Tongue Ties and Obstructive Sleep Apnoea - Sparkle Dental
Tongue Ties and Obstructive Sleep Apnoea
Tongue Ties and Obstructive Sleep Apnoea
Sparkle Dental | 9/11/2016
Recent studies from Stanford Sleep Centre have identified tongue ties as a risk factor for Obstructive Sleep Apnoea (OSA).  This has major implications in the prevention of a growing public health problem. 

Research tying tongue ties to Obstructive Sleep Apnea

This year, a study published in the European Respiratory Journal supported that tongue ties untreated at birth would lead to obstructive sleep apnoea later in life.
In this study of 160 children, researchers from Stanford Sleep Centre found that children with OSA could fall into one of two categories – those with enlarged adenoids and tonsils, and those with tongue ties.
Children in the tongue tie group tended to have symptoms of obstructive sleep apnoea at a later age than those in the enlarged adenoids and tonsils group. 
It was possible to predict that in the group of children with tongue ties, that the older the child, the greater the severity of obstructive sleep apnoea.

Why does obstructive sleep apnoea develop in tongue tie patients?

Tongue ties have an impact of oral and facial development, which in turn impacts the development of the airway, making it more collapsible.
It is normal for the tongue to be placed high in the palate during oral functions like sucking, swallowing and chewing.  This intimate tongue to palate contact stimulates normal upper jaw and palatal development.   Nasal breathing is associated with this position.
When the tongue is restricted, these functions are restricted and the tongue adopts a lowered posture.  This has been linked to altered palate development, deficits in mid face development and disproportionate growth of the lower jaw.
This combination of events results in the development of a smaller airway, which is more prone to collapse during sleep.
This continued interaction of restricted tongue function, altered nasal breathing and disturbance of orofacial growth occurs slowly over time, with progressive worsening into adulthood.  
In this study of children, those with tongue ties were more likely to have high narrow palates, confirming the progressive disturbance of facial growth over time.  The slow progression of these changes explains why children with tongue tie presented with symptoms later than their counterparts who had enlarged adenoids and tonsils.

What are the implications?

Screening and treating tongue ties will have a growing role in the prevention of obstructive sleep apnoea.
In addition, these tongue ties are a common cause of breastfeeding problems.    Normal breastfeeding is important in establishing normal orofacial function and development.
Brazil is the first country to have passed a frenum inspection law, where every newborn is assessed for tongue and lip ties.  Several other countries are now in this process.  Their validated protocols for assessment of tongue and lip ties are being promoted around the world to guide professionals to know when to intervene.
More education on tongue ties will need to be provided to health care professionals.  In the study described previously, two thirds of the children (above the age of 3 years) with tongue tie  had a history of speech pathology or difficulties feeding, yet the tongue tie had not been previously identified to them.
Standardised international protocols for tongue tie release are being developed for the first time.
The Academy of Applied Myofunctional Sciences is driving major change in medicine around the world in the area of tongue ties and correction of oral dysfunctions.   Dr Shereen Lim is a founding member of this group and has been actively engaged in continuing education in this field through this body to remain up to date with the latest research and protocols.  She has also committed to courses in Brisbane and the US to learn frenum release procedures from leaders in this field.

Myofunctional therapy is critical for successful tongue tie release.

In another study by Stanford Sleep, researchers demonstrated that myofunctional therapy was essential to restore normal nasal breathing following tongue tie release.
Yet another study of 101 children who had tongue tie released demonstrated that myofunctional therapy before and after release was important for successful release of restrictions. 
This therapy is essential for restoring normal functions, and also preventing reattachment and scarring of the wound.   In the same way that someone having their feet bound together from birth, and then untying them would require rehabilitation, orofacial myofunctional therapy is aimed to remove compensations and repattern normal function following release.

What to do with a tongue tie left untreated at birth?

Be aware of any signs and symptoms of sleep disordered breathing, and consult with a professional who is familiar with assessment of tongue ties and understands the impact on normal functions.
We do not offer tongue release at this stage, but a good question worth asking your provider if release is recommended is will they go beyond a simple snip to release the back of the tongue tie also called the “posterior tongue tie”.   This will be important for the back part of the tongue to elevate to the roof of the mouth for normal oral rest posture and swallowing.
Consult with a professional trained in myofunctional therapy prior to the release.   Exercises before, immediately after the procedure and following recovery to repattern normal functions will ensure optimal release over time.
Contact us to organise a consultation if you would like an opinion regarding the degree of restriction and impact of tongue tie or to discuss the option of myofunctional therapy prior to tongue tie release. 

Related blog categories: apnoea, frenums, myofunctional, obstructive, restricted, sleep, therapy, ties, tongue

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