Tongue tie is one of the most direct structural causes of this pattern. A tethered tongue cannot assume the correct resting position against the palate. It sits low in the floor of the mouth, which keeps the mouth open, prevents the palate from being shaped correctly by tongue pressure during growth, and facilitates habitual mouth breathing rather than nasal breathing.
- Altered facial growth, a longer, narrower face with a high arched palate
- Dental crowding and malocclusion
- Enlarged tonsils and adenoids
- Recurrent ear, nose, and throat infections
- Disrupted sleep and poor sleep quality
- Snoring and sleep-disordered breathing
- Poor concentration and behaviour related to sleep deprivation
The adenoid face and tongue posture
The classic elongated facial profile associated with chronic mouth breathing, sometimes called adenoid facies, is a developmental consequence of low tongue posture and open mouth breathing during the years of facial growth. The palate develops high and narrow. The lower jaw drops and rotates back. These changes are not just cosmetic: they affect dental occlusion, airway size, and sleep quality throughout life. Early identification and treatment of the underlying cause is preferable to orthodontic correction later.
Tongue tie, tongue posture, and palatal development
The palate develops its shape in response to tongue pressure during childhood. A tongue resting correctly on the roof of the mouth creates a broad, well-formed palate with room for the teeth. A tongue that sits low due to restriction leaves the palate to develop high and narrow, creating the crowded teeth and orthodontic problems we see so frequently in tongue tied children. This is why early identification matters enormously.
Not all mouth breathing is caused by tongue tie
Nasal obstruction, from enlarged adenoids, allergic rhinitis, or anatomical variation, is a common cause of mouth breathing that needs to be assessed alongside oral function. This is where ENT evaluation is invaluable. Our assessment will identify whether the pattern is structural, functional, or both, and guide you toward the appropriate pathway.
Our approach: Release Restrictions, Retrain Function, Relieve Tension includes myofunctional rehabilitation and nasal breathing retraining as integral parts of treatment, not afterthoughts.
The National Tongue Tie Centre was established in 2007 as Ireland's first clinic dedicated entirely to the assessment and treatment of tongue tie. The centre treats over 1,000 patients per year and receives patients from across Ireland and internationally.
Led by Dr. Justin Roche (Consultant Paediatrician, FRCPCH, FRCPI, IBCLC), Kate Roche (Chartered Physiotherapist, IBCLC, Feeding Therapist). Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frequently asked questions
Watch your child at rest when they are relaxed or asleep. If their lips are parted, their tongue is resting in the floor of the mouth rather than against the palate, or they are audibly breathing through the mouth rather than silently through the nose, this is open mouth posture. Snoring and dry mouth on waking are also indicators.
Very likely. A high, narrow palate is one of the most consistent findings in children with tongue tie and low tongue posture. The palate develops its shape in response to the tongue pressing against it during growth and how we chew our food. A tongue that cannot reach the palate due to restriction leaves it to develop high and narrow.
Releasing the restriction creates the structural possibility for correct tongue posture. But the habit of mouth breathing and the associated muscle patterns need to be retrained. This is where myofunctional rehabilitation, nasal breathing training such as Buteyko, and where needed support from an ENT perspective become important.
The earlier, the better, because facial growth is most responsive in the first decade. But treatment at age 8, or older, can still make a meaningful difference, particularly in preventing further deterioration and supporting orthodontic treatment. It is never too late to assess.
If there is significant nasal obstruction, enlarged adenoids, recurrent ear or sinus infections, or sleep-disordered breathing, then ENT evaluation would be warranted alongside a tongue tie assessment. We will advise you on the most appropriate pathway at your appointment.
Book a comprehensive assessment at the National Tongue Tie Centre. Our clinical team will assess your child's tongue and lip function thoroughly, explain what we find, and give you an honest recommendation. Call us, complete our online enquiry form, or visit www.tonguet.ie. Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frenuloplasty is a surgical procedure. Risks, benefits, and individual expectations will be discussed in full at your assessment appointment before any decision to proceed is made.
