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  • Writer's pictureAshleigh Richmond

Part 1 - Ashleigh's Tongue Tie Release Journal - Myofunctional Therapy Evaluation

Taking numerous trainings on tongue tie and tethered oral tissue I found myself having many of the symptoms described in the adult case studies. Join me on my journey to reduce my symptoms, start myofunctional therapy, release my tongue tie and expand my palate!

Adult tongue tie

Adult tongue ties are complex. After years of suffering I'm hopeful that I get some relief. Let's see what my Myofunctional Therapy assessment tells me.

I first started taking tongue tie and tethered oral tissue trainings in 2019 because I was seeing so many babies with breastfeeding issues that I suspected was related to ties. After getting my IBCLC in 2021 I expanded my education further with TOTs training, IBCLC Masterclass, Breath Baby and Tongue Tied Academy courses. I was HOOKED! I could not stop the pull to continue to learn more about how to identify tongue ties (and other oral ties) and work to help these babies feed functionally.

What I learned about myself along the way.

In the first couple of trainings I kept noticing symptoms that I had myself. I grind my teeth constantly, my palate is insanely narrow, despite going through orthodontia as a teen my teeth are a hot mess and crooked, I choke when I take pills (my husband will tell you I frequently choke on water as well), I have tension in my upper back and neck that on an x-ray looks like I've had whiplash when I haven't and I have recently started snoring. I've been through chiropractic, physical therapy, craniosacral therapy and massage for my body tension over the years with some relief but my pain always returns. I also have frequent sinus issues that have gotten worse as I've gotten older. I used to chalk all these things up to stress or age, but follow along as I find out if the root cause is my oral dysfunction.

How did I eat as a baby?

Being an IBCLC Lactation Consultant always makes me relate issues back to being an infant. My mom breastfed me for 10 months after I was born in 1982. This was no small feat! Her doctor was "old school" and was actually supportive of nursing when most doctors at that time were not. Other than her doctor she had little breastfeeding support, all she had was La Leche League and determination. No internet to look up anything and few books to refer to. When she went back to work things got tough as there were not electric pumps and she was expressing with a plunger-type hand pump during her shift at a retail store and then storing the pumped milk in the product freezer. She's a powerhouse I tell you! One thing to note is that my mom had an INSANE milk supply. She always says she was "Bessie the Dairy Cow" and had to shove cloth diapers in her bra because she leaked like crazy. I'm assuming miniature me rode that letdown for sure! I did get bottles of breastmilk and formula as a baby as well.

So now that I see all these symptoms, what do I do? 

As other moms will tell you, we tend to always put ourselves last. I saw many of the same symptoms as I was seeing in myself in my daughter. I started her in myofunctional therapy at 12. I wanted her to go first and see if we could work through her messy eating, open mouth breathing and nasal congestion. Now that she is on her way, it was my turn.

I started at our local orthodontist for an evaluation. They noted: abnormally small mouth opening and that my teeth were shifting to where my tongue was resting on top of my lower teeth. I've noticed this as well and it's SUPER irritating. The underside of my tongue is always rubbed raw. During my evaluation, the orthodontist suggested Invisalign or regular braces. I wanted to get a second opinion because my gut was telling me (and all my trainings) that wasn't going to be enough to fix all my issues. There was no mention of palate expansion either which was strange to me. Back in the 1990's, when I had braces, palate expansion was not a thing. I also had the world's WORST orthodontist, but I won't go into that.

At Wisco Lactation we are so blessed to have an amazing Occupational Therapist and Myofunctional Therapist, Julia Shannon. She did a full assessment for me and I'm so glad she did! Here are some things that Julia found.

Myofunctional Therapy Assessment:

Forward Head Posture

Forward head posture

Here's were that neck pain is coming from ya'll! For every inch you move your head forward, the perceived weight of your head on your spine will increase by 10lb per inch. This means that if your head is positioned 3 inches further forwards than it should be, it can feel like your head weighs 40lbs more. Ouch! Tongue ties can cause muscles to compensate for the lack of proper positioning of the tongue causing forward head posture. This can lead to neck and back pain, which can then worsen a forward head position.

Tori in mouth

Tori on the upper gums and floor of the mouth

Tori are bony growths that can happen in the mouth. Some studies relate these to teeth grinding (which I've noticed I do pretty much all day long especially on my left side). Genetics can also play a role. All I know is that they hurt when anything touches them and food can get stuck up there while I'm eating. Tooth grinding – especially during sleep – can be a sign of a tongue tie. This is because the short frenulum keeps the tongue from assuming its natural rest position against the palate (roof of the mouth).

Narrow palate

Narrow and high palate

My mouth is small you guys! I have to use the child size appliances at the dentist. My sister is my dental hygienist and it's a running joke. Because my tongue cannot get all the way up to the roof of my mouth my palate did not spread as I was growing up. Genetics also involved here as well. I did not have palate expansion when I had braces. I have a somewhat sensitive gag reflex that can be related to the high palate. The roof of the mouth is also the floor of the nose so possibly related to my sinus issues as well.

Tongue Tie

Tight lingual frenulum

There's the tongue tie! Look how tight my frenulum is! Julia had me suction my tongue to the roof of my mouth and open as wide as I could for the photo on the left. When opening my mouth my jaw clicks and pops. I can barely open my mouth and you can see that only the tip & edges of my tongue reach the palate, not the whole tongue. There is really no posterior (back of tongue) lift at all. The photo on the right she had me open my mouth as wide as I could and lift my tongue. I'm trying SO HARD to get my tongue up there and my tongue is pulling far to my left (interesting that is the side I grind my teeth on too). My jaw is shifted to the right so to compensate and get to "neutral" my tongue has to shift to the left causing more tension on that side. That tongue tip is not even close to getting to my palate. You can also see in this photo that the floor of my mouth is lifting along with my tongue to try to compensate.

Tongue Tie

Tongue and lip lift

The photo on the left has Julia holding down the floor of my mouth while I lift my tongue to see how much I can truly lift without that compensation. This gives us a truer representation of my actual tongue lift. My Tongue Range of Motion Ratio (TRMR) is a grade 2, but with as much as the floor of my mouth lifts it's really a grade 3. The photo on the right is me lifting my upper lip. Thankfully I have good lip lift so no issues there.

Airway Opening

Airway opening

These photos give a small glimpse into my airway opening. This is in no way a full assessment of my airway. I am a Mallampati III. The Mallampati score is one assessment to describe the relative size of the base of the tongue compared to the oropharyngeal opening in hopes of predicting a difficult airway. This can help predict sleep apnea. I recently started snoring which wakes my husband and I am so embarrassed about. I'm hopeful this process of expanding my palate and releasing my tongue tie eliminates my snoring. If not I'm going to dig a bit deeper to find other possible causes. What is interesting is that when my teeth shifted again recently the snoring showed up all of the sudden. Another thing to notes is the scalloping on the sides of my tongue from lack of space and it laying against against my teeth.

What's next for me? 

Julia and I ran out of time in our assessment so she didn't get to see me eat/drink or give me any myofunctional therapy exercises. So we are going to do that when we meet again. Expanding my palate first before tongue tie release is ideal for my situation, but I can't get in to be assessed for that until May. Stay tuned for my next blog post to follow along as Julia and I work together to decide what is next for me!

This blog post is in no way medical advice and just my personal experience. Please consult with your local myofunctional therapist for a full assessment.

Local to the Milwaukee, Wisconsin area? Have a child you want to have assessed for tongue or lip ties? Book a visit with our Myofunctional Therapist, Julia!


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