Patient Story

A 2-year-old male child presents with a chief complaint per mother of “not being able to stick out his tongue.” (Figure 38-1). On examination, the child could not protrude the tip of the tongue over the mandibular anterior teeth and could not effectively lick his upper lip. Neither gingival recession nor speech pathology was noted. A diagnosis of ankyloglossia was made. Frenectomy was suggested and delayed until child’s age made feasible necessary behavioral management in the dental chair.

Introduction

Ankyloglossia refers to a congenital abnormality, where a short and/or thick lingual frenum may restrict tongue movement (Figure 38-2).¹ Severity may vary significantly.

Synonym

Tongue-Tie.

Epidemiology

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  Reported prevalence varies from 0.1 to 10.7 percent, dependent on age population surveyed.¹

  
  
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  It has been reported as being more prevalent in males, although this is a controversial and inconclusive finding.²

Etiology and Pathophysiology

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  This is a developmental, congenital condition.

  
  
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  There have been reports associating ankyloglossia with specific syndromes such as X-linked cleft palate.³

  
  
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  However, most incidences of ankyloglossia occur in individuals without any other congenital disease.

  
  
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  A positive family history of ankyloglossia was noted in a wide range (10% to 53%) of families surveyed in a 2002 study,⁴ while it has been strongly associated with maternal cocaine use.⁵

Risk Factors

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  Family history.

  
  
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  Maternal cocaine use (3.2 times the increased risk).⁵

Diagnosis

Clinical Features

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  Variably short and thick lingual frenum with concomitant limitation of tongue mobility (range of motion) and/or functionality.

  
  
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  Clinical diagnosis is typically made during early feeding disturbances in children, in which severe ankyloglossia prevents/impedes completion of a sufficient oral seal during nursing.

  
  
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  Initial diagnosis in neonates and young infants might be made by lactation consultants.

  
  
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  A randomized controlled trial demonstrated in 2005 that 95 percent of infants receiving surgical correction had improved feeding, compared to <10 percent in the control group.⁶

Differential Diagnosis

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  Feeding and speech difficulties may be associated with other intrinsic behaviors and causative factors.

  
  
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  Therefore, a comprehensive review is required to determine the possible contribution of ankyloglossia and the need for management.

Management

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  Management approaches, which are surgical, are often based on the severity of the ankyloglossia and its impact (i.e., effects on feeding, speech, peer acceptance, social life and self image). SOR B

  
  
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  A comprehensive evaluation of the severity of the problem and the impact of the problem on the child’s pathology is important prior to any surgical correction.

  
  
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  It should be noted that the literature reflects possible recurrence of ankyloglossia due to excessive scar tissue formation.⁷

  
  
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  Surgical Options

  
  
  
  
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    Frenotomy—Surgical release of frenal constriction.

    
    
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    Frenectomy—Complete excision of entire frenum.

    
    
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    Frenuloplasty—Surgical rearrangement of frenal attachments and extension.

Patient Education

Parents should be advised to seek consultations from a pediatric dentist (or dentist familiar with ankyloglossia in young children), lactation consultant (if nursing is a specific issue), and speech pathologist (if speech is affected) to have a comprehensive evaluation of the child’s limitations, to ensure that ankyloglossia is a contributing factor to child’s pathology, prior to referring the child for surgical correction.

Patient Story

A 13-year-old female presents to your office because of persistent “bleeding” from her gums. The bleeding occurs most often during brushing of her teeth. She has no other history of bleeding or other contributory medical history. Her gingiva appear edematous and friable (Figure 38-3).

Introduction

Gingivitis refers to a reversible and (classically) bacterial-plaque mediated gingival inflammation. There are other sub-genres of gingivitis that may have additional etiologic factors (such as pregnancy gingivitis). Gingivitis does not include the broad spectrum of periodontal diseases in children (those associated with loss of soft and hard (alveolar bone) tissue support around the teeth).

Synonym

Gum disease or gingival disease.

Epidemiology

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  Epidemiologic studies suggest a nearly universal prevalence of gingivitis in children and adolescents, beginning in the primary dentition and peaking during puberty.^8,9

  
  
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  The lingual surfaces of primary and permanent molars are most often affected by gingivitis.⁸

  
  
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  The American Academy of Periodontology International Workshop on Classification of Periodontal diseases and conditions lists dental plaque-induced gingival disease as a distinct category of disease that affect “young individuals.” There are specific conditions (namely puberty and diabetes) that can modify the gingival response to bacterial plaque.¹¹

Etiology and Pathophysiology