Tongue-tie (ankyloglossia) is a condition present at birth in which a short, thick or tight band of tissue under the tongue (the lingual frenulum) limits how the tongue moves. Some people never have problems from it. Others have trouble breastfeeding, speaking or keeping teeth clean. This guide summarizes Mayo Clinic’s information on signs, complications and treatment, including the procedure often called a frenotomy or frenectomy.
Signs of tongue-tie
Mayo Clinic lists:
- difficulty lifting the tongue to the upper teeth or moving it side to side
- trouble sticking the tongue out past the lower front teeth
- a tongue that looks notched or heart-shaped when stuck out
Mayo Clinic says tongue-tie is more common in boys than girls and sometimes runs in families. Why it happens is largely unknown.
Problems it can cause
- Breastfeeding. A baby who can’t keep the tongue over the lower gum may chew instead of suck, causing nipple pain and poor feeding.
- Speech. It can interfere with sounds such as “t,” “d,” “z,” “s,” “th,” “n” and “l.”
- Oral hygiene. Older children and adults may have trouble sweeping food from the teeth, which can contribute to tooth decay and gingivitis.
- Other activities, such as licking the lips or playing a wind instrument.
Breastfeeding signs in babies
MedlinePlus, from the National Library of Medicine, says tongue-tie signs in a newborn look much like other breastfeeding problems:
- fussiness, even after feeding
- trouble creating or keeping suction, tiring within a minute or two or falling asleep before eating enough
- poor weight gain or weight loss
- problems latching, or chewing on the nipple
The breastfeeding parent may have breast pain or plugged milk ducts. MedlinePlus notes most experts don’t recommend checking newborns for tongue-tie unless there are feeding problems. Most providers consider it only after feeding problems and 2 to 3 days of support from a lactation specialist.
When to see a doctor
Mayo Clinic suggests seeing a doctor if your baby has signs causing problems such as trouble breastfeeding. Also go if a speech-language pathologist thinks speech is affected, if an older child has trouble eating, speaking or reaching the back teeth, or if your own symptoms bother you. Diagnosis is usually by physical exam.
Treatment options
Mayo Clinic notes treatment is controversial. Some doctors and lactation consultants recommend correcting it right away. Others prefer to wait and see, since the frenulum may loosen over time or never cause problems. A lactation consultant can help with breastfeeding, and speech therapy may help speech.
Frenotomy
A quick procedure, done with or without anesthesia in a hospital nursery or office, in which the frenulum is snipped with sterile scissors or cautery. Mayo Clinic says discomfort is minimal, bleeding is usually only a drop or two, and a baby can breastfeed immediately. Complications are rare but can include bleeding, infection, damage to the tongue or salivary glands, scarring or reattachment.
Frenuloplasty
A more extensive repair for a thick frenulum or when more repair is needed. It’s usually done under general anesthesia, with dissolving stitches. Tongue exercises may be recommended afterward. Risks are similar, plus scarring and reactions to anesthesia.
What to expect
MedlinePlus says surgery is rarely needed and most breastfeeding problems can be managed with a lactation consultant’s help. When a frenulotomy is done, it’s usually in the surgeon’s office. More severe cases or older children are treated in a hospital operating room. A z-plasty closure may be used there to prevent scar tissue. Infection or bleeding afterward is possible but rare.
Questions to ask
Mayo Clinic suggests asking how severe the tongue-tie is, whether treatment is needed, what the options and risks are, whether anesthesia is necessary, whether surgery will improve breastfeeding and whether you should see an ear, nose and throat specialist. See also pediatric vs general dentists and your child’s first dental visit.
Frequently asked questions
Does every tongue-tie need surgery?
No. Mayo Clinic says some cases cause no problems and the frenulum may loosen over time.
Is a frenotomy painful for a baby?
Mayo Clinic says discomfort is minimal because the frenulum has few nerve endings or blood vessels.
Can adults have tongue-tie treated?
Yes. Mayo Clinic says surgery may be needed for infants, children or adults if tongue-tie causes problems.
Sources
- Mayo Clinic: Tongue-tie, symptoms and causes
- Mayo Clinic: Tongue-tie, diagnosis and treatment
- MedlinePlus: Tongue tie
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “Newborn baby, Newborn infant, Moscow, Russia” by Vyacheslav Argenberg, via Wikimedia Commons, licensed CC BY 4.0. Resized and compressed for the web.
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