Tongue Tie and Lip Tie: A Dentist's Balanced View

"Someone told me my baby has a tie. Does it need cutting?" More parents ask me this every year, often after reading about it online. The honest answer is that many babies have a visible tie and need nothing at all. A small number do benefit from a simple procedure, and the key is telling the two apart calmly and carefully.

What are tongue tie and lip tie?

Everyone has small folds of tissue called frenula (singular: frenum). One connects the underside of the tongue to the floor of the mouth, and another connects the upper lip to the gum above the front teeth.

• Tongue tie (ankyloglossia) means the fold under the tongue is short, tight or thick enough to limit how the tongue moves.
• Lip tie describes an upper lip frenum that looks prominent or attaches low on the gum.

The important word is function. How a frenum looks tells us much less than how the tongue and lip actually work. Many frenula that look tight cause no problems.

Possible concerns

Breastfeeding

A tongue tie that truly restricts movement can sometimes make breastfeeding harder. Signs may include:

• Nipple pain or damage for the mother that doesn't settle
• The baby struggling to latch or slipping off the breast
• Clicking sounds, very long or very frequent feeds
• Poor weight gain

These signs have many possible causes, such as positioning, milk supply or a baby who is still learning. That's why the first step is usually an assessment by a lactation consultant and your paediatrician, who look at the whole feeding picture. Often, support with positioning and latch solves the problem without any procedure.

Speech

Speech problems caused by tongue tie are uncommon. Most children with a tie learn to speak clearly. If you have concerns about your child's speech, a speech and language therapist is the right person to assess it, and they can advise whether the tongue plays any part.

Upper lip tie

Upper lip ties rarely need treatment. A small gap between the top front baby teeth is very common and often narrows or closes as the adult teeth come in. A prominent upper frenum in a baby is usually a normal finding. Current evidence does not support routinely releasing lip ties to help breastfeeding.

When is treatment considered?

If a tongue tie is clearly limiting movement and causing real difficulty that hasn't improved with feeding support, a frenotomy may be recommended. In young babies this is usually a quick procedure in which the tight fold is released, and many babies feed again soon afterwards. As with any procedure, there are small risks, such as bleeding, so the decision should be based on a careful examination and a clear reason.

A word about over-diagnosis

In recent years, the number of tie procedures has risen sharply in many countries. A 2024 clinical report from the American Academy of Pediatrics urged caution, noting that a frenum's appearance alone is not a reason to treat, and that feeding should be assessed fully before any procedure. Paediatric dental organisations share a similar careful approach.

Practical tips for parents:

1. Don't panic if someone mentions a tie. Ask what problem it is causing.
2. Get feeding help first from a lactation consultant if breastfeeding is difficult.
3. Ask for a functional assessment, not just a look.
4. Ask what happens if you wait, and what the expected benefit is.
5. Seek a second opinion if you feel unsure. It's always reasonable.