue.  When it cannot, this can “confuse” the body, and/or it can affect the ability of digestive fluids to end up in the proper places at the proper times.  Choking and gagging can occur because tongue movement is inappropriate.  This is the oral equivalent of stumbling because your feet lack their normal range of movement.

Neurological problems and migraines have also been anecdotally (but frequently) reported.  It is less clear how these are related, but there are some plausible explanations.  Headaches may be related in part to simple muscle tension.  The tongue is a major muscle running through the neck, and when it is constantly tight, that impact can extend beyond the mouth and throat.  In addition, though, there are a number of major nerves that run from the brain through the face.  If the face grows where it shouldn’t, or doesn’t grow where it should, pressure ends up on nerves that aren’t designed to have pressure on them (or not on nerves that should have pressure).

It sounds a little bizarre, but there are reports of certain Down Syndrome symptoms being reversed with orthodontic fixtures against the palate, and certain neurological disorders being corrected by means of a mouthpiece.  These seem to operate the same principle of correcting nerve stimulation, which is a speculative, but plausible, mechanism for oral ties to impact neurological function.


*Be careful reading medical content, even from sources normally considered reliable, that refer to “folic acid.” There has historically been very imprecise usage of this term, which results in inaccuracies that are strongly relevant to MTHFR and related matters.  In most cases, when studies indicate that “folic acid” is needed, the real takeaway should be that folate is needed.

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