/Great article to get your head around.

Cheers
Eva Hoebee
Australia/


  Modern Myths about Tongue-tie: The Unnecessary Controversy Continues

September 01, 2015 
</blog/2015/9/1/modern-myths-about-tongue-tie-the-unnecessary-controversy-continues> / 
Jennifer Kennedy </blog/?author=5363c943e4b0144153136ada>

23 years ago when I was doing my research on tongue-tie’s impact on 
breastfeeding and developing the Assessment Tool For Lingual Frenulum 
Function, the most problematic attitude I ever encountered was 
resistance to the idea that tongue-tie could create a breastfeeding 
problem. (1). This resistance was purely due to lack of knowledge about 
the physiology of infant suck. Occasionally back then, I might have met 
someone whose resistance was ego-driven: the “Not Invented Here” line of 
thinking but that was the exception rather than the rule. Then, the 
challenge for those of us who understood how tongue-tie impacted infant 
suck was to educate, educate, and educate some more.

Today, the controversy over various aspects of the tongue-tie phenomenon 
are liberally laced with ego-driven resistance. It seems as if the 
entire world of practitioners has something to say about tongue-tie, 
regardless of level of expertise on the subject. And now the notions of 
“ lip” and “buccal” tie, and to complicate matters even more, this thing 
called “Tethered Oral Tissue,”  have entered the picture to further 
confuse parents and practitioners alike. Is this labyrinth of 
information, misinformation and dis-information helping us to get 
treatment for truly tongue-tied babies?

A dialectic between smart people who have no vested interest other than 
to help others remains ever useful. An out and out brawl between various 
factions of people spouting dogma that is liberally littered with poorly 
informed opinion does not. I am all for helping moms and babies, but I 
am definitely for helping them using solid evidence so that they get the 
right kind of help, at the right time, from the right practitioner.

I vote that we get back to anatomy and physiology/AND/to using the 
evidence to support what we do as practitioners and as parents faced 
with making the decision to have surgery performed on our infants. Let’s 
start with what we*/know/*about tongue-tie.

*The facts:*

*Fact 1:*Tongue-tie does exist. It even has its own gene(s) that codes 
for it.

*Fact 2:*It manifests with various syndromes, which in and of themselves 
are relatively rare.

*Fact 3:*It is hereditary.

*Fact 4:*It has for a very long time had a clear definition:*/Tongue 
mobility restriction due to a tight and/or short lingual frenum./*

*Fact 5:*It is a*congenital anomaly*. Regardless of whether tongue-tie 
is genetic or epi-genetic, it occurs during development in the embryonic 
period.

*Fact 6:*Because tongue-tie, by definition, is impaired tongue mobility 
due to a congenital anomaly, it can cause deficits in all functions that 
require optimal tongue mobility, whether that be breastfeeding, 
bottle-feeding, chewing, protecting the airway, cleaning the teeth, or 
helping to form speech sounds. The degree to which this happens is 
somewhat known but more research needs doing before we have a firm grasp 
on this. Only then can we fine tune our treatment approach.

*Fact 7:*The incidence of tongue-tie was only hypothesized until of 
late. A study out of Australia has shown that the incidence hovers 
around*5% of all people*. (2) More research needs doing before we know 
an exact figure. The problem with incidence figures in the past was that 
no standardized assessment was being used. Dr. Todd, however, used a 
standardized, evidence-based screening tool for three years in a row in 
a large sample of infants. He was able to come up with what appears to 
be a very solid incidence statistic as a result. Please note here that 
Mother Nature does not create catastrophic increases in incidence of 
congenital anomalies unless some catastrophic epigenetic influence is at 
play. To claim that there is a rise in incidence to the tune of 20-50% 
is a clear misunderstanding of how epigenetic influences function 
epidemiologically.

*Fact 8:*Scissors frenotomy performed by trained practitioners has 
little to no risk. (No such data exists for laser, electrocautery or 
scalpel frenectomy.)

*Fact 9:*Breastfeeding improves post-frenotomy/frenectomy as long as 
tongue function is normalized as a result. Not all babies will show such 
improvement. (3) Anecdotally,*many*babies will need further therapy to 
restore proper tongue-function post-surgery.

*Fact 10:*Any connective tissue in the body (frena included) can be 
tight and impair optimal function. At what point that tightness can so 
severely impact function that no compensation can over-ride the 
restriction is an important question to put to the researchers.


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