Tongue-tie

A tongue-tie refers to a visually tight/restricted lingual frenum that is causing difficulties in performing certain actions that require the use of the tongue, such as breastfeeding.

What is a lingual frenum?

The lingual frenum refers to the fold of soft tissue located under the tongue, joining it to the base of the mouth. Everybody has a lingual frenum and they will all appear different to one another.

An example of a lingual frenum in a baby's mouth, highlighted by the yellow circle. Shutterstock Images.



An example of a lingual frenum in a child's mouth, highlighted by the yellow circle. Shutterstock Images.
 

There are a number of frenum's present in the mouth. For example, the labial frenum that can be seen when lifting the upper and lower lips. Frenums are present from birth.

What is a tongue-tie?

A tongue-tie refers to the restricted movement of the tongue causing functional limitations, accompanied by a visually restricted lingual frenum

Ankyloglossia is the medical term for a tongue-tie.
 

Posterior tongue-tie

There is a lack of scientific evidence to support the medical diagnosis of a 'posterior' tongue-tie.

The Australian Dental Association's Ankyloglossia and Oral Frena Consensus Statement 2020 reports that the term ‘posterior’ tongue tie was introduced in 2004 through an opinion piece published in the American Academy of Pediatrics newsletter. There is a lack of evidence from dissection studies of cadavers to support this diagnosis. The use of the term 'posterior' tongue-tie can result in a normal lingual frenum being classified as abnormal. The term ‘posterior’ tongue tie should not be used as a medical diagnosis

How is a tongue-tie diagnosed?

The diagnosis of a tongue-tie should not be made based only on the appearance of the lingual frenum. Difficulty in performing functions that require the use of the tongue and a visually tight/restricted lingual frenum must both be present for diagnosis. For example, tongue-ties have been shown to be associated with breastfeeding issues. Some people may experience issues with speech however research does not show tongue-ties routinely affect speech development or production.

If you suspect your child has a tongue-tie, the health professional to first seek advice from depends on what issue your child is experiencing. If you are experiencing breastfeeding problems, look to consult with an International Board Certified Lactation Consultant (IBCLC), midwife or maternal child health nurse that can provide a breastfeeding assessment and recommendations.

If you are concerned about your baby's transition from soft to hard foods or their speech development, it is best to seek advice from a speech pathologist. The health professional will take a thorough case history, assess your child's tongue function and whether the problem is impacted by your child's tongue function in order to make a diagnosis.

How is a tongue-tie treated?

It is best to try non-surgical treatment methods before looking into surgical treatment for a tongue-tie. For example, if experiencing breastfeeding issues, non-surgical treatment methods can include advice on positioning, latch optimisation, feed frequency, supporting mothers to maintain milk supply, and the use of external tools such as nipple shields or supplementary nursing systems. If your child is still experiencing problems, surgery may be explored as an option.

The surgical treatment completed can be a frenectomy, frenotomy or frenuloplasty. These treatments are all based on cutting the lingual frenum to try and create a better range of motion for the tongue. All surgical procedures are associated with risks, including treatments for tongue-tie. The surgeon treating your child will advise you of the risks associated with the treatment before it is done.

Surgical treatment of a tongue-tie for adults is considered elective treatment. The decision to undergo treatment should be made between the adult patient and their dentist. 

Will a tongue-tie cause future problems?

If your infant or child has a visually tight/restricted lingual frenum but is not experiencing any issues, such as problems breastfeeding, the lingual frenum should be considered normal. There is no way to predict whether someone with a tight lingual frenum will develop issues in the future. If your infant or child is not currently experiencing issues, surgical treatment is not warranted. Surgical treatment can always be completed in the future if your child experiences issues associated with their tongue's function.

More information

For more information on tongue-ties, see the ADA's Ankyloglossia Consensus Statement.