My Story Part III - The Big Snip

Hi there!

The saga continues! In my last post I talked about how my tongue tie affected my speech and my experience with speech therapy.  In this post, I'm going to relate what led to my decision to finally have a lingual frenectomy and starting work with my orofacial myologist.
  

The Observant Student Dentist

Even though I did not find speech therapy helpful at the time, I still thought that it could help me in the future, that maybe I needed more intensive therapy with someone with more experience.  In any case, I set aside the idea of speech therapy while I focused on graduate school.

A few years later, while on internship, I used my student status to obtain dental insurance through a New York dentistry school.  I met with the student dentist assigned to me and during the first examination he mentioned my tongue tie.  He then made an observation that no other dentist I had seen in over 30 years had ever made: my frenulum was pulling on my gums, causing them to recede.

Hey, at least I brushed...

I was aware I had gum recession but I had always thought it was due to not flossing enough, over-brushing, and/or genetics.  It never occurred to me that it could be connected to my ankyloglossia.  I suddenly realized that my tongue tie was affecting my oral health!  

Dental Health and Tongue Tie

Now, it is known that people with tongue tie often cannot properly clean their teeth after they eat, particularly in the areas between their teeth and cheek, because their tongues cannot reach.  I was no different: after every meal, food was trapped between my cheeks and teeth so that I had to scrape it out using my fingers.  Imagine, being out to dinner and having to reach into your mouth and use your finger to remove food trapped above your teeth.  Sexy.

But gross personal habits aside, the inability of tongue tied persons to use their tongues to clean their teeth means they are at greater risk of developing plaque, cavities, and gum disease.  Here's a great website on a book on tongue tie that outlines much of what I have already talked about including issues that will come up later in my story: 

http://www.tonguetie.net/index.php?option=com_content&task=view&id=3&Itemid=3

Some people who are tongue tied may find themselves overcompensating by brushing extra long or hard, or using more toothpaste because they are trying to make up for the fact that their tongue can't do its job.  In my case, years of over-brushing has weakened my enamel, making my teeth more sensitive, and contributed to gum erosion.  While I cannot say that these things are 100% attributable to my tongue tie, my tongue tie definitely made them worse.

The Final Decision

Well, that was it for me.  It was clear that my tongue tie was affecting in more ways than I had realized and I'd had enough.  I was determined to have a lingual frenectomy.  However, I had reservations.  It's a big decision to get one's tongue snipped.  Surely I would need speech therapy afterward, right?  During my frenectomy consultation, I asked the surgeon if I would need therapy after the procedure.  Oh no, he assured me, everything would improve on its own.  Well, I didn't buy that.  I had been eating, drinking, and talking a certain way for 34 years.  I didn't believe that would change simply because I could move my tongue more.  In fact, I was greatly concerned that my tongue thrust would worsen because my tongue would have the freedom to stick out even more!

So I hit the interwebs and began looking for information on recovery after lingual frenectomy.  I also began looking for a speech therapist.  During my searching, I came across a webpage in which people were commenting on treatment options for tongue tie and I saw a term I'd never seen before: orofacial myologist.

What is an orofacial myologist?  It is someone "that evaluates and treats a variety of oral and facial (orofacial) muscle (myo-) postural and functional disorders and habit patterns that may disrupt normal dental development and also create cosmetic problems" (From the International Association of Orofacial Myology's website - http://www.iaom.com/orofacialMyology.html). They are also known as myofunctional therapists.

Consulting With My Orofacial Myologist
Using the International Association of Orofacial Myology's (IAOM) website directory, I located an orofacial myologist (OM) in Dutchess County, NY.  I called her and told her I was getting a lingual frenectomy for a tongue tie and was considering myofunctional therapy.  She asked me a series of questions regarding my dental and orthodontic history. She even asked questions that I was surprised to hear: Did I snore? Did I have allergies?  Did I have breathing difficulties? Was I frequently tired during the day?  

Just by listening to me talk on the phone she could hear my speech difficulties.  She said it was very important we meet before I had the lingual frenectomy as it was vital she examined my teeth and bite and overall orofacial functioning.  When we met, she told me that a lingual frenectomy was just what I needed.  During the OM's evaluation of me, she looked at my tongue and palate, recorded me talking and repeating back words and numbers.  She took photos of my face.  She was positive, encouraging, and VALIDATING.  She affirmed everything I've said here: about my tongue tie and tongue thrust interfering with my braces, about speech therapy being ineffective because of my tongue tie and open bite, about my dental health being affected because I couldn't use my tongue to clean my teeth.  She also confirmed my belief that I absolutely needed therapy after my lingual frenectomy.  We made an appointment for two days after the procedure.  That's right, therapy would begin RIGHT AWAY.

I emphasize that because it is extremely important to get the tongue moving after a lingual frenectomy but more on that in my next post.

I cannot stress enough how wonderful it was meeting my OM and having her confirm every belief I held about how my ankyloglossia was affecting me.  She even pointed out things that were connected to my tongue tie that I weren't even aware of!  Meeting with her was one of the best decisions I have made in my life.

The Procedure
The lingual frenectomy procedure took about 5 minutes. That's it.  That time may vary case by case but it is generally a quick procedure.  It was done by laser, which my myofunctional therapist said is the best way to go because the laser cauterizes the skin, hastening healing time.  Incidentally, there are numerous videos on YouTube of frenectomies being done by laser, so it is easy to see what the procedure entails.  Some frenectomies are done by cutting the frenulum with an instrument and require stitches.  There is more bleeding in this procedure and people generally report more discomfort following this type of frenectomy, especially since it requires stitches.  

I did receive a couple of shots of anesthetic.  Once that took effect the procedure was absolutely painless.  The surgeon held my tongue and gently worked the laser on my frenulum.  I'll never forget the moment when the surgeon, immediately following cutting my frenulum, asked my to stick out my tongue.  I slowly stuck it out... and could feel it move past my teeth!  I then began extending it down my chin and could feel it reaching down to the center of my chin!  I was amazed!

The surgeon gave me gauze to hold under my tongue for about 30-45 minutes, if I remember correctly, and instructed me to eat ice cream that night.  Yay, ice cream!  I was also give a prescription for painkilllers - I believe it was acetaminophen with codeine. I was instructed not to eat solid, crunchy foods.  After an hour or so, my tongue did hurt, I'm not going to lie, but I was able to talk and to drink and eat ice cream that night.  Over the next few days, I would sometimes experience a sharp pain when opening my mouth to eat something and sometimes during eating when my tongue moved in a way it never had before.  But it would pass and I only used the painkillers for the first 3 days.

In my next post I will discuss the benefits I started to experience, in some cases within hours of having the lingual frenectomy, and beginning my myofunctional therapy.

Happy trails!