What is a Posterior Tongue-Tie?

A posterior-tongue tie is a restriction that may be less obvious to people who aren’t trained to look at function and symptoms of a tongue-tie. I’ve been seeing these types of ties more often in my practice over the past few years.

Did you know there are two types of tongue-ties? Anterior tongue ties are the more obvious of the two types. It’s easily diagnosed because can see it right away when you life the tongue up. The underside of the tongue is connected too tightly to the floor of the mouth, and that the range of motion is restricted.

Here are some examples of anterior tongue-ties (Image from CEFAC).

Anterior Tongue Tie

Posterior tongue-ties aren’t obvious at first glance. The back part of the tongue is restricted rather than the front portion of the tongue and the restriction is totally different.

Here are some examples of people who actually have posterior tongue-ties. Based on how much they can stick their tongues out you wouldn’t think they are tongue-tied.

Posterior Tongue Tie

Diagnosing Posterior Tongue-Tie

Posterior tongue-ties can be difficult to diagnose because the other muscles of the face and mouth compensate for the restriction. One clue I look at is the floor of the mouth lifting up to allow the tongue to move to the palate. Often people with this tie can stick their tongue out a long way or get the front or the whole tongue to rest on the top of the mouth.

However, when these muscles compensate we see pain and tension all throughout the neck, face, jaw, shoulders, and more. This can lead to clenching, grinding, TMJ problems, postural problems, as well as sleep apnea or other sleep disordered breathing conditions. Babies with a posterior tongue-tie may also have difficulty breast-feeding.

Finding the right diagnosis can be a frustrating process for patients. They often go through many other treatments to address the symptoms above, but find no relief until they find someone who knows about the root cause of them.  To make matters worse, there aren’t too many doctors or dentists who are familiar with the symptoms and effects of a posterior tongue-tie, or who know how to release them properly. The release procedure is still simple but it has to be done a certain way to get the best possible results and prevent reattachment.

The first step is to find a myofunctional therapist who is experienced with posterior tongue-ties to help address the condition. I screen for the signs and symptoms that can easily be missed or dismissed as clues to help identify the posterior tongue-tie. Myofunctional therapy is critical to deal with any tongue-tie. There are very specific exercises that need to be chosen to work on the posterior restriction and the associated muscular weaknesses, compensations and dysfunctions.

If you take the right steps, a posterior tongue-tie can be easily treated, and the oral and facial muscles can be retrained for a lifetime of good health.