Tongue Tie in Children: How It Affects Jaw Development and Speech

More Than a Newborn Problem

When most people hear the term tongue tie, they think of newborns struggling to breastfeed. And while feeding difficulties in infancy are indeed one of the most common reasons tongue tie is identified and treated early, the consequences of an unresolved tongue tie extend far beyond the newborn period.

Children who have a tongue tie that was not identified or not fully resolved in infancy carry that restriction into childhood and beyond. The effects on jaw development, dental health, speech, breathing, and sleep accumulate quietly over the growth years, often without anyone connecting these difficulties back to a small band of tissue under the tongue that was never properly addressed.

At Dr Gray Dentistry in Durban, Dr Gray assesses tongue function as a routine part of evaluating children's jaw development and bite, because the tongue is not a passive bystander in the mouth. It is one of the most powerful developmental forces shaping the upper jaw, the palate, and the airway during childhood, and when its function is restricted, the consequences are wide-ranging.

What Is Tongue Tie?

Tongue tie, known clinically as ankyloglossia, is a condition where the lingual frenulum, the band of tissue connecting the underside of the tongue to the floor of the mouth, is shorter, thicker, or tighter than normal. This restriction limits the range of motion of the tongue, preventing it from moving freely in all the directions that normal tongue function requires.

Tongue ties exist on a spectrum of severity. At one end are obvious, anterior tongue ties where the frenulum is clearly visible, extends to near the tip of the tongue, and causes significant, visible restriction. At the other end are posterior tongue ties, sometimes called submucosal tongue ties, where the frenulum is less visible but still present as a band of tighter tissue further back under the tongue. Posterior tongue ties are significantly underdiagnosed because they require a more thorough assessment to identify and are not always visible on casual inspection.

The severity of functional impact does not always correlate directly with how obvious the tie appears. Some children with visibly short frenulums develop good compensatory tongue function. Others with less visually dramatic ties have significant functional restriction that affects multiple aspects of development.

How the Tongue Shapes the Jaw

To understand why tongue tie matters for jaw development, it helps to understand what the tongue normally does during childhood growth.

When tongue function is normal, the tongue rests in its natural position against the roof of the mouth, the palate, for most of the day and night. This resting tongue pressure against the palate is a continuous, gentle developmental force that shapes the upper jaw from within, encouraging it to grow broad, wide, and well-formed. During swallowing, the tongue presses firmly upward against the palate, reinforcing this developmental pressure many hundreds of times every day.

When the tongue is tied, it cannot rise to its correct resting position against the palate. Instead it rests on the floor of the mouth, and the developmental pressure that normally shapes the upper jaw from within is absent. The result is that the upper jaw grows narrow and high-arched rather than broad and flat, in the same way a tent collapses when the central pole is removed.

A narrow upper jaw created by inadequate tongue pressure has cascading consequences: less space for the permanent teeth, more crowding, a narrower nasal floor above the palate and therefore a narrower nasal airway, a bite that is more likely to develop problems, and a palate that is higher and less well-formed. All of these consequences are the direct downstream effects of a tongue that could not do its developmental job because of a restriction that was never addressed.

Signs of Tongue Tie in Older Children

Because tongue tie is so strongly associated with newborn feeding difficulties, it is frequently missed in older children where the presentation looks different. The following signs in children beyond infancy are worth investigating for possible tongue tie:

Speech difficulties
The tongue is essential for the production of a wide range of speech sounds. Sounds that require the tongue tip to contact the roof of the mouth, including l, n, t, d, r, and th sounds, are particularly affected by restricted tongue movement. Children with tongue tie may have persistent articulation difficulties, a lisp, or speech that remains unclear beyond the age at which it would normally have resolved, despite speech therapy that has produced limited improvement.

It is worth noting that speech therapy alone cannot resolve articulation difficulties caused by tongue tie, because the restriction preventing correct tongue placement is still physically present. Releasing the tongue tie and then working with a speech therapist produces significantly better outcomes than speech therapy without release.

Dental and jaw signs
The dental and jaw consequences of tongue tie described above produce identifiable findings on examination:

A narrow, high-arched upper palate is one of the most consistent findings in children with unresolved tongue ties. The palate has a characteristic tent-shaped or cathedral arch appearance rather than the broad, relatively flat shape of normal palatal development.

Dental crowding, particularly in the upper arch, is common because the narrow palate has insufficient space to accommodate all the permanent teeth.

A gap between the two upper front teeth, a diastema, can be caused or maintained by a tight labial frenulum, the band of tissue between the upper lip and the gum, which is sometimes associated with tongue tie as part of a broader pattern of frenulum restriction.

An open bite can develop in children with tongue tie, driven by the forward tongue rest posture and the tongue thrust swallowing pattern that frequently develops as a compensation for restricted tongue movement.

Breathing and sleep
As discussed in the mouth breathing post in this series, the tongue's resting position directly affects breathing patterns. A tongue that cannot rest against the palate drops to the floor of the mouth, contributing to mouth breathing, forward head posture, and the airway consequences that accompany these patterns.

Children with unresolved tongue ties frequently show signs of disrupted sleep, snoring, and mouth breathing. Some have obstructive sleep apnoea. The connection between tongue tie and airway health is increasingly recognised and is one of the reasons that assessment of tongue function is an important part of a comprehensive airway-focused evaluation.

Feeding and eating difficulties beyond infancy
Some children with tongue tie continue to show feeding difficulties beyond the newborn period. They may be slow, messy eaters, may struggle with certain food textures, may have difficulty clearing food from around their teeth with the tongue, or may gag more easily than peers. These difficulties often go unconnected to tongue function because the feeding problems of infancy are assumed to have resolved.

Compensatory habits and postures
Children with tongue tie frequently develop compensatory patterns to manage their restricted tongue movement. These include thrusting the tongue forward between the teeth during swallowing, a tongue thrust swallowing pattern that has significant consequences for bite development and open bite formation. They may also develop characteristic lip and jaw postures as compensations, and may hold tension in the jaw and neck muscles as a result of the effort required to manage restricted tongue function.

Tongue Tie and Orthodontic Treatment

Tongue tie has specific and important implications for orthodontic treatment that are not always recognised.

It limits what orthodontic treatment can achieve
If a tongue tie is not addressed before or during orthodontic treatment, the restricted tongue continues to apply abnormal forces to the teeth and palate throughout and after treatment. A narrow palate widened with a palatal expander will tend to relapse if the tongue cannot maintain its correct resting position against the palate after expansion. An open bite closed with braces will tend to reopen if the tongue thrust swallowing pattern driven by the tongue tie is not resolved. Orthodontic treatment in the presence of an unresolved tongue tie is working against a persistent structural and functional obstacle.

Palatal expansion is more effective when tongue function is normal
When the tongue can rise to its correct resting position after palatal expansion, it actively maintains the expanded width, supporting the retention of the result. When the tongue tie prevents this, the expanded palate is not being maintained by the natural developmental pressure it is designed to receive, and relapse is more likely.

Release before or during treatment produces better outcomes
For these reasons, Dr Gray assesses tongue function at Dr Gray Dentistry as part of orthodontic treatment planning, and where a tongue tie is identified as a contributing factor to the presenting problems, release is recommended before or during treatment rather than after, when the opportunity to prevent treatment complications has already passed.

Tongue Tie Release: What It Involves

Tongue tie release, known as a frenectomy or frenotomy, is a procedure that divides the restrictive frenulum to restore normal tongue mobility. In children, it is typically a straightforward procedure that can be performed with local anaesthetic and takes only a few minutes.

Modern laser frenectomy is a particularly precise and comfortable approach, producing minimal bleeding, reduced post-operative discomfort, and a faster healing period than traditional surgical methods. Dr Gray does tongue tie releases in the rooms under local anaesthetic or can organise under sedation a tongue tie to be relieved.

Release alone is not the complete solution. The tongue has often developed compensatory movement patterns over years of restriction, and simply releasing the frenulum does not automatically produce correct tongue function. Myofunctional therapy, specific exercises that retrain the tongue to adopt its correct resting posture and swallowing pattern, is an important part of the post-release process and significantly improves the outcomes of both the release and any associated orthodontic treatment.

When to Seek Assessment

If your child has any of the following, tongue tie assessment is worth pursuing:

A history of breastfeeding difficulties in infancy that were attributed to tongue tie, whether or not a release was performed. Persistent speech difficulties that have not resolved with speech therapy. A narrow, high-arched palate identified at a dental visit. Crowded teeth in the upper arch. An open bite or a tongue thrust swallowing pattern. Mouth breathing or disrupted sleep. Difficulty with certain food textures or messy eating beyond the toddler years.

Assessment of tongue tie in older children requires a functional assessment, not just a visual inspection.

Assess Your Child's Tongue Function at Dr Gray Dentistry, Durban

Dr Gray at Dr Gray Dentistry in Durban, South Africa includes assessment of tongue function and frenulum restriction as part of a comprehensive evaluation of children's jaw development and orthodontic needs, coordinating with ENT specialists, myofunctional therapists, and other practitioners to ensure the full picture is addressed.

Book your child's assessment at Dr Gray Dentistry in Durban today.