Tongue-tie: What It Is, How to Spot It, and When It Needs Treating
Does your baby feed for a long time but never seem satisfied? Do you get sore nipples every single time you nurse? Or is your child old enough now but still can't quite get certain sounds out clearly?
These things aren't always down to poor latch technique, and they don't always sort themselves out with age. Sometimes the cause is a condition called tongue-tie, which is more common than most people realize and, importantly, not difficult to put right once it's properly assessed.
What is tongue-tie?
Underneath everyone's tongue there's a thin band of tissue called the lingual frenulum. It connects the underside of the tongue to the floor of the mouth, acting a bit like a tether that stops the tongue from moving too freely.
Tongue-tie happens when that tether is too short, too thick, or attached too close to the tip of the tongue. The result is a tongue that can't move, stick out or lift to the roof of the mouth as far as it should. And because the tongue is held back from doing its job properly, the effects show up in several different ways.
It's present from birth, and it's a matter of anatomy. Nothing about how parents care for their baby causes it.
The two types of tongue-tie
Dentists divide tongue-tie into two main forms.
1. Anterior tongue-tie. The band attaches close to the tip of the tongue and is visible to the naked eye. When the tongue is stuck out, the tip is often pulled into a heart shape or a V shape.
2. Posterior tongue-tie. The band sits deeper, hidden beneath the lining of the mouth, and is very hard to see just by looking. Finding it takes an experienced dentist who examines by feel and assesses how well the tongue actually moves.
This is why some families are told their baby's tongue looks perfectly normal, yet the feeding problems carry on regardless. Not every type of tongue-tie is obvious at a glance.
In a proper assessment, the dentist measures how far the tongue can move in order to grade the severity, alongside judging how well it functions day to day. Some people have a short frenulum but feed well and speak clearly, and may not need any treatment at all.
Grading the severity
Grade | Free tongue length | Severity |
Normal | More than 16 mm | Not considered tongue-tie |
Class I | 12 to 16 mm | Mild |
Class II | 8 to 11 mm | Moderate |
Class III | 3 to 7 mm | Severe |
Class IV | Less than 3 mm | Very severe |
These figures are only a guide for grading. Measuring tongue length tells you something about how well the tongue works, but only up to a point, which is why dentists always assess function alongside the measurement.
Warning signs by age group
Babies:
What to watch for in your child
Difficulty feeding: struggles to stay latched, slips off often, and makes clicking or smacking sounds while feeding
Long feeds without satisfaction: tires easily, falls asleep at the breast, becomes fussy, and gains weight more slowly than expected
How the tongue looks: can only stick the tongue out a short way or move it a little, often not past the gums or lips, and milk leaks from the corners of the mouth
What mothers notice in themselves
Severe nipple pain: cracked, broken or misshapen nipples that look flattened after a feed, even when positioning is correct
Milk supply problems: repeated mastitis, engorgement or blocked ducts, because the baby can't drain the breast effectively
Older children:
Unclear speech: particularly sounds that need the tongue to lift
Eating difficulties: trouble swallowing or chewing, and an inability to lick lips or an ice cream
Incomplete mouth cleaning: the tongue can't sweep food debris away well, so brushing needs more attention than usual, and tongue position may be one of the factors affecting how the teeth line up
Worth knowing: tongue-tie does not make a child a late talker. Children understand language perfectly normal. It simply makes certain sounds harder to produce because the tongue's movement is restricted.
Adults: usually a long-standing problem
Oral health issues: the pull of the frenulum may cause gaps between the lower front teeth and gum recession. A tongue with limited movement also sweeps food away less effectively, so cleaning between the teeth needs extra care.
Everyday awkwardness: difficulty licking lips or clearing food from the cheeks, trouble swallowing tablets, and in some cases problems wearing removable dentures, because the frenulum catches the edge of the denture and loosens it
A quick self check
Try these four things in front of a mirror. If several of them apply to you, it's worth coming in for an assessment.
Can you stick your tongue out past your lower lip?
With your mouth open wide, can you lift the tip of your tongue to touch the roof of your mouth?
Can you sweep your tongue fully across to the left and right corners of your mouth?
When you stick your tongue out, does the tip form a heart shape, dip in the middle, or look like a V?
For babies: slide a clean finger under the tongue and lift gently. If you feel a tight band or the tongue barely lifts, it's worth having a dentist assess it.
What happens if it's left alone?
If the tongue-tie is mild and isn't affecting daily life, for example if your baby feeds well and eats normally, your dentist may simply recommend keeping an eye on it for the time being.
Where it is affecting daily life, treating it early may reduce the problems that follow, such as weaning sooner than you'd planned or slow weight gain. Speech, however, improves through practice as well as treatment.
How tongue-tie is treated
The right approach depends on age and how thick the frenulum is. There are three main options.
1. Frenotomy, for newborns and infants
Takes only a few minutes with very little bleeding. It usually needs no more than a local anaesthetic, and sometimes none at all. Stitches generally aren't required.
The advantage: your baby can go straight to the breast afterwards, and feeding both helps stop any bleeding and comforts them at the same time.
2. Frenectomy, for older children and adults
Suited to cases where the frenulum has thickened with age. It takes roughly 15 to 30 minutes, and you go home the same day.
The advantage: a local anaesthetic is usually enough, though a child who finds it hard to cooperate may need a general. The wound is closed with dissolving stitches so it heals in the right position.
3. Laser treatment, an increasingly popular option
Your dentist may consider using a laser. The advantage: a smaller wound, less bleeding, less swelling and bruising, and less discomfort in the early days.
The part you can't skip: tongue exercises
Surgery only unlocks the tongue. A tongue that has been tethered for years still has to learn how to move all over again, and this part matters enormously.
Tongue exercises: build strength in the muscle and stop the wound from healing in a way that lets the frenulum reattach
Speech practice, for older children: essential for children who have already settled into incorrect sound patterns, and best done with a speech and language therapist
Feeding support, for babies: mothers may want to see a lactation consultant to adjust positioning so the baby feeds more effectively
Looking after yourself afterwards
First 24 hours: cold compress under the chin, soft or cold food such as rice porridge or ice cream, and nothing hot, spicy or hard. Babies can feed as normal straight away.
First week: start gentle warm salt water rinses after the first day has passed, brush as usual but avoid the wound itself, and take any medication exactly as your dentist has prescribed.
Weeks 2 to 4: do the tongue exercises consistently as instructed. This matters a great deal, as it prevents the frenulum from reattaching. Attend your follow up appointment.
Normal and nothing to worry about: during the first week or two the wound may develop a white or pale yellow film over it (slough). This is natural healing, not pus and not an infection.
Possible side effects
Common and expected: temporary numbness at the tip of the tongue, slight bleeding, soreness and swelling, which usually settle on their own within one to three days.
Less common: wound infection, which good hygiene prevents, and reattachment of the frenulum, which usually comes down to skipping the tongue exercises.
Tongue-tie is common, it isn't something frightening, and it's treated with a procedure that doesn't take long.
Three things matter most: finding it early, treating it appropriately, and keeping up the tongue exercises. Not everyone needs surgery, and not everyone should simply wait and see, which is why an assessment by a dentist is the best place to start.
If you have questions or would like to be sure about a symptom, come in for a consultation and assessment at SKM Dental Clinic. Our dental team will look at things thoroughly and work with you to find the approach that fits your situation.
📞 Contact us
Mittraphap Rd: 099 467 8789 or 094 262 8448
Klangmuang Rd: 099 171 7161 or 043 22227
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