I recently read an article in The New York Times about a boy who is now able to speak freely after his tongue was released. I was delighted to see that the issue of tongue tie is getting some attention; however, I wish to take issue with the statement that “Tongue tie is being overdiagnosed.”
My experience has been to the contrary. I recently evaluated a man in his 70s for trouble with articulation or speech sound production. The dentist who referred him thought the gentleman’s difficulty was due in part to his new dentures. As soon as I saw this man speak, I realized he couldn’t raise his tongue tip freely because he was tongue tied. When asked how he was able to eat all these years, the man replied that he has always taken “tiny bites.” Another former client of mine, a 16-year-old girl with a horrendous production of the /r/ sound, was unable to make any progress until her tongue thrust and associated tongue tie was diagnosed. Because her tongue was tied, she was unable to lift the sides of her tongue to produce /r/ clearly. Following the release of her tongue by an oral surgeon and orofacial myology therapy to retrain her tongue, she now achieves accurate production.
Dr. Alison Hazelbaker, a lactation consultant and most recently, the author of the book, “Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment,” was herself tongue tied until age 42. She writes movingly of the difficulty she encountered during her life prior to the frenotomy that released her tongue. She tells how she always had difficulty eating, speaking and with her oral hygiene. She attributes three abscesses in her adult teeth to her inability to clear food from between her teeth and cheeks because of the restricted range of movement of her tongue. She is very happy that her tongue is now free but she expresses anger that her pediatrician did not intervene when she was a baby. She is the mother of five children, two of whom were born tongue tied. Her two tongue-tied sons had the simple tongue clip frenotomy within 24 hours of their birth.
To address the potential for overdiagnosis of tongue tie, Dr. Hazelbaker has created a screening tool, the Hazelbaker Assessment Tool for Lingual Frenulum Function. This tool will help diagnose and treat babies with tongue tie. When tongue tie is diagnosed by function (as opposed to just appearance), it should not be over-diagnosed. Appropriate diagnosis and treatment should make a difference in the lives of most people with tongue tie; however, it is especially beneficial if the tongue tie is assessed and treated in infancy. With early intervention and treatment, a child may even be able to achieve age appropriate speech without the need for speech therapy.