Most people who walk through my door aren’t coming in because they know they have a tongue tie. In fact, the majority have no idea. They come because something hasn’t been adding up—feeding struggles, gagging, choking, speech concerns, restless sleep, mouth breathing, jaw tension, or a long list of symptoms no one has been able to explain. Occasionally a dentist, orthodontist, or therapist has suggested they get checked, but more often than not, the family is simply searching for the root cause of ongoing problems.

And when we dig deeper during an evaluation—when we look at how the tongue actually moves, rests, stabilizes, and supports breathing and swallowing—we often find that a tongue tie is at the center of the issue. Not always, but far more often than people expect.

This is where so many families get stuck. Providers may have said everything “looks fine,” or “there’s no string,” or “they can stick out their tongue.” Yet the symptoms persist. That’s because most healthcare training focuses on what the tongue looks like, not whether it can function the way the body needs it to.

A Real Client Story (And One We See Often)

Not long ago, I evaluated a 12-year-old boy who had been struggling for years with open-mouth posture, frequent gagging, and choking episodes severe enough to send his family to the emergency room more than once. He had been in speech therapy for years but still couldn’t master certain sounds. His mother had taken him to pediatricians, ENTs, emergency rooms, and multiple therapists—yet no one could explain why he continued to struggle.

When I asked him to lift his tongue, the restriction was immediately clear. His mother’s eyes filled with tears—not out of fear, but out of relief. After twelve years of searching for answers, someone had finally looked under his tongue and found what others had missed. Stories like his are not rare. They walk into our office every single week.

What a Tongue Tie Actually Is

A tongue tie is not defined by how the frenulum looks but by how the tongue functions. A healthy tongue should be able to elevate fully to the palate, move side to side, create a stable suction seal, support efficient chewing and swallowing, maintain correct oral rest posture, and contribute to nasal breathing and facial development.

A restricted tongue may struggle with these tasks even if it can stick out of the mouth. Many people compensate by using their jaw, neck, or facial muscles to “fake” movements their tongue cannot perform. This can lead to messy or slow eating, speech distortions, mouth breathing, gagging, tension, dental crowding, sleep disruptions, and TMJ symptoms.

Mid-tongue restrictions and submucosal ties often don’t look dramatic, which is why they are frequently missed during quick visual checks.

Why Tongue Ties Get Missed

Most providers are caring and well-intentioned, but tongue ties are simply not covered deeply in standard training. Evaluations tend to focus on what is visible rather than on how the tongue performs. Because of this, functional problems are overlooked. Children and adults also adapt. They learn compensations that make things appear “good enough,” even though the effort required is significantly higher. A child may appear to eat normally but work twice as hard to chew. An adult may have clear speech but carry constant tension in their jaw, neck, or face. These adaptations hide the underlying restriction.

What a Functional Evaluation Includes

A true functional evaluation looks at how the tongue behaves in real tasks—chewing, swallowing, speaking, resting, and breathing. It assesses whether the tongue can lift without compensation, maintain stability, coordinate with surrounding muscles, and support proper oral and airway health.

This type of evaluation answers the questions families have been trying to solve for years:

• Is this truly a tongue tie?
• Is a release necessary?
• If so, when is the right time?
• What therapy is needed to prepare the muscles?
• How do we prevent reattachment and protect long-term results?

Common Symptoms People Never Associate With Tongue Ties

Symptoms vary by age, but many share the same functional root. Infants may struggle with latch, milk transfer, prolonged feeds, or reflux-like symptoms.
Children, teens, and adults may experience slow or messy eating, gagging, choking on certain foods, speech challenges, mouth breathing, restless sleep, tongue fatigue, neck tension, swallowing difficulties, dental crowding, or sleep-disordered breathing. These symptoms are not quirks. They are signals that the tongue may not be able to do its job.

Why Myofunctional Therapy Matters

Myofunctional therapy plays a crucial role in determining whether a release is necessary, improving muscle function before surgery, supporting wound healing, preventing reattachment, and normalizing oral function. Research consistently shows that outcomes are significantly better when therapy is used before and after a release.

When to Seek an Evaluation

If anything in this article sounds familiar—whether for you or your child—a functional evaluation can finally provide clarity. You do not need to guess or feel dismissed. You deserve answers that make sense and a plan that supports long-term breathing, feeding, sleep, and function. Schedule a pediatric or adult evaluation by calling 812-549-0183 or click here.