Q: I have a student with a restricting lingua frenulum that limits his tongue mobility and impacts his speech intelligibility. What do you write in the referral letter to the physician?

Write a letter that explains how the restricting lingua frenulum is impacting as many of the following six areas as you can: speech, oral rest, preparation for swallow, the swallow, health, and social appearance. The letter is sent in the hopes that the primary physician will refer the client to the appropriate oral surgeon. The letter is intended to inform the doctor about this patient, and to educate him/her about this kind of patient in general. Please remember that the following describes a theoretical client. Modifications to these descriptions will need to be made for your specific client.

Sample Letter

Dr. Smith:
Johnny Jones is a patient of yours and a (client/student/patient) of mine. I am writing to request that he be referred for a lingua frenectomy. I have found that Johnny’s restricting lingua frenulum impacts him in the following ways:

• Speech: The tongue-tip cannot elevate properly for several phonemes including: T, D, N, L, S, Z, Ch, Zh, and the retroflex R.
• Oral Rest: Johnny is resting the mouth in an open position with the tongue-tip down and the tongue-blade pressing forward against the upper teeth. This is due in part to the short frenulum. Persistent pressure like this may have a negative impact on dental alignment. I have referred the family to their dentist/orthodontist for an opinion.
• Swallow Preparation: The short frenulum is preventing the tongue-tip from being able to sweep food from all the teeth, especially from the side teeth and molars. Also, the bolus forms poorly.
• Swallow: Johnny is using an inappropriate swallow as a result of the tight frenulum. This has been called a “tongue thrust swallow,” a “reverse swallow” or an “infantile suckle swallow.” The tongue is pressing forward during every one of the hundreds of swallows he performs per day. This also is putting undo pressure against the front teeth.
• Health: Food particles that are left throughout the mouth, after completion of the swallow, make his dental hygiene a concern. They also put Johnny at risk for aspiration.
• Social Appearance: The family is concerned that the “tongue tie” is having a negative impact on Johnny socially. His siblings and several other children have made fun of his “weird tongue.”

I am seeing Johnny once per week for work on his speech, oral rest, and swallowing.
Thank you for evaluating Johnny’s lingua frenulum. I look forward to your report.