The lingual frenulum, depending on its size or its insertion, can cause five problems: ankyloglossia, a lower interincisor diastema, alterations in the relationship with the prosthesis or with orthodontic appliances, such as imbalances, or periodontal pathology.

The tongue tie is synonymous with stagnant tongue. This means that the tongue tie is short and tongue movements are restricted. This physical restriction of the movement of the tongue causes oral problems such as language disorders, atypical swallowing, oral breathing, narrow palate, favoring the appearance of dental malocclusions, among others.

This lingual anomaly has a prevalence in the Spanish state of approximately 4.8%, although only 0.04% of children present this alteration in the lingual frenulum.

In order to assess the degree of ankylosis, the method described by Williams and Waldron is used. This method evaluates three distances, using the letters A, B and C. The letter A corresponds to the distance between the mandibular insertion point of the frenulum and the sublingual gland; B, the distance between the sublingual gland and the lingual insertion of the frenulum, and C the distance between the lingual insertion of the frenulum and the tip of the tongue. From these distances, the following relationship is calculated: C / A + B + C. The relationship obtained allows us to assess the degree of ankylosis and classify it into 3 groups:

  • Reduced mobility (ratio between 0.14 and 0.22)
  • Acceptable mobility (between 0.22 and 0.39)
  • Significant mobility (between 0.39 and 0.51)

A diagnosis of tongue tie can be made when the tongue cannot contact the hard palate with the mouth open and when the tip of the tongue cannot protrude more than 1 to 2 centimeters outside the lower incisors.

Other authors such as Kotlow, studied the values ​​of the free tongue, which refers to the length of the tongue from the insertion of the frenulum to the tip. According to this, some categories have been determined:

  • Normal free tongue: greater than 16 millimeters (mm)
  • Class I or mild tongue tie: 12 to 16mm
  • Class II or moderate tongue tie: between 8 and 11mm
  • Class III or severe tongue tie: 3 to 7mm
  • Class IV or complete tongue tie: less than 3mm

What symptoms can tongue tie?

Tongue tongue can cause different problems:

  • Suction difficulties in the neonate and cause inflammation of the mother’s nipple.
  • Swallowing difficulties. The position of the tongue between the incisors causes vestibular tilt of the upper and lower incisors and anterior open bite.
  • Alterations in phonation, especially of the linguo-lip-dental consonants.
  • In attempts to mobilize, the tongue acquires a helical or bifid shape and curved inward.
  • Difficulty in autoclysis, which is why there is an increase in the incidence of cavities.
  • Lingual ulcerations due to friction or continuous microtrauma.
  • Orthopedic orthodontic problems. The frenulum can indirectly produce an incorrect position of the teeth and language disorders.

When the frenulum is short and inserted high in the alveolar process, the tongue becomes flat, which can create abnormal pressure against the mandibular incisors, resulting in excessive vestibular tilt of the lower teeth.

Another alteration that may occur is the formation of an ogival or very narrow palate, since if the tongue is not in contact with the palatal and maxillary processes, they will not develop laterally, and a posterior cross occlusion and a anterior open bite. Ankyloglossia is also present in some syndromes such as Beckwith-Wiedemann and Riga-Fede disease.


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