Function of the Lingual Frenulum and Pain Causes

"Lingual frenulum" is the medical term for the skin under your tongue. Some infants and adults need this skin cut, particularly if they have feeding or speech challenges. Several procedures can correct a short lingual frenulum, a medical condition called ankyloglossia but commonly known as tongue-tie.

This article discusses the lingual frenulum—what it is, what it does, and the complications that can develop with this structure.

The Lingual Frenulum: Does It Have a Function?

Everyone has skin under their tongue, but the lingual frenulum varies in length and size. The lingual frenulum is a thin fold of mucous membrane that runs from the bottom of your mouth to the middle of the underside of your tongue. Its job is to help keep your tongue in the correct position while you speak, eat, and swallow.

Possible Complications From the Lingual Frenulum

For some people, the length of the lingual frenulum can cause complications. When this structure is too short or anchored close to the tip of the tongue, it can lead to ankyloglossia.

Ankyloglossia is present at birth. This condition does not always cause problems, but more severe cases—such as a very short lingual frenulum or a tongue anchored to the floor of the mouth—can lead to complications.

Feeding Difficulties

A newborn with a significant tongue-tie might have difficulty breastfeeding. Older children with this condition might experience decreased tongue movement. Some have challenges moving the tongue from side to side or sticking it out, which can cause eating or swallowing difficulties.

Speech Challenges

Older children with ankyloglossia can also have difficulty pronouncing certain words. Tongue-tie can lead to difficulty with speech. Sounds that are most often affected include "s," "n," "t," "d," and "l." Speech therapy can help.

Jaw Development

In more severe cases, ankyloglossia can affect the way the jaw develops, leading to mandibular prognathism—a condition that causes the lower jaw to stick out farther than the upper jaw. It can also prevent the upper jaw from fully developing.

Additional Complications

A short lingual frenulum can also lead to:

• Gum recession around the teeth near the tongue
• Snoring
• Mouth breathing
• Jaw clenching
• Teeth grinding
• Difficulty chewing
• Swallowing issues
• Sleep apnea
• Muscle tension in the head or neck
• Temporomandibular disorder (TMD)

Surgeries to Correct or Cut the Lingual Frenulum Attachment

In some cases, people need surgery to release the lingual frenulum. A healthcare provider may recommend procedures such as frenotomy, frenectomy, or frenuloplasty, depending on the severity of the condition.

• Frenotomy (or frenulotomy) is a simple procedure, often done on infants. It involves a quick clip of the lingual frenulum, resulting in one or two drops of blood, if any at all. There are no nerves in the lingual frenulum, so a frenotomy is done without anesthesia.
• Frenectomy involves surgery to remove the lingual frenulum. A healthcare provider may use a scalpel, surgical scissors, a laser, or electrocauterization (heat from an electric current) to perform this procedure.
• Lingual frenuloplasty is a more involved procedure reserved for challenging tongue-tie cases. This surgery is performed under general anesthesia, the lingual frenulum is cut with a scalpel, and the wound is closed with stitches.

Each of these procedures has its risks. Frenectomy using a scalpel can lead to excessive bleeding. Electrocauterization causes less bleeding but can result in burns. It is also not safe for people who have pacemakers. Laser frenectomy results in less pain and swelling and minimal scarring. However, it takes longer to heal.

How Safe Are Lingual Frenulum Piercings?

Oral piercings—whether in the lingual frenulum or elsewhere in the mouth—can cause significant complications, including:

• Swelling, bleeding, and infection
• Broken teeth
• Increased saliva production
• Receding gums
• Excessive scar tissue
  

Mouth jewelry can also get stuck, requiring surgery to remove it. Due to the wide range of potential complications, the American Dental Association advises against all oral piercings.

Summary

The lingual frenulum is a thin piece of tissue that connects the underside of the tongue to the bottom of the mouth. If this structure is too short—a condition present at birth called ankyloglossia, or tongue-tie— it can cause difficulties with speech, eating, swallowing, sleeping, breathing, and more.

A healthcare provider can perform a procedure to cut the lingual frenulum or remove it altogether. This surgery is painless and typically doesn't cause any bleeding. Older people might require more involved procedures, including removing the lingual frenulum.