Short answer: Tongue-tie (ankyloglossia) is a restriction of tongue movement caused by the membrane (frenulum) that connects the underside of the tongue to the floor of the mouth being short, thick or attached close to the tip of the tongue. In babies it can lead to breastfeeding difficulties, and in older children to difficulty making certain sounds; however, not every tongue-tie causes problems. If there are symptoms, it can be treated with short procedures called frenotomy or frenectomy.
A mother who struggles to breastfeed her newborn, or a parent who notices that their child cannot make certain sounds, sometimes comes across the possibility of tongue-tie. Known medically as ankyloglossia, this condition is when the thin membrane under the tongue restricts tongue movement. Tongue-tie is quite common; however, not every tongue-tie needs treatment. What matters is correctly assessing whether the tongue-tie really affects the baby's feeding, the child's speech or oral health. In this article we explain what tongue-tie is, its symptoms, when intervention is needed, the difference between frenotomy and frenectomy, and the process after the procedure.
What is tongue-tie?
Tongue-tie is a restriction of tongue movement that results from the membrane connecting the underside of the tongue to the floor of the mouth, called the "lingual frenulum", being shorter, thicker or tighter than normal, or attached very close to the tip of the tongue. Everyone has a frenulum under their tongue; the problem is when this structure is formed in a way that prevents the tongue from moving freely.
Tongue-tie is a congenital condition and is seen slightly more often in baby boys. The fact that it occurs in more than one person in some families suggests there may be a hereditary tendency. Clinically, two types are usually described: anterior tongue-tie, in which the membrane is attached close to the tip of the tongue and can be easily seen, and posterior tongue-tie, in which the membrane lies further back, under the mucosa, and is harder to notice. There are still differing views among experts on the definition of posterior tongue-tie and the need to treat it.
In a child with tongue-tie, when the tongue is stuck out, its tip may look notched in a heart shape, the tongue may not be able to lift up to the upper teeth or the palate, or its sideways movement may be restricted.
What are the symptoms of tongue-tie: breastfeeding and speech
The symptoms of tongue-tie vary by age. In babies, feeding is most often affected, while in older children speech and cleaning inside the mouth may be affected.
In babies
- Difficulty latching onto the breast, frequently slipping off the breast
- A clicking sound during breastfeeding
- Long but unsatisfying feeds, the baby getting hungry often
- Poor weight gain
- For the mother, nipple pain, cracks or misshapen nipples, and a decrease in milk supply
These symptoms can have many causes other than tongue-tie; factors such as breastfeeding position, premature birth or the structure of the mother's breast can also lead to similar problems. For this reason, the assessment should be made together with a pediatrician and, if necessary, a lactation consultant.
In older children
- Difficulty making sounds such as "l", "r", "t", "d" and "n" that require the tip of the tongue to touch the palate
- Being unable to stick the tongue out past the lips, difficulty with movements such as licking an ice cream
- Difficulty cleaning the teeth and the inside of the mouth with the tongue
- A gap between the lower front incisors
In a significant proportion of children with tongue-tie, speech develops completely normally. A speech delay should not be attributed to tongue-tie alone; a comprehensive language and speech assessment should be carried out.
When is intervention needed for tongue-tie?
Intervention for tongue-tie is recommended only when the tongue-tie leads to a significant functional problem. For tongue-ties that cause no symptoms and are noticed by chance during an examination, a procedure is usually not needed; as the child grows, the frenulum can stretch and tongue movements can become adequate on their own.
The main situations in which intervention comes into consideration are:
- Breastfeeding problems that persist despite lactation counseling and position adjustments, the baby failing to gain weight or ongoing nipple pain for the mother
- Speech difficulties that a speech therapist's assessment links to tongue-tie and that do not improve with therapy
- Oral hygiene problems related to restricted tongue movement
- Some situations in which, from an orthodontic perspective, the position of the tongue affects the success of treatment
The decision should be made taking into account the views of different specialists such as the pediatrician, pediatric dentist, oral surgeon, ear, nose and throat specialist, speech therapist and lactation consultant. Avoiding unnecessary interventions is just as important as carrying out necessary ones.
In recent years, there has been discussion that the number of tongue-tie procedures has increased markedly in some countries and that part of this may be related to increased awareness rather than a real need. For this reason, professional organizations recommend trying simple methods such as breastfeeding support and position adjustments before a procedure, and making the decision by evaluating the symptoms and examination findings together.
What is the difference between frenotomy and frenectomy?
Frenotomy is a simple cut of the tongue-tie, while frenectomy is a more extensive removal of the membrane, with the area stitched if necessary. Which procedure is chosen depends on the child's age and the type and thickness of the tongue-tie.
Frenotomy
It is preferred especially for babies in their first months. The thin frenulum is cut within a few seconds with sterile scissors or a laser. Because the frenulum is thin and has few blood vessels in babies of this age, bleeding is usually very minimal. In practice, a topical anesthetic is usually used or no anesthesia is needed at all. The baby can be breastfed immediately after the procedure.
Frenectomy and frenuloplasty
These are performed in older children and for thick or posterior tongue-ties. The frenulum is removed more extensively or reshaped and is usually closed with dissolvable stitches. Depending on the child's age and cooperation, it can be done under local anesthesia, sedation or general anesthesia. With laser procedures, bleeding and the need for stitches may be reduced; however, when it comes to the outcome, the right indication and experience matter more than the method.
What should you pay attention to after a tongue-tie procedure?
Healing after a tongue-tie procedure is usually quick; however, some points need attention so that the area heals properly and reattachment is prevented.
- First days: A whitish-yellow tissue may be seen at the incision site for a few days; this is a normal part of healing and not a sign of infection.
- Pain management: There may be mild fussiness and tenderness. Always consult your pediatrician or dentist about which painkiller can be used and at what dose.
- Feeding: Babies can be breastfed immediately. For older children, soft and lukewarm foods should be preferred in the first days.
- Exercises: Some practitioners recommend certain tongue exercises to prevent the area from reattaching. Whether these exercises are necessary is debated; follow your practitioner's recommendation.
- Speech therapy: For procedures done because of speech difficulties, speech therapy support can be helpful in learning to use the tongue's new range of movement.
- Follow-up: If bleeding does not stop, or in situations such as fever, increasing swelling or refusing to feed, see a doctor without delay.
For other questions about oral and dental health in children, you can visit our frequently asked questions page.
Who should you see in Ankara if you suspect tongue-tie?
If you notice breastfeeding difficulties in your baby, or restricted tongue movement or difficulty making certain sounds in your child, it is advisable to talk to your pediatrician first and, if necessary, get support from a dentist, an ear, nose and throat specialist or a speech therapist. At our clinic in Oran, Çankaya, an intraoral examination of the tongue-tie is carried out; its effects on oral hygiene, tooth alignment and orthodontics are assessed and, if necessary, a plan is created together with the relevant specialists.
Frequently asked questions
Does tongue-tie resolve on its own?
In mild tongue-ties, the frenulum can stretch as the child grows and tongue movements can become adequate. Thick or short tongue-ties that cause a significant loss of function, however, usually do not resolve on their own. The decision to treat is based on the symptoms.
Does tongue-tie cause speech delay?
Tongue-tie can make certain sounds harder to produce, but it is usually not the reason speech starts late. A speech delay can have many causes, such as hearing or language development. For this reason, a comprehensive assessment should be carried out.
Is it safe to cut a tongue-tie in babies?
A frenotomy performed by an experienced practitioner with the right indication is generally a short, low-risk procedure. Although rare, bleeding, infection or reattachment may occur. The decision to perform the procedure should be made for babies with significant breastfeeding problems, based on the assessment of the relevant specialists.
At what age is tongue-tie surgery performed?
For breastfeeding problems, a frenotomy can be performed in the first weeks or months. A frenectomy performed because of speech or other functional problems is usually planned according to the child's age and cooperation. Rather than a specific age limit, the presence of symptoms is what matters.
