What is Tongue-Tie (Ankyloglossia)?

Tongue-tie — also known as ankyloglossia — is a condition in which a person’s tongue remains attached to the floor of their mouth. This occurs when the lingual frenulum (a thin strip of tissue connecting your tongue and the floor of your mouth) is shorter than usual. A short frenulum can restrict your tongue’s movement.

Ankyloglossia is most common in newborns and young children, but adults can have it too. It’s associated with breastfeeding (chestfeeding) difficulties and speech problems. Tongue-tie is a congenital condition, which means people are born with it.

What’s the difference between anterior tongue-tie and posterior tongue-tie?

An anterior tongue-tie is in the front of your child’s mouth near the tip of their tongue, just behind their lower teeth and gums. It often looks like a thin web. A posterior tongue-tie (sometimes called a “hidden” tongue-tie) is further back where the floor of their mouth meets their tongue, making it more difficult to see.

Anterior tongue-ties are more common than posterior tongue-ties.

Who does tongue-tie affect?

Anyone can develop tongue-tie. In some cases, ankyloglossia is hereditary (meaning it runs in families). Tongue-tie mostly affects newborns and young children. But it’s possible for older children and adults to have the condition.

How common is this condition?

Ankyloglossia occurs in up to 10% of newborns (depending on the study and definition of tongue-tie).

Does tongue-tie go away?

In some instances, children learn to adjust to tongue-tie as they grow older. But if ankyloglossia is causing problems, it’s best to treat it early, as some symptoms worsen with age.

Symptoms and Causes

What are the symptoms of tongue-tie?

Symptoms of tongue-tie range from mild to severe. Your child’s tongue may appear to be heart-shaped or may have a notch in it. In many cases, ankyloglossia is mild enough that symptoms don’t interfere with daily life.

Newborn tongue-tie may result in:

• Difficulty latching when breastfeeding.
• Breastfeeding for extended periods of time.
• Constant hunger.
• Trouble gaining weight.
• A clicking sound while your child is feeding.

If you’re breastfeeding, you may also have symptoms related to your child’s tongue-tie, including:

• Cracked, sore nipples.
• Pain during nursing.
• Insufficient milk supply.

In young children, tongue-tie symptoms may include:

• Speech difficulty with sounds that require your child’s tongue to touch the roof of their mouth or upper front teeth. A tongue-tie doesn’t impact the number of words your child has or says, just their pronunciation.
• Difficulty swallowing.
• Difficulty moving their tongue toward the roof of their mouth or from side to side.
• Difficulty licking ice cream.
• Difficulty playing a wind instrument.
• Problems sticking their tongue out and up.

Adult tongue-tie may result in:

• Mouth breathing.
• Inability to speak clearly.
• Difficulty kissing.
• Jaw pain.
• Tongue thrust.

What causes tongue-tie?

The tongue and the floor of the mouth fuse together during fetal development. Over time, the tongue separates from the floor of the mouth. Eventually, only a thin band of tissue (the lingual frenulum) connects the bottom of the tongue to the floor of the mouth.

As a baby grows, the small band of tissue under the tongue shrinks and thins. In children with ankyloglossia, the band of tissue remains thick, which makes it difficult to move the tongue.

Diagnosis and Tests

How is tongue-tie diagnosed?

In infants, ankyloglossia is often diagnosed by a pediatrician or a lactation consultant.

Dentists often diagnose tongue-tie in older children and adults.

Does tongue-tie affect speech?

The true impact of tongue-tie on speech isn’t clearly understood. Your child’s tongue needs contact with the roof of their mouth when pronouncing the lingual sounds “t”, “d”, “z”, “s,” “th,” “n,” and “l.” When their tongue is severely restricted and can’t reach the roof of their mouth, your child can have problems with articulation (pronunciation).

Speech therapy is beneficial for many children with ankyloglossia. Tongue-tie surgery may also be necessary for optimal results.

Management and Treatment

How does tongue-tie affect breastfeeding?

In order to create an adequate seal when breastfeeding, your infant must extend their tongue over their jaw line. If your baby has tongue-tie, this isn’t possible. They often attempt to use their gums to keep the nipple in their mouth during breastfeeding. This can be painful.

Is tongue-tie surgery necessary?

In some cases, tongue-tie isn’t severe enough to cause noticeable symptoms. Infants and young children who have tongue-tie but don’t have problems with feeding, swallowing or speaking may not need treatment.

If your child has tongue-tie and has trouble feeding, their healthcare provider can perform a tongue-tie surgery in which they cut their lingual frenulum. This is called a frenectomy (also known as frenulectomy, frenotomy or tongue-tie division). It’s often performed without sedation on infants.

Tongue-tie surgery causes minimal discomfort for infants. Young children and adults may receive pain medications or general anesthesia before the procedure.

As with any surgical procedure, a tongue-tie procedure carries risks of complications, including:

• Bleeding.
• Infection.
• Scarring.
• Injury to the saliva ducts in your mouth.

What happens if I don’t treat tongue-tie?

Left untreated, moderate to severe cases of tongue-tie can cause problems including:

• Feeding problems, which can cause poor weight gain or malnourishment. (Breastfeeding is usually more difficult in comparison to bottle feeding when a baby has a tongue-tie.)
• Speech impediments, which can cause problems in school.
• Difficulty eating certain foods.

Prevention

Can I prevent tongue-tie?

Since people are born with tongue-tie, there’s no way to prevent it. For more severe cases of tongue-tie, early diagnosis and treatment are key to a successful recovery.

Outlook / Prognosis

What can I expect if my child has tongue-tie?

Most infants and children with tongue-tie recover completely with minor surgery and/or speech therapy. Some may not need treatment at all.

Living With

What questions should I ask my healthcare provider?

If your baby has a tongue-tie, here are some questions you may want to ask their healthcare provider:

• How can I make sure my child receives adequate nutrition?
• Could tongue-tie be the cause of my child’s breastfeeding or nutrition difficulties?
• Is a frenectomy the right treatment for my child?
• Is it necessary to have a frenectomy right away, or can it wait?
• If my child has a frenectomy, what post-surgical complications should I watch out for?

Tongue-tie is a relatively common condition that can lead to potential feeding problems or speech issues. People who are born with tongue-tie may improve without treatment over time. But tongue-tie surgery is necessary in most cases. During this simple procedure, your child’s surgeon clips their lingual frenum, allowing their tongue to move freely and without restriction. Tongue-tie surgery is a straightforward way to ease ankyloglossia symptoms. Ask your child’s healthcare provider about treatment options and timelines.