Chapter 38: Dental Complications—Soft Tissue (Gingiva and Mucosa)

Ankyloglossia

Patient Story

A 2-year-old male child presents with a chief complaint per mother of “not being able to stick out his tongue.” (Figure 38-1). On examination, the child could not protrude the tip of the tongue over the mandibular anterior teeth and could not effectively lick his upper lip. Neither gingival recession nor speech pathology was noted. A diagnosis of ankyloglossia was made. Frenectomy was suggested and delayed until child’s age made feasible necessary behavioral management in the dental chair.

Introduction

Ankyloglossia refers to a congenital abnormality, where a short and/or thick lingual frenum may restrict tongue movement (Figure 38-2).¹ Severity may vary significantly.

Synonym

Tongue-Tie.

Epidemiology

• Reported prevalence varies from 0.1 to 10.7 percent, dependent on age population surveyed.¹

• It has been reported as being more prevalent in males, although this is a controversial and inconclusive finding.²

Etiology and Pathophysiology

• This is a developmental, congenital condition.

• There have been reports associating ankyloglossia with specific syndromes such as X-linked cleft palate.³

• However, most incidences of ankyloglossia occur in individuals without any other congenital disease.

• A positive family history of ankyloglossia was noted in a wide range (10% to 53%) of families surveyed in a 2002 study,⁴ while it has been strongly associated with maternal cocaine use.⁵

Risk Factors

• Family history.

• Maternal cocaine use (3.2 times the increased risk).⁵

Diagnosis

Clinical Features

• Variably short and thick lingual frenum with concomitant limitation of tongue mobility (range of motion) and/or functionality.

• Clinical diagnosis is typically made during early feeding disturbances in children, in which severe ankyloglossia prevents/impedes completion of a sufficient oral seal during nursing.

• Initial diagnosis in neonates and young infants might be made by lactation consultants.

• A randomized controlled trial demonstrated in 2005 that 95 percent of infants receiving surgical correction had improved feeding, compared to <10 percent in the control group.⁶

Differential Diagnosis

• Feeding and speech difficulties may be associated with other intrinsic behaviors and causative factors.

• Therefore, a comprehensive review is required to determine the possible contribution of ankyloglossia and the need for management.

Management

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