Episode 200: Functional Impact: When A Tongue Tie Is ACTUALLY A Tongue Tie

Hi and welcome to episode 200 of the Untethered Podcast.

It is your host Haley Balkan and we are going to dive into a very brief episode today together on Tethered oral Tissues. It's just me and you, so let's.

Jump in and yay. Happy 200 episodes to the Unto Their podcast. Let's do this thing.

Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses.

Let's get started. There's been a lot of discussion on social media and amongst different professionals about tongue ties and lip ties and the research or the lack of research and so I just want to lay it all out there and have a very informative but short episode on what we need to be looking at, what we need to be doing and the key things to remember when it comes to assessing, diagnosing tethered oral tissues and making referrals. Or if you're a parent, knowing what questions to ask, know who, knowing who to trust, who to listen to. Right? So hopefully arming you with this information is going to help you figure out who to go seek or what next question to ask. All right, so let's jump right on in because we only have a few minutes. So I put up a post on Instagram last week that said something along lines of like let 2023 be the year that large SLP accounts were like 80,000 plus followers and you know, other medical providers providing information. All of that fun stuff like people with large following, let it be the year that they put their ego aside, have healthy conversations with colleagues instead of blocking them, and listen to patients and caregiver caregivers over a lack of research. Okay. Because we need to put patients first. I just wanted to put that out there. The next thing I want to highlight is that I want this to be the year that we remember the diagnosis, the definition of the diagnosis of a tongue tie or definition of a tongue tie, a lip tie, a cheek tie, Right. There has to be a functional impact. It's not enough that the tissue presents as being, quote, unquote tight or short or restricted. Is that important? And should we monitor it if there are no symptoms present? Absolutely. But a tie is not a tie, whether it's cheek, lip or tongue, unless there's functional impact. And what do I mean by functional impact? I mean, feeding is impacted, sleep is impacted. Maybe down the line, we see kids who've been in speech forever because they don't have full range of motion and can't actually hit certain sound targets. So it impacts their speech behavior because their sleep is impacted. Right. We start to see these snowballing issues, right? Airway issues, always getting sick, all these issues that tie back to what's going on inside the mouth. But we have to remember, and I'm sharing this, we have to remember the functional impact and what that means. Because I still see a lot of professionals and parents, and I can't blame a parent, but a professional who's taken courses and who admittedly says they know how to assess and diagnose a tongue tie but then spreads misinformation. We need to make sure that we are imparting the correct information and empowering parents. And so I see a lot of parents saying things like, oh, well, my child was diagnosed with the tie, but we didn't do the release. And my baby, you know, was totally fine with feeding and speech and, you know, sleep and all the things. Right? And they still are fine. Well, then it's not a tie. If there's no functional impact, there's no impact on their overall health. We're not seeing systemic snowballing of issues and signs and symptoms that are, you know, impacting their optimal. Their ability to function every day in their optimal health. Then it's not a tie. It's just a typical frenum or, you know, frenulum, if that's what you want to call it. Right. Our frena. Our tissues, those oral tissues exist. Everybody should have them. It comes down to how pliable are they, how stretchy are they? Do you have full range of motion? Is there any restriction? And then beyond that, what is the functional impact? That is the question we need to be asking. And if we cannot answer that, or we don't see a functional impact, or we don't have the education to know how to answer that, that's when we seek out an evaluation, right? And with an evaluation, we. And this is where I also said, like, let's let this be the year that teachings pathologists and occupational therapists and then PTs who may be trained in this as well. Because we are the only providers who have feeding and swallowing beyond like breastfeeding in our scope of practice and covered by our licensure. We are the only people who can actually do a functional feeding, oral, sensory, oral motor feeding evaluation under the age of four. That is what is needed. Can we still do it after four? Absolutely. But after four, if you're starting to see airway issues and tongue tie concerns and maybe there's malocclusion, right. There's issues with the jaw or the, the TMJ or airway. Right. That may look more like an orofacial myofunctional evaluation, which for SLPs and OTS and PTS is kind of an extension. Extension of what we're already doing in our assessments. If we're trained to look at airway and tether tissues and you know, the orofacial complex in the way that myofunctional therapists are SLP mile, you know, SLP OTPT myotherapists are. So over the age of four, you can go to a general myofunctional therapist if the child has the cognitive capabilities of at least a four year old. Some children need to be a little bit older because there is this active engagement in a myo eval and in myotherapy that requires the child to understand what they're asking them to do in order for us to, you know, or adult in order for us to get the most accurate information. So that's really what I wanted to plug. There's one other thing I want to say. Today I was recording an episode with a colleague and we were talking. She, you know, she said she's a pediatric dentist who does tetheral tissue releases. And she said to me, we really need to, you know, be not just encouraging, but requiring that children have pre op and post op therapy. And we need to. Another, another colleague said to me this week, we need to condition the muscle groups, right? We need to condition the, basically the oral structures, soft tissue before the release so it's prepared. And then we need to get in there, we need to continue therapy after. And so anybody who is going for a release without proper oral motor intervention or myofunctional or patient myofunctional intervention, that's not a provider you should be seeing because that is, in my opinion, even if you get a good release, the function in most cases is not there. Will some children maybe gain the function afterwards? Maybe. Have we seen children improve drastically after release? We have, but most people need the surrounding support. And I truly, it's my professional opinion that a lot of these procedures are happening without a lot of the procedures that are happening without proper care surrounding them. And I'm not talking just body work. We need to be working in the mouth. We need to be teaching the tongue proper function. And we need to realize that when a tongue is released, right, it's now free, quote unquote. But it's not going to change how it functions if it's not trained. We need that neuromuscular re education or as my colleague Karen said, we need to condition the muscle group. Okay. Her episode will be coming out in a few weeks. We need to condition the muscle group. So what does that look like? That is that pre op and post op therapy that we talk talk about. And one of the things I put on my post was like, let this also be the year that more providers collaborate with the patients and also require the therapy surrounding tethered oral tissue releases. Because so many of the comments that I see over failed releases or issues that evolved after the release. When you ask and you have a conversation with these individuals, they tell you no one told me I needed pre and post upper. They told me, but they didn't require it. So I didn't do it. Or you know, we didn't have the money to do that. Well, in some cases it can be actually detrimental to have a release and leave out the supports that you need to make that really successful. Right. So that's what I kind of want to wrap this up on. Like I said, today is a very short and sweet episode because this is a very important message. The other thing I want parents and providers to be aware of is that we cannot just fall back on the lack of research or cite things that serve our purpose when it endangers the public. We are seeing that when patients have proper support with a skilled release provider and they have that pre op and post op therapy was what I mean by proper support. Right? We do see the benefits. Sometimes they're more immediate, sometimes they take longer. But that is part of the therapeutic process. There is this dance between, you know, what we do, I joke. It's like a dance between an art and a science. And we have to be critical thinkers. As professionals. We have to put our critical thinking hat on. We have to go, okay, what does this patient in front of us need today? Right, who is this patient? What do they need? How can I help them? What are their goals? What are their next steps? Beyond just what I'M recommending what does that parent desire for their child? What does that adult patient need for themselves? Right. And so with that, as we start to wrap this up, we need to realize that the research is lacking. There is, there are some good research, there's more coming out, but the research is also lacking. There's also a 17 year lag in research. And you can, you can look this up, this is documented, it's across all areas of medicine. It's also true that all areas of medicine have certain areas that are lacking in research. It's also true in the tongue tied space that individuals who have tried to publish research or do research have been blocked by boards, some boards that they sit on, because these boards of individual as a collective whole, you know, that individual may be aside, do not agree, they don't believe that Heather, oral tissues are an issue. So they block the research from being done. So the point of me sharing this is we need to keep these things in mind. Okay? There is a lot of red tape behind the scenes. And at the end of the day, our patients come first. Our experience needs to be pulled into this. And when the research is there to discuss both sides of a situation, then we can have a better balanced conversation around it. But we have a due diligence, we have an ethical responsibility, and we have a licensure to uphold that requires us to present all sides of the information and make sure that our patients have informed consent. And that also falls on individuals when posting on social media. Which is why I always say we need to do a functional evaluation to determine next step, determine if the tie needs to be released or not. The last thing I will say as I wrap this up is just because a patient has a tire, presents with a tie, and has symptoms on a functional evaluation, it doesn't mean that they need a release. Right. When you start feeding therapy or myofunctional therapy, we sometimes realize within two to three weeks that the tongue appeared to be tense, the tongue appeared to be tied, the lip appeared to be tied because of the surrounding tension that was mimicking a tie. Right? Or maybe there's not enough space for the tongue to live in the palate and it's actually a tongue space issue, not a tongue tie issue. There are other things that individuals in this space are trained to assess for. So no, not everybody who walks in the door goes for a release and not everybody who gets diagnosed with a tethered oral tissue, a tie, whether it be tongue lip buckle, not everybody ends up needing a release or getting released. Sometimes things look different even just two to three weeks or a month later. So please Next Steps if you're a parent, seek out a provider that you know. As I've explained, for a functional assessment based on your child's age right under the age of four, you want an ot, SLP or PT trained in pediatric feeding, myo and tethered oral tissues and airway. Ultimately, over the age of four, a oral patient myofunctional evaluation can be appropriate versus, you know, having to see one of those specific providers slp, OTPT professionals. If you want to work with birth to three and you want information on tots and you know, how tots and airway myo and all that impacts the birth to three population and how you as an SLP or ot, you know, can work with these patients, then come join me in Feed the Pete's. Go to FeedThePeds.com I'm going to plug that here real quick because we need more of you. We have over 1500 of you that have gone through the course in the past couple years, but we need more and our patients are constantly, you know, not our patients, patients. Parents are constantly asking for more providers. So join me in this mission. Go to FeedThePedes.com and join us this week because doors are open right now and they close on Friday. I cannot wait to see you all inside if you're joining us, if you're not, if you're a parent, if you're a provider who wants to learn more, just check out more episodes of this podcast. Join me at hellybalkin on Instagram. There's tons of free information for you and I look forward to hanging out with you over there. All right everybody, we'll chat soon.

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