Is the Neonatal Tongue Screening Test a valid and reliable tool for detecting ankyloglossia in newborns?

BACKGROUND: Although there is a lack of strong evidence for the association between ankyloglossia in newborns and impaired breastfeeding, screening for ankyloglossia using the Neonatal Tongue Screening Test (NTST) is mandated by law in Brazilian maternities. AIM: To assess the reliability and validity of the NTST. DESIGN: cohort study; baseline sample comprised 268 mother-newborn dyads. At follow-up, 169 mothers were contacted by telephone. Interviews with the mothers for data collection were performed up to 48 h and at 1-3 months after childbirth. Trained and calibrated personnel performed the oral examinations of the newborns. Thirty newborns were examined for inter-reproducibility assessment. RESULTS: Of the 268 newborns included, 212 had a lingual frenulum that could be visually inspected and their NTST scores ranged from zero to nine (mean = 2.0, ±2.0). Interexaminer reproducibility was acceptable (Intraclass correlation coefficient = 0.77). Internal consistency of the NTST was poor (Cronbach's alpha = 0.28). Construct validity was investigated through the association between NTST scores and difficulties in breastfeeding at baseline and follow-up, and infants' weight gain at follow-up (mean age 32 ± 6.7 days). No statistically significant associations were found. CONCLUSION: NTST is neither reliable nor valid for detecting ankyloglossia that may interfere with breastfeeding in newborns.

Relationship between mandibular incisor irregularity and type of occlusion in ankyloglossia.

PURPOSE: To investigate the relationship between the lingual frenulum length with mandibular incisor irregularity and type of occlusion in children with ankyloglossia. MATERIALS AND METHODS: Eighty children aged between 7 and 12 years with ankyloglossia enrolled in the study. The patients were classified according to Kotlow's classification. Mandibular incisor crowding was measured and the molar relationship was determined. The data were analysed statistically using Fisher's exact test, X2 and Pearson's correlation. RESULTS: Of the 80 patients, 45 (56.3%) had mild, 23 (28.8%) had moderate and 12 (15%) had severe ankyloglossia. Fifty-nine (73.8%) of the patients had mild irregularity, 18 (22.5%) had moderate and 3 (3.8%) had severe irregularity. In 56 (70%) of the patients, Class I occlusion was observed, 17 (21.3%) had Class II and 7 (8.8%) had Class III occlusion. No significant differences were found between types of ankyloglossia with mandibular incisor irregularity and occlusion types. A significant positive correlation was determined between the length of the lingual frenulum length and mandibular incisor irregularity. There were significant positive correlations between the lingual frenulum length, incisor irregularity and age. CONCLUSION: Mild and moderate types of ankyloglossia are unrelated to mandibular incisor crowding and occlusion type.

Rigo-Fede disease: case report.

Riga-Fede disease results when an infant's instinctive tongue thrusting and raking motion over recently erupted primary mandibular incisors causes a traumatic ulceration of the tongue and/or mouth floor. The symptoms and therapeutic approach to the condition are highlighted in this case report.

Lingual frenulum protocol with scores for infants.

An experimental protocol model for frenulum evaluation was first designed, and administered to ten infants in 2010. After obtaining the data and statistical analysis, the protocol was re-designed and administered to 100 infants. The aim of this study is to present an efficient and effective lingual frenulum protocol with scores for infants. From the experimental protocol model, a new protocol was designed. One speech-language pathologist, and specialist in orofacial myology, administered the new protocol to 100 full-term infants. All steps of the protocol were recorded and photographed. The data collected was sent to two specialists in the area, who evaluated the cases based on the recordings and photographs. The data from the three evaluations were compared. A two-part protocol was designed to evaluate the lingual frenulum in infants. The first part consists of clinical history with specific questions about family history and breastfeeding. The second part consists of clinical examination: anatomo-functional, non-nutritive and nutritive sucking evaluations. A new lingual frenulum protocol with scores for infants was designed, and has proved to be an effective tool for health professionals to assess and diagnose anatomical alterations of the lingual frenulum, and its possible interference with breastfeeding.

Lingual frenulum protocol.

An efficient lingual frenulum protocol with scores is presented. From a specific lingual frenulum evaluation used until 2004, a new protocol was designed. Ten speech language pathologists experienced in orofacial myology used the new protocol with different groups of subjects. 1235 subjects were evaluated during 3 years. From the experience of these ten speech language pathologists, the protocol was re-structured, and a scoring system was added. Absence of alteration (normal tongue and frenulum) was scored zero. The alterations observed were scored in ascending order. Four additional speech language pathologists experienced in orofacial myology were trained by the researcher to administer the final version of the protocol. The protocol was administered in 2008 and 2009 to 239 subjects: 160 children between 7 years and 2 months old and 11 years and 7 months old; and to 79 adults from 16 years and 8 months or older. From the results of administration of the protocol, a new lingual frenulum protocol with scores was designed. According to the scores, the frenulum can be considered altered or normal. When the sum of general tests is equal or higher than 3, the frenulum may be altered. The interference of the lingual frenulum in the oral functions may be considered when the sum of the functional tests is equal or higher than 25. This new lingual frenulum protocol with scores was designed and has been an efficient tool to diagnose an altered lingual frenulum.

Accreditation of midwife lactation consultants to perform infant tongue-tie release.

Infants with a tongue-tie or ankyloglossia have a short lingual frenulum, which can lead to problems with breastfeeding: attachment difficulties, nipple pain and damage, poor weight gain and eventually a reduction in milk supply. Trained clinicians can release the frenulum (frenotomy) in infants having difficulty with breastfeeding. Although traditionally performed by medical practitioners, we argue that this simple procedure is within the scope of practice of other clinicians. This paper outlines the process of setting up and maintaining credentialing for midwife lactation consultants (International Board Certified Lactation Consultants (IBCLCs)) to assess infant tongue-ties and perform frenotomy when appropriate at a tertiary maternity hospital. Since 2005, 11 midwives/IBCLCs have been credentialed to perform frenotomies at The Breastfeeding Education and Support Services at The Royal Women's Hospital in Melbourne, Australia. We believe that nurses/midwives/lactation consultants working in other settings could be trained to perform frenotomies, thus enabling faster resolution of breastfeeding problems.

Posterior crossbite in the deciduous dentition period, its relation with sucking habits, irregular orofacial functions, and otolaryngological findings.

INTRODUCTION: The aim of this study was to assess unilateral posterior crossbite, sucking habits, orofacial functions, and otolaryngological findings in the deciduous dentition. These findings would allow us to establish a preventive program for posterior crossbite, based on interceptive treatment at an early stage of dental development. We would determine the predictive value for posterior crossbite development in correlation with the duration of sucking habits. METHODS: Data were collected on 30 children (13 boys, 17 girls) with unilateral posterior crossbite (mean age, 5.5 years; range, 3.6-7.2 years) and 30 children (17 boys, 13 girls) without crossbite (mean age, 5.9 years; range, 5.4-6.7 years), randomly selected from a local kindergarten. Information about each subject's nutritive and nonnutritive sucking behaviors was collected through parent interviews and questionnaires. An orthodontist and an otolaryngologist clinically examined all the children. Study models were obtained from all children, and dental arch parameters including arch widths in the canine and second deciduous molar regions were measured directly from the models. The data were then compared between the posterior crossbite and the noncrossbite groups. RESULTS: The results indicated correlations between prolonged pacifier sucking habit (P = 0.001), short frenulum linguae (P <0.001), smaller maxillary arch width (P <0.001), greater mandibular arch width (P <0.002), and unilateral posterior crossbite. A receiver operating characteristic curve was plotted for the pacifier sucking time. The borderline for the development of posterior crossbite suggested by the receiver operating characteristic curve was 18 months of pacifier sucking duration. The odds ratios between the crossbite and noncrossbite groups were 3.6 (CI = 0.97-13.4) for pacifier habit duration of 18 to 35 months and 21.9 (CI = 3.7-129.4) for pacifier suckers of more than 36 months. No significant correlation between enlarged adenoids and tonsils or impaired nasal breathing and the crossbite was found. CONCLUSIONS: These results suggest that the duration of a pacifier habit and a short frenulum linguae are associated with posterior crossbite at the age of 4 or 5 years because of the low tongue posture in the mouth. Pediatricians and pedodontists should give precise recommendations for enhancing breast feeding and discontinuing pacifier habits at least until the child is 18 months of age. Further studies are also needed to determine more objectively the etiology of tongue posture, swallowing pattern, and the length of the frenulum linguae in children with posterior crossbite.

Lingual Chondrolipoma in a Dog.

A 13-year-old female Yorkshire terrier was presented with difficulty swallowing because of a lingual mass, which had grown to a size of 0.8 × 0.8 × 0.8 cm in 1 month. Grossly, the mass was located in the lingual frenulum and the cut surface was grey-white in colour. Microscopically, the mass was unencapsulated and composed of lobules of mature adipose tissue and cartilaginous tissue with abundant basophilic myxoid matrix separated by fibrous connective tissue. Immunohistochemically, almost all of these cells were positive for vimentin and S100. Chondroid cells and their adjacent spindle cells were also positive for SOX9. Based on these findings, a diagnosis of chondrolipoma was made. To the best of our knowledge, this is the first report of a chondrolipoma originating as a primary tumour in the lingual frenulum of a dog.

Prevalence of malocclusion in 13-15 year-old North Jordanian school children.

OBJECTIVES: This study was carried out to determine the prevalence of malocclusion in 13-15-year-old North Jordanian schoolchildren. METHODS: One thousand and three children aged 13-15 years (619 females, 384 males) were examined using Björk et al. (1964) registration method. A full clinical examination was carried out in the school premises using a mouth mirror under natural lighting. Alginate impressions were then taken for each student together with a wax bite. The impressions were poured the same day by an orthodontic technician. Peri-apical radiographs were taken for the students when hypodontia was suspected. RESULTS: Overall, the prevalence of malocclusion was 92%. Class II and III molars were found in 18.8% and 1.4% of the sample respectively. The malocclusion traits detected were crowding (50.4%), midline shift (31.7%), spaced dentition (26.7%), increased overjet (24.7%), deepbite (16.9%), crossbite (6.8), abnormal tooth form (7.7%), median diastema (6.9%), missing teeth (6%), ectopic canines (5.9%), inverted incisors (5.2%), high frenal attachment (3.9%), openbite (2.9%), tooth impaction (1.8%), reversed overjet (1.9%), scissorbite 0.3%. There was no statistically significant difference between males and females in the overall prevalence of malocclusion and the occlusal traits investigated. However, some dental anomalies showed significant differences. CONCLUSIONS: Prevalence of malocclusion among north Jordanians is comparable with other populations.

Frenulectomy of the tongue and the influence of rehabilitation exercises on the sEMG activity of masticatory muscles.

This study aimed to assess by surface electromyography (sEMG) the changes in sub-mental, orbicularis oris, and masticatory muscle activity after a lingual frenulectomy. Rehabilitation exercises in subjects with ankyloglossia, characterized by Class I malocclusion, were assessed as well. A total of 24 subjects were selected. Thirteen subjects (mean age 7±2.5years) with Class I malocclusion and ankyloglossia were treated with lingual frenulectomy and rehabilitation exercises, while 11 subjects (mean age 7±0.8years) with normal occlusion and normal lingual frenulum were used as controls. The inclusion criteria for both groups were the presence of mixed dentition and no previous orthodontic treatment. The sEMG recordings were taken at the time of the first visit (T0), and after 1 (T1) and 6months (T2) for the treated group. Recordings were taken at the same time for the control group. Due to the noise inherent with the sEMG recording, special attention was paid to obtain reproducible and standardized recordings. The tested muscles were the masseter, anterior temporalis, upper and lower orbicularis oris, and sub-mental muscles. The sEMG recordings were performed at rest, while kissing, swallowing, opening the mouth, clenching the teeth and during protrusion of the mandible. These recordings were made by placing electrodes in the area of muscle contraction. At T0, the treated group showed different sEMG activity of the muscles with respect to the control group, with significant differences at rest and during some test tasks (p<0.05). In the treated group, an increase in sEMG potentials was observed for the masseter muscle, from T0 to T2, during maximal voluntary clenching. During swallowing and kissing, the masseter and sub-mental muscles showed a significant increase in their sEMG potentials from T0 to T2. During the protrusion of the mandible, the masseter and anterior temporalis significantly decreased their sEMG activity, while the sub-mental area increased significantly. No significant change was observed in the control group during the follow-up. The sEMG potentials of treated patients at T2 reached about the same values as those of the control group at T2. At T0 and T1 the differences between the two groups were more diffused, suggesting a clinical improvement of muscular functions after treatment. Lingual frenulectomy and rehabilitation exercises seem to affect the function of the orofacial muscles. Improvement in muscle sEMG potentials after treatment was demonstrated by sEMG, which can be considered the correct method to monitor this intervention.

Sublingual foregut cyst.

Foregut cysts are usually found in the mediastinum, the lung, or the wall of the upper gastrointestinal tract, but only rarely at the base of tongue. We report a sublingual foregut cyst in a 27-year-old man.

Assessment of lingual function when ankyloglossia (tongue-tie) is suspected.

Dental specialists are frequently confronted with the task of attempting to determine whether a cause and effect relationship exists between a short or restricting lingual frenum (ankyloglossia or tongue-tie) and a specific oral motor dysfunction. Because there is no standardized definition of what constitutes a condition of tongue-tie, the dental practitioner is often unsure as to the appropriate course of action with a patient with suspected ankyloglossia. This paper describes clinical measures that permit quantifying several anatomic and functional aspects of the tongue. Such baseline analysis provides a more definitive appraisal of lingual function as well as a more objective basis for making pre- and posttreatment comparisons.

An oral 'follicular' choristoma presenting in the anterior floor of the mouth.

A 46-year-old Asian man presented with hair growing from the anterior floor of his mouth. The diagnosis of this lesion was an oral choristoma of a 'follicular' variety. A choristoma is defined as an overgrowth of normal tissue at an abnormal site. Only one other case of this particular lesion has been reported to date. This article proposes mechanisms as to the aetiology of this lesion, and its inclusion in the classification of oral choristomas.

Ankyloglossia and tongue mobility.

AIM: Ankyloglossia or tongue-tie is a congenital condition of newborns when the inferior lingual fraenulum is too short and is attached to the tip of the tongue limiting its movement. The aim of this study was to evaluate the relationship between ankyloglossia classification and tongue mobility. In addition, the prevalence of ankyloglossia among males and females was assessed. METHODS: 300 subjects (150 boys and 150 girls) with an age range of 7-12 years were randomly selected from different schools. The distance between the uppermost point of lingual fraenulum and its insertion into the oral floor was measured in the subjects. The subjects were categorised from having no ankyloglossia to severe tongue-tie based on the measurements. RESULTS AND CONCLUSION: This study showed that ankyloglossia was more common in males. It also showed that only subjects with a lingual fraenulum of <1.5 cm suffered from inadequate tongue movement.

Frenotomia lingual em bebês diagnosticados com anquiloglossia pelo Teste da Linguinha: série de casos clínicos / Lingual frenectomy in babies diagnosed with ankyloglossia through the Tongue Test: a series of case reports

Objetivo: relatar uma série de casos clínicos de frenotomia lingual em bebês diagnosticados com anquilo-glossia pelo Teste da Linguinha. Relato de casos: cinco bebês, de 0 a 2 anos de idade, foram diagnosticados nas Unidade Básicas de Saúde e na Santa Casa de Misericórdia de Sobral, Ceará, com anquiloglossia mode-rada a severa. As mães relataram dificuldades de amamentação e engasgos das crianças. Os pacientes foram submetidos a procedimentos cirúrgicos de frenotomia lingual, que foram realizados na Universidade Federal do Ceará (UFC), Campus Sobral, no Grupo de Estudos em Odontopediatria (GEOP) do curso de graduação em Odontologia. As cirurgias foram realizadas com os pacientes conscientes e sob estabilização protetora. Foi administrada apenas anestesia tópica nos pacientes menores de 1 ano e anestesia infiltrativa naqueles com faixa etária maior que 1 ano. Em seguida, foi executado um pequeno corte na porção mediana do freio lingual e, quando necessário, realizada divulsão dos tecidos adjacentes. Ao final, foi feita a limpeza do local da cirurgia com a confirmação visual da efetiva liberação da língua. Por fim, as crianças receberam atestado e as mães, recomendações pós-cirúrgicas. Além disso, as crianças foram encaminhadas para consulta com o fonoaudiólogo e foram marcadas três consultas de retorno para o acompanhamento dos casos. Considera-ções finais: a frenotomia lingual mostrou-se uma técnica cirúrgica conservadora, eficaz e segura. Os bebês apresentaram excelentes resultados pós-operatórios e encontram-se em acompanhamento multiprofissional. (AU)

Objective: to report a series of clinical cases of lin-gual frenectomy in babies diagnosed with ankylo-glossia through the tongue test. Case Reports: five babies aged 0 to 2 years were diagnosed with moderate to severe ankyloglossia in Basic Health Units and in Santa Casa de Misericórdia do So-bral, Ceará, Brazil. The mothers of the children reported difficulties in breastfeeding and gagging. The patients were submitted to surgical procedu-res of lingual frenectomy, which were performed at the Federal University of Ceará (UFC), Cam-pus Sobral, in the Group of Studies in Pediatric Dentistry of the undergraduate dental course. The surgeries were performed with conscious patients under protective stabilization. Only topical anesthesia was administered in patients younger than 1 year and infiltrative anesthesia was used for those older than 1 year. Thereafter, a small cut was per-formed on the median portion of the lingual fre-nulum and, if necessary, divulsion of the adjacent tissues was performed. At the end, the surgical site was cleaned and the effective release of the tongue was confirmed visually. Finally, the chil-dren received medical certification and the mo-thers received postoperative recommendations. In addition, the children were referred to visits with a speech therapist and three follow-up ap-pointments were scheduled. Final considerations: lingual frenectomy proved to be a conservative, effective, and safe surgical technique. The babies presented excellent postoperative results and they are under multi-professional follow-up. (AU)

Rigid swelling of sublingual caruncle area due to the salivary gland duct obstruction by a sialolith.

Sialolithiasis is the presence of calculus within the ductal system of a salivary gland. Among the diagnostic methods are inspection, palpation, checking the amount of saliva secreted and the identification of a sialolith. The authors present the case of a 37-year-old female patient with edema of the submandibular area and a bulging sublingual caruncle due to a calculus that obstructed the salivary gland ostium.

Lingual frenulum and effect on breastfeeding in Thai newborn infants.

BACKGROUND: Breastfeeding has abundant biological and psychological benefits. Effective breastfeeding requires good latching on, which is possible when the infant is able to cup around the maternal areola with his tongue. One of the most common conditions resulting in poor latching on is tongue-tie. OBJECTIVE: To determine the prevalence of tongue-tie with subsequent breastfeeding difficulties and other factors affecting the success of breastfeeding in newborn infants. METHODS: This was a prospective, cross-sectional study of healthy Thai infants without contraindications for breastfeeding. Physical examination of the infants and mothers and their breastfeeding practices were assessed between 24 and 48 hours of life. RESULTS: 2679 mother-infant dyads were recruited. The study detected a prevalence of 16% for severe tongue-tie, 37.9% of which was associated with breastfeeding difficulties. Using multiple logistic regression analysis, moderate (adjusted OR 13.3, 95% CI 7.2-24.5) and severe (adjusted OR 62, 95% CI 34.1-112.8) tongue-tie, short nipples (adjusted OR 1.5, 95% CI 1.1-2.2), mothers feeling the infant's tongue on the nipple area (adjusted OR 3.4, 95% CI 2.2-5.2) and mothers' inability to feel the infant's tongue (adjusted OR 11.8, 95% CI 4.3-32.4) independently increased the risk of breastfeeding difficulties. CONCLUSIONS: Tongue-tie is not uncommon and is associated with breastfeeding difficulty in newborn infants. Mothers of infants with severe tongue-tie should be closely and individually coached during breastfeeding and followed up, especially during the first critical weeks of the infant's life.

Evidence of improved milk intake after frenotomy: a case report.

Ankyloglossia (tongue tie) is a well-recognized cause of breastfeeding difficulties and, if untreated, can cause maternal nipple pain and trauma, ineffective feeding, and poor infant weight gain. In some cases, this condition will result in a downregulation of the maternal milk supply. Milk-production measurements (24-hour) for a breastfeeding infant with ankyloglossia revealed the ineffective feeding of the infant (78 mL/24 hours), and a low milk supply (350 mL/24 hours) was diagnosed. Appropriate management increased milk supply (1254 mL/24 hours) but not infant milk intake (190 mL/24 hours). Test weighing convincingly revealed the efficacy of frenotomy, increasing breastfeeding milk transfer from 190 to 810 mL/24 hours. Postfrenotomy, breastfeeding almost completely replaced bottle-feeding of expressed breast milk. This case study confirms that ankyloglossia may reduce maternal milk supply and that frenotomy can improve milk removal by the infant. Milk-production measurements (24-hour) provided the evidence to confirm these findings.