May 9, 2018
by Pat Pine, RDH, COM™
Ever wonder what organ really controls our body? Most assume it is the heart. The heart pumps blood to the lungs, which is needed to breath efficiently. Both heart and lungs are vital to the human body’s machinery – but consider the tongue! Medical communities are surprised at this possible revelation.
Is the tongue a muscle or an organ of the body? The tongue is comprised of intrinsic muscle and extrinsic muscle and is covered with mucous membrane. It is attached to a floating bone called the hyoid bone. This floating bone is attached to many muscles – anterior, posterior and inferiorly, which keeps it in place. This horseshoe shaped bone serves as an anchoring structure for the tongue and its surrounding muscles. This exceptional bone is found at the root of the tongue just above the thyroid cartilage, below the chin, at the midline of the neck. The four muscles above or superior to the hyoid bone provide attachment to muscles that form the floor of the mouth. But many other muscles are controlled by our tongue inferiorly or below the chin. They are attached to the collar bone. Hum, the tongue is attached to the collar bone? Didn’t know that!
Why Do We Care About This Horseshoe Shaped Bone?
This free-floating bone is not attached to another bone in the body. Positioning of the hyoid bone is the responsibility of the infrahyoid and suprahyoid muscles. These muscles are very important for the complete act of swallowing and action of the larynx. The four-infrahyoid muscles are referred to as “strap muscles” and are attached from the hyoid bone inferior to the clavicle, or scapula. Stay with me here. The suprahyoid muscles are attached above the hyoid bone and infrahyoid below the hyoid with attachment to the clavicle or collar bone.
An ankyloglossia, or tethered oral tissue, also named tongue-tie, can be the cause of medical conditions that are not routinely diagnosed. Headaches, shoulder and neck pain can be caused by tight muscles attached to the hyoid bone. With a tongue-tie those suprahyoid muscles are typically tight, pulling on the tongue when it attempts to function, but cannot because it is anchored to the floor of the mouth. This restricts the tongue from normal movement and function. The tongue has many duties, including maintaining the airway, assisting with chewing, swallowing, and most importantly facial development, speech and digestion.
When the tongue is developing in utero at about the fourth week, its first duty is to shape the maxilla. The tongue should reach the palate to form a nice wide horseshoe shape. When the frenum is tight, short or anchored to the floor of the mouth, this shape will not take place, nor will normal facial development take place. Orthodontic treatment is sure to be scheduled in the future for patients with a tethered tongue, if it is not released at a very young age. Malocclusion is sure to develop. This singly attached muscle has not been able to do its job.
What is Instigating the Problems?
It all starts at birth. A short, tight membrane underneath the tongue, called frenum, frenulum, frenula, attaches the tongue to the floor of the mouth. The oral cavity has seven frenums. Each one can be tethered or restrict normal movement. The tongue frenum is exceedingly strong and can restrict movement and normal function. It seems like an epidemic the past years that infants are challenged with tethered oral tissues, both tongue and lip ties. This can prevent normal development, because of breast or bottle-feeding issues, and they are often diagnosed with failure to thrive. Babies are not able to nurse with a tongue that is tethered. The tongue cannot create its peristaltic action (wave like) while breast feeding. The infant’s symptoms determine if the tethered tissues are to be non-invasive surgically released. These are all very real concerns. Families are already dealing with the many concerns of a new baby. Tethered oral tissues (TOTs) shouldn’t have to be one of them.
Our tongue controls our body in ways we are unaware. The human body is amazing in the way it operates and functions together, seemingly without any thought on our part.
Airway – The airway is the most valuable system in the human body. Without it the body would not be thriving. If the tongue is anchored or tethered too tightly to the floor of the mouth, movement and function are restricted. This can be the cause of snoring, sleep apnea, gagging and vocal sounds. Without a clear airway normal breathing cannot take place. Should the tongue fall back into the airway while sleeping, snoring erupts and disrupts households. During the day with a tethered tongue, the airway may be blocked and the only way to open the airway is to place the head in a forward position to breathe through the mouth. Open mouth posture can cause fatigue, brain fog, lack of attentiveness, and also hyperactivity.
Breast feeding/Bottle feeding – This is impossible when the tongue is anchored to the floor of the mouth. Movement, function and freedom of the tongue are needed to allow for a good latch/seal on the breast or bottle. A good latch in turn creates suction to release nourishment. The infant needs to breast feed efficiently in order to keep the breast milk supply replenished. Pain and great discomfort occurs when the nursing infant’s tongue is tethered. It doesn’t matter how tethered at this point. It is causing pain and frustration to the mother and frustration and failure to thrive to the infant. This can lead to developmental concerns. There are many other symptoms that are attached to tongue-tie and breast and bottle feeding i.e. clicking, gagging, gassiness, reflux.
Children and adults can have health issues that are attached to tongue-ties. More information can be viewed in the book, Please Release Me – The Tethered Oral Tissue (TOT) Puzzle found at www.musclesinharmony.com. This book can give you answers to many of your own questions. Infants need to be evaluated by an experienced, knowledgeable professional who works with tongue-ties and lip-ties.
Chewing – Without proper movement and function, the tongue cannot move food from side to side for sufficient chewing for complete digestion. It’s been stated that we need to chew our food 30 times before we swallow it. Not sure if that happens, as many people are in the eat and run mode.
Cleaning of the Mouth – Freedom and movement is needed for the tongue to clean each and every tooth in the mouth. If it can’t reach to the posterior molars, 3rds included, it could be tethered.
Facial Development – Our nose is not an ornament on our face but allows the body to keep functioning. Nasal airway is important to breath filtered, moist, humidified air. There is a saying, “If we don’t use it we lose it!” This is true. When not using our nasal passages to breathe the mid-face will not develop or grow normally.
Obstructive Sleep Apnea (OSA) – OSA has become an important topic of discussion and study in the dental and medical communities. It should be a topic of conversation with all patients, at each dental visit as it can impact life or death. Patients with sleep apnea can die from heart attacks. These patients are unaware that they snore or stop breathing at night or while taking a nap. Some patients are aware of their snoring, but feel it’s normal for their age or weight. This is not true. This involuntary period when breathing stops is called apnea. Normally, air is flowing through the nose to the lungs at all times. If the air space in the throat is too narrow the flow of air stops. Snoring is a trait of OSA. Symptoms include headaches, forgetfulness, grumpiness, irritability, poor job performance, depression, and loss of interest in sex. More severe health issues can be hypertension, heart disease, stroke, and diabetes. Proper diagnosis is essential followed by treatment.
Open Mouth Posture – This is also called mouth breathing. Mouth breathing allows infections to enter the body easily since there is no filter via the oral cavity. The tonsils are present to help filter but many times they enlarge and become part of the problem with obstructive sleep apnea for children and adults alike. Mouth breathing does not allow proper respiration. The inhaled air mixes with nitric oxide (NO). NO is a vasodilator and enhances the uptake of oxygen. Breathing (or respiration, or ventilation) is the process of moving air into and out of the lungs to facilitate gas exchange with the internal environment, mostly by bringing in oxygen and flushing out carbon dioxide. Nasal passages act as a tunnel to filter, moisturize and humidify the air entering the lungs. The lungs will not perform correctly as they are struggling to provide concentrated oxygen for the body with non-filtered air. Every cell in the body is affected by mouth breathing due to the lack of essential oxygen. Other symptoms of mouth breathing can include: snoring, sleep apnea, headaches, migraines, hypertension, TMD – pain, dark circles under eyes, and ear and sinus infections.
School Work – This can be hindered when the airway is compromised by the tongue, resulting in insufficient breathing. Foggy brain and fatigue can be common when sufficient oxygen is not getting to the brain. Mouth breathing, forward head posture, enlarged tonsils, sore throat from mouth breathing can all be symptoms causing school work concerns. These disorders can be evaluated and addressed by an Orofacial Myologist for myofunctional therapy.
Speech – Communication is a must with or without cell phones. Our verbal language starts at a very young age. First words, cooing, sounds like mama, dada, are normal for infants. Infants are mesmerized by our voice, tone and words. Movement of the tongue is important for pronunciation of words and working words into sentences. Without clear interaction with others, social speaking skills can be hindered. The tongue has several jobs. Clarity of speech is definitely an essential one. The tongue requires the freedom to move and reach the palate to sound out letters, words, phrases. If it cannot perform as nature intended then lisping and other disorders can occur. Test yourself – place your tongue tip below your lower anterior teeth, push and hold, now try to talk. Can’t do it right! When restricted the tongue can’t perform as it was intended to do.
Swallowing – The tongue assists in swallowing 1200-2000 times per day. Restricted to swallowing via tongue-tie does not allow saliva or food to be chewed completely and swallowed normally. The digestive system needs the salivary enzymes to mix with chewed food for complete digestion. The four to six pounds of pressure on the teeth with an abnormal swallow is called a reverse swallow, or tongue thrust. It can create havoc on the oral cavity. Malocclusion, called open bite, can occur. This includes bi-lateral, unilateral, anterior, molar to molar, anterior-bilateral and several others.
Pleasure – Our tongue brings pleasure in different ways. The tongue is the sensory organ that detects sweet, sour, salty, and bitter, thus enhancing our enjoyment in eating and drinking. Vocalization, singing, playing musical wind instruments would be impossible without the tongue. On a more serious social note – French kissing and affectionate words to partners would be impossible.
Classifications – There are a variety of classifications of tethered oral tissues. These are presented here courtesy of Dr. L. Kotlow from Albany, New York. There are four classifications of tongue-tie. They can be found in the book Please Release Me – The Tethered Oral Tissue (TOT) Puzzle by Patricia Pine, RDH, COM™.
Class IV tongue-tie is located at the tip of the tongue and extending half way between the salivary duct and tip of the tongue.
Class III tongue-tie is located from the salivary duct half way to the top of the tongue.
Class II tongue-tie is located between the back of the salivary duct halfway to the base of the tongue.
Class I tongue-tie is located from the base of the tongue, halfway to the salivary duct. Classification does not reflect the severity of the restriction.
Class III – entire floor of the mouth lifts, short, tight.
Lip tie – attached tightly to lip Class III.
Copyrighted photos courtesy of Pat Pine, RDH, COM. Do not copy.
My Tongue Is Tied – Now What Do I Do?
Schedule an appointment for any age group with a Certified Orofacial Myologist, who provides Myofunctional Therapy (COM™). The COM™ can evaluate tongue and lip ties along with assessing conditions that may be occurring without your knowledge, i.e. swallowing issues. Some symptoms adults often just brush off, stating, “Oh, I am ok”. Infants and children go with the flow and struggle through life unaware that there is a problem, not knowing there is a remedy called orofacial myology. Living in discomfort or pain is not good for the body as inflammation should be reduced immediately.
Certified Orofacial Myologists (COM™) typically work with a multi-disciplinary group of professionals to assist in a smooth transition of a tethered tongue to a tongue with freedom. First and foremost, pre-stretching is required for complete success. Your orofacial myologist will train the tongue to perform specific exercises pre- and post-release. Once the tongue is free it has no idea what to do with food, speech, swallowing, etc. A dentist who is experienced and knowledgeable with TOTs is essential to provide the frenum release. Currently, the tool of choice is a CO2 laser. In the past, scissors or cauterization were used for frenectomies. Patients who have neck or shoulder tightness or torticollis, will be referred to a chiropractor and/or cranial sacral therapist for non-
invasive bodywork. Your chosen orofacial myologist has a network of professionals for your convenience. It’s a team effort for smooth therapy. Your certified orofacial myologist may detect additional oral disorders, which means a comprehensive assessment is needed. Releasing tethered tissue is not the total answer. Re-education of oral and facial muscles is necessary to improve dysfunction and improve physical health.
Overlooked Tethered Tissues
When the tongue-tie is overlooked in an infant, future total health problems can occur. When a tight frenum is holding that lower jaw, that jaw cannot grow forward. This affects skeletal development and oral facial growth. It decreases oxygen to the brain, hindering normal neurological growth and development. This unusual muscle, also called an organ, controls our future aspects of physical health as an adult. All aspects of the body are connected. It’s a puzzle worth putting together with your therapist. Have you looked in a mirror to check out the frenum under your tongue yet? It just might answer some of your questions.
Clearly the tongue can meet the criteria of causing problems in the body. Yes, the tongue should be evaluated for tongue release, at any age. But, the tongue-tie release is not the miracle cure for other possible issues in the body. Ignoring a tongue-tie will cause health issues long term. Those adults may be having many symptoms such as shoulder, neck pain, and headaches while never thinking it could be this frenum under the tongue. They may feel they are too old. That is not the case. Adults are never too to be checked by a COM™!
Who Is In Control Of Your Body?
The tongue has a range of tasks that control the entire body, within every different body system. It seems that the tongue is controlling our systems. Let’s start there with your tongue, checking for proper function, freedom and mobility. The disorders listed above can be resolved by seeing a Certified Orofacial Myologist (COM™) who specializes in this type of oral therapy to harmonize muscles and identify which muscles of the face, lips, and mouth are not properly functioning. We are connected in so many ways. Let’s get back to total health.
Ask these questions about your children/grandchildren/yourself:
These are only a few questions on a long list that will assist in helping you or your child. Check out the websites below for more information.
Please Release Me – The Tethered Oral Tissue (TOT) Puzzle
Muscles in Harmony
Benefits of Nose Breathing and Nitric Oxide
Tongue Tie from Confusion to Clarity
TOTS – Tethered Oral Tissues
About the Author
Pat Pine, RDH, COM™ is a national and international speaker with experience in a variety of clinical and non-clinical dental arenas. Her passion for safety and infection prevention has led to her speaking on OSHA and infection prevention for the last 25 years. Pat established a one-of-a-kind OSHA Training Boot Camp and widely acclaimed in-office training programs. Pat’s new professional niche is Orofacial Myology. Her advanced her knowledge as a Certified Orofacial Myologist (COM™) providing myofunctional therapy, this allows her to overlap both topics, keeping patients healthy while keeping their oral muscles in harmony. Pat’s speaking engagements are interactive and fun. To arrange a program, in-office, component, state or national meeting, contact Pat at firstname.lastname@example.org.
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In my country, in Burkina Faso, West Africa, we know this about the tongue.
We treat it indigenous.
I had concerns about my son’s tongue, I wanted to treat it in the village, but my husband didn’t believe in that; he even does not believe that the boy has anything something wrong.
In the USA, the only listening ear that I got was to send my son to speech therapy.
He is 10 today, he is no more taking speech therapy, he is doing very good in school, but I know something still needs to be done to help him.
From my believes from my village, I know, unless we cut this thing, my son will not be a “talking boy”.
I am glad medicine is acknowledging this.
Our children will get the help they need since babies, like in my village.
Hi im charmaine im 48 and im like I have a very small toungh..its very tight and short I cant poke my toungh out very far and when I try it hurts ..im amazed my mum didnt notice when I was,a child ..I cant ask her now ..as, she passed away years ago.I suppose im left with it ..I just wish I could have got it done when I was,a baby .plus I get loads ov headaches too
Charmaine, fortunately, the procedure is still very much possible. It is inexpensive, and quick and requires 2 weeks of 30-60 minutes of exercises per day and a 15 ish minute surgery. The release will really help you out. Good luck!
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