Looking for all the thoughts and opinions on these things for a child. Worth the effort and procedure? Are tongue ties THAT big of a concern when child compensates well? Any success or "wish we had" stories?
Myofunctional Therapy and Frenectomy
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Last: 7 days ago by milkman00
What is the problem for which a frenectomy is supposedly the answer?
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We've been dealing with this as well. One lady said he had slight posterior tongue tie. Said 85%of issue could be resolved thru myofunctional therapy.
Most recent pedi ent said she didn't see a tongue tie. Only been doing myofunctional therapy for 2 months. He can stick it out, but has speech issues.
Ironically he never took to pacifier. Now I wonder if that would have helped him build tongue strength amd control.
Not many people know of myofunctional therapy. Found out it is covered by insurance, but few providers amd the one local is out of network.
Good luck. Myofunctional has been most beneficial so far after years of basic speech therapy.
Most recent pedi ent said she didn't see a tongue tie. Only been doing myofunctional therapy for 2 months. He can stick it out, but has speech issues.
Ironically he never took to pacifier. Now I wonder if that would have helped him build tongue strength amd control.
Not many people know of myofunctional therapy. Found out it is covered by insurance, but few providers amd the one local is out of network.
Good luck. Myofunctional has been most beneficial so far after years of basic speech therapy.
Kool said:
What is the problem for which a frenectomy is supposedly the answer?
A tongue tie. The tongue tie leading to some issues such as a slow eater, not swallowing properly/tongue thrust, mouth breathing while sleeping, forward head posture, narrow palate, straining when saying certain sounds like the long vowel sound for E. But the compensation for all these things is there. So, it's one of those things where we ask ourselves: would training and strengthening the tongue and then correcting the tie improve the quality of life to a measurable extent.
The biggest concerns that led down the road to checking into oral dysfunction was sleeping with mouth open, snoring, and extreme teeth grinding. Essentially, airway concerns.
milkman00 said:
We've been dealing with this as well. One lady said he had slight posterior tongue tie. Said 85%of issue could be resolved thru myofunctional therapy.
Most recent pedi ent said she didn't see a tongue tie. Only been doing myofunctional therapy for 2 months. He can stick it out, but has speech issues.
Ironically he never took to pacifier. Now I wonder if that would have helped him build tongue strength amd control.
Not many people know of myofunctional therapy. Found out it is covered by insurance, but few providers amd the one local is out of network.
Good luck. Myofunctional has been most beneficial so far after years of basic speech therapy.
I appreciate your thoughts. I did see your own post on this similar issue. We aren't dealing with speech concerns here (other than some compensation for some sounds like the long E). We see an SLP who has been doing myo for a long time. It's just so hard to know how far to go and which direction to take with these things.
I will just put this out there and I welcome all of the negative comments that it will receive, but tongue tie is WAY over-diagnosed in the pediatric population. There is a big "cottage industry" out there that has infiltrated lactation consultants, pediatricians, speech and language therapists, dentists, and ENTs around the issue.
Just last week, I told an adult patient that the integrative dentist offering "gentle laser" treatment for a "posterior tongue tie" would not, in all likelihood, cure her neck pain (with MRI documented cervical disc disease).
In a neonate who is having trouble latching, staying on latch, and breastfeeding in general, if there is a tongue tie, a release can be tremendously helpful.
If the child has speech delay and articulations errors because of a tongue tie, a frenectomy can be helpful. Speech therapy should be initiated before and continued after it is done.
There is mixed evidence, at best, that tongue tie is CAUSATIVE in obstructive sleep apnea. There is an association between the two, but correlation does not equal causation. My grandparents had a rooster that would crow every morning before the sun came up. After that rooster died, magically, the sun continued to rise in the morning.
Forward head position is more likely nasal obstruction and adenoid and tonsillar hypertrophy.
Tread carefully out there.
Just last week, I told an adult patient that the integrative dentist offering "gentle laser" treatment for a "posterior tongue tie" would not, in all likelihood, cure her neck pain (with MRI documented cervical disc disease).
In a neonate who is having trouble latching, staying on latch, and breastfeeding in general, if there is a tongue tie, a release can be tremendously helpful.
If the child has speech delay and articulations errors because of a tongue tie, a frenectomy can be helpful. Speech therapy should be initiated before and continued after it is done.
There is mixed evidence, at best, that tongue tie is CAUSATIVE in obstructive sleep apnea. There is an association between the two, but correlation does not equal causation. My grandparents had a rooster that would crow every morning before the sun came up. After that rooster died, magically, the sun continued to rise in the morning.
Forward head position is more likely nasal obstruction and adenoid and tonsillar hypertrophy.
Tread carefully out there.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Kool said:
I will just put this out there and I welcome all of the negative comments that it will receive, but tongue tie is WAY over-diagnosed in the pediatric population. There is a big "cottage industry" out there that has infiltrated lactation consultants, pediatricians, speech and language therapists, dentists, and ENTs around the issue.
Just last week, I told an adult patient that the integrative dentist offering "gentle laser" treatment for a "posterior tongue tie" would not, in all likelihood, cure her neck pain (with MRI documented cervical disc disease).
In a neonate who is having trouble latching, staying on latch, and breastfeeding in general, if there is a tongue tie, a release can be tremendously helpful.
If the child has speech delay and articulations errors because of a tongue tie, a frenectomy can be helpful. Speech therapy should be initiated before and continued after it is done.
There is mixed evidence, at best, that tongue tie is CAUSATIVE in obstructive sleep apnea. There is an association between the two, but correlation does not equal causation. My grandparents had a rooster that would crow every morning before the sun came up. After that rooster died, magically, the sun continued to rise in the morning.
Forward head position is more likely nasal obstruction and adenoid and tonsillar hypertrophy.
Tread carefully out there.
Thanks, this is the kind of information I was looking for. We saw an ENT when snoring started way back when and was told tonsils were more or less normal size for age, perhaps a tiny bit enlarged. Since then, tonsils have never been a concern by any dental professional. Illnesses typically associated with enlarged adenoids and tonsils also have never been present outside infrequent minor colds. So, we've never felt pressure to rush to another ENT for CBCTs or the like.
The tongue thrust is pretty clear and the food left over on the tongue after swallowing, also the slow speed of eating. I just don't know if these things are that big of a deal. And if it'll all help with being able to sleep with mouth closed.
Tonsils and adenoids tend to have their greatest growth between 2 and 8 years of age, so what was not a problem in the past might be a problem now. Nasal saline and Flonase can help with snoring and mild apnea (see the other thread nearby). Mouth breathing during sleep isn't always a problem or emblematic of an issue. When you hit REM sleep, all muscle tone is lost and the mouth is going to go wherever gravity takes it. Definitely listen for apnea at night, though, and the best time to listen is after the child has been asleep at least an hour and a half (first REM period not normally attained before then), better time to listen is far into sleep.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Kool said:
Tonsils and adenoids tend to have their greatest growth between 2 and 8 years of age, so what was not a problem in the past might be a problem now. Nasal saline and Flonase can help with snoring and mild apnea (see the other thread nearby). Mouth breathing during sleep isn't always a problem or emblematic of an issue. When you hit REM sleep, all muscle tone is lost and the mouth is going to go wherever gravity takes it. Definitely listen for apnea at night, though, and the best time to listen is after the child has been asleep at least an hour and a half (first REM period not normally attained before then), better time to listen is far into sleep.
Thanks for this tip, I will try to listen. And maybe reconsider a ENT. They do Xlear twice a day (morning and before bed).
The child has the best attitude, always in a joyful mood, a long attention span, and is very rarely ever tired. Always says they sleep great. So, we are thankful for these things.
I think Kool is definitely correct in the over diagnosis or should I say over treatment of tongue and lip ties.
The airway resistance would have to be evaluated if it is in fact due to some nasal issue in which an allergist could help with (nasal steroids, etc)
Or if its an issue with tonsils/muscle tone in the throat. Or perhaps its an oral condition such as narrowing of the palate and crowding/tongue etc.
I have a colleague that uses Vivos oral appliance that seems to help a lot in pediatric patient with airway/sleep. Might be something to look into that could be helpful short of a surgical procedure for tonsils etc.
Myofunctional therapy is definitely something new on our radar as dentists, but I think it shows promise.
The airway resistance would have to be evaluated if it is in fact due to some nasal issue in which an allergist could help with (nasal steroids, etc)
Or if its an issue with tonsils/muscle tone in the throat. Or perhaps its an oral condition such as narrowing of the palate and crowding/tongue etc.
I have a colleague that uses Vivos oral appliance that seems to help a lot in pediatric patient with airway/sleep. Might be something to look into that could be helpful short of a surgical procedure for tonsils etc.
Myofunctional therapy is definitely something new on our radar as dentists, but I think it shows promise.
lazuras_dc said:
I think Kool is definitely correct in the over diagnosis or should I say over treatment of tongue and lip ties.
The airway resistance would have to be evaluated if it is in fact due to some nasal issue in which an allergist could help with (nasal steroids, etc)
Or if its an issue with tonsils/muscle tone in the throat. Or perhaps its an oral condition such as narrowing of the palate and crowding/tongue etc.
I have a colleague that uses Vivos oral appliance that seems to help a lot in pediatric patient with airway/sleep. Might be something to look into that could be helpful short of a surgical procedure for tonsils etc.
Myofunctional therapy is definitely something new on our radar as dentists, but I think it shows promise.
We did address the narrow palate with expansion. The Myo said they would have liked to see the palate a little wider but we got what we got. We are using Vivos currently. Have an ortho appointment tomorrow to discuss braces and will discuss the Myo with them; though this ortho isn't the most functional minded out there (we chose them for the beautiful smiles they produce - though this is truly the least of our concerns - and their addressing jaw growth in the least invasive way).
Myofunctional Therapy puts off a craniosacral vibe to me from the people I have met that do that kind of work.
aggiederelict said:
Myofunctional Therapy puts off a craniosacral vibe to me from the people I have met that do that kind of work.
I can see that. It's on the border for me but I think it's just because it seems newer. But the tongue is a muscle and any weak muscle can lead to issues so strengthening it doesn't seem "woo-woo" in and of itself.
When yall did expansion did they do anything on the bottom or just the top?
milkman00 said:
When yall did expansion did they do anything on the bottom or just the top?
We did bottom and top for a year.
If I ever decided to look into a frenectomy, I would definitely go to an ENT only. It might be more expensive, but I have heard of a few horror stories from non physicians doing them and things going very badly.
That being said, I will echo the above in that I have heard very little support from pediatricians and ENT docs in support of routine frenectomy.
That being said, I will echo the above in that I have heard very little support from pediatricians and ENT docs in support of routine frenectomy.
bigtruckguy3500 said:
If I ever decided to look into a frenectomy, I would definitely go to an ENT only. It might be more expensive, but I have heard of a few horror stories from non physicians doing them and things going very badly.
That being said, I will echo the above in that I have heard very little support from pediatricians and ENT docs in support of routine frenectomy.
It never would have crossed my mind to have the procedure done by an ENT. Why do you recommend this?
bigtruckguy3500 said:
If I ever decided to look into a frenectomy, I would definitely go to an ENT only. It might be more expensive, but I have heard of a few horror stories from non physicians doing them and things going very badly.
That being said, I will echo the above in that I have heard very little support from pediatricians and ENT docs in support of routine frenectomy.
Not saying you're wrong but Can you elaborate on what horror story happened and what you think an ENT could've done differently to prevent that ?
The main issue I've heard about is post operative bleeding. Probably low probability event, but in one case the kid has permanent brain damage due to anoxic brain injury. And to be fair, I think an oral surgeon would be just as good of an option (possibly marginally better) as an ENT. I just have more confidence in an oral surgeon or ENT in their ability to handle a post operative bleed, and to not discharge a patient unless the bleeding is well controlled. Dental offices close at 5pm or earlier, and all the complications get seen in the ER, where ENT/OMFS or the ER doc has to handle it.
bigtruckguy3500 said:
The main issue I've heard about is post operative bleeding. Probably low probability event, but in one case the kid has permanent brain damage due to anoxic brain injury. And to be fair, I think an oral surgeon would be just as good of an option (possibly marginally better) as an ENT. I just have more confidence in an oral surgeon or ENT in their ability to handle a post operative bleed, and to not discharge a patient unless the bleeding is well controlled. Dental offices close at 5pm or earlier, and all the complications get seen in the ER, where ENT/OMFS or the ER doc has to handle it.
Holy crap, that is horrific and utterly should be a zero probability event. They must have dug pretty deeply into the tongue in the floor of the mouth and gotten airway obstruction, I can't imagine the bleeding alone would have been enough to cause that.
That area is indeed the bailiwick of ENTs, with some overlap with oral surgeons, as bigtruckguy notes.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
And this was done in a dentist office? Holy crap...Yeah that seems like a 1 in a million; so unfortunate for that kid. I absolutely agree with you Kool that is is in ENT jurisdiction but the way bigtruck made it sound was that no one else was qualified (or preferred). While I definitely refer lingual frenectomies because definitely is a lot of vasculature and other stuff I don't want to mess with in the floor of the mouth, labial ones are a piece of cake and with a laser this is practically no bleeding ( as a DDS).
Saw our ortho today. He said he doesn't see a visible need for a frenectomy. He also said that if tongue thrust is an issue, there is something he can do to train the tongue out of that habit. He agreed going to an ENT for an eval and opinion was a good idea. So, that's the next step. I think we feel like the Myo therapy will be a good idea, just trying to nail down our thoughts on the frenectomy.
Have you looked into a REMplenish water bottle?
Interesting timing, my wife took my son for an evaluation with a myofunctional therapist yesterday. We saw her once when he was baby struggling with some stuff as an infant and had his tongue ties cut. I think that helped at the time in some ways, but our pediatrician would disagree with that.
Our main concerns right now are some ADHD type symptoms, and have had a few people recommend getting his airway checked out. He's got a super crowded mouth with his new teeth coming in, and has already seen an ortho who said an expander is in his near future.
It's always a fine line with specialists like that, they have really good info and ideas, and also often seem to believe every issue a kid has can be solved by their recommendations.
Good luck the rest of the way.
Our main concerns right now are some ADHD type symptoms, and have had a few people recommend getting his airway checked out. He's got a super crowded mouth with his new teeth coming in, and has already seen an ortho who said an expander is in his near future.
It's always a fine line with specialists like that, they have really good info and ideas, and also often seem to believe every issue a kid has can be solved by their recommendations.
Good luck the rest of the way.
My 7 year old had a frenectomy done last fall. It never affected her eating as an infant and was told as she aged it could be fine, but as she got older, when she smiled it was all you could see at the top of her lip, so we took care of it for cosmetics so she wouldn't have to deal with it later in life. Used an oral surgeon.
PDWT_12 said:
Interesting timing, my wife took my son for an evaluation with a myofunctional therapist yesterday. We saw her once when he was baby struggling with some stuff as an infant and had his tongue ties cut. I think that helped at the time in some ways, but our pediatrician would disagree with that.
Our main concerns right now are some ADHD type symptoms, and have had a few people recommend getting his airway checked out. He's got a super crowded mouth with his new teeth coming in, and has already seen an ortho who said an expander is in his near future.
It's always a fine line with specialists like that, they have really good info and ideas, and also often seem to believe every issue a kid has can be solved by their recommendations.
Good luck the rest of the way.
Oh man, your last paragraph is exactly what I have been thinking. Of all the various specialists we've met with, I have yet to meet one that I feel is trying to deceive us, I think they all truly feel their recommendation is what is best, but we've had so many different thoughts! Who do we trust?? It's so hard.
We just have to do our due diligence and then make the best decision we possibly can.
Best of luck to you as well!
spike427 said:
Have you looked into a REMplenish water bottle?
We have actually. We are using an Owala which is also supposed to be decent. I've just heard enough negative about the REMplenish that it turned us off a bit (cost being one, yikes!). Thanks so much for bringing that up as a consideration though!
maroonpivo said:
My 7 year old had a frenectomy done last fall. It never affected her eating as an infant and was told as she aged it could be fine, but as she got older, when she smiled it was all you could see at the top of her lip, so we took care of it for cosmetics so she wouldn't have to deal with it later in life. Used an oral surgeon.
I'm glad to hear you had a positive experience! Our tongue tie isn't visible, almost at all. The Myo is the only one who has 100% confirmed it and that was after a lot of testing. Part of what's making this so hard…
Yep. I think we've found the truth is always somewhere in the middle. Take the info you can from the experts you trust and follow your instincts when you can.
ADHD can definitely be a symptom of pediatric sleep apnea. Or it can be just ADHD. A crowded arch, high palate, etc., are further cues. Listen to the kid during sleep, wait until they have been asleep at least an hour and a half to two hours to increase your chances of catching them during a REM period, but the best time to listen is very late into the sleep period as those REM periods are longer and denser. If you can't figure it out, you could always get a sleep study.
And there is very little evidence that a tongue tie affects sleep apnea, despite what a few studies seem to suggest. Summarized, "a 2025 systematic review concluded there is "mixed evidence" and an "unclear relationship" due to lack of standardized diagnostic criteria for ankyloglossia (tongue tie) and reliance on surveys rather than validated clinical assessment tools." In fact, the American Academy of Otolaryngology-Head and Neck Surgery's 2020 clinical consensus statement concluded that "there is no evidence that ankyloglossia causes sleep apnea." I have no doubt you can find isolated papers which will state the contrary, but the preponderance of evidence simply doesn't suggest a causal relationship. Nor has there ever been a good case/control study showing that releasing a frenulum improves sleep apnea.
And there is very little evidence that a tongue tie affects sleep apnea, despite what a few studies seem to suggest. Summarized, "a 2025 systematic review concluded there is "mixed evidence" and an "unclear relationship" due to lack of standardized diagnostic criteria for ankyloglossia (tongue tie) and reliance on surveys rather than validated clinical assessment tools." In fact, the American Academy of Otolaryngology-Head and Neck Surgery's 2020 clinical consensus statement concluded that "there is no evidence that ankyloglossia causes sleep apnea." I have no doubt you can find isolated papers which will state the contrary, but the preponderance of evidence simply doesn't suggest a causal relationship. Nor has there ever been a good case/control study showing that releasing a frenulum improves sleep apnea.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
maroonpivo said:
My 7 year old had a frenectomy done last fall. It never affected her eating as an infant and was told as she aged it could be fine, but as she got older, when she smiled it was all you could see at the top of her lip, so we took care of it for cosmetics so she wouldn't have to deal with it later in life. Used an oral surgeon.
Are you conflating a lip tie with a tongue tie (labial frenulum with a lingual frenulum)? A labial frenectomy is sometimes done because it is felt it will inhibit closure of a persistent gap between the central incisors or to prevent gum recession. Or it could be a cosmetic issue.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
I assumed poster meant labial frenectomy when I read that post.
lazuras_dc said:
I assumed poster meant labial frenectomy when I read that post.
I did as well. Just sharing their experience and that an oral surgeon was used.
Yeah, sorry, didn't mean to downplay a dentist's training. It's no different in the MD/DO world as well. I've seen patients go to physicians that do cosmetic procedures, or wellness treatments, that they simply took a short weekend course on from the manufacturer of the equipment, and then create complications they don't know how to handle. It's actually getting really bad with NPs that have been granted independent practice in certain states, and in some states they are practically working independently but just pay a physician a token amount of money to be their supervisor on paper.
Labial frenulum.
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