Tongue-tie

The lingual frenum is a normal string or band of tissue connecting the underside of the tongue to the floor of the mouth. Tongue-tie (also knowns as ankyloglossia) is a condition where tongue movement is limited by a short or tight lingual frenum, which may in turn affect functions such as feeding and speaking.

Causes of tongue-tie

During development (before birth) the lingual frenum separates from the tongue, enough to allow free tongue movement. For some people, more tissue remains, resulting in a short or tight frenum known as a tongue tie. Many adults and children will not have problems despite having a short, tight lingual frenum.

Signs of tongue-tie

The signs of tongue-tie can include:

• The tongue can’t poke out of the mouth past the lower front teeth and lips.
• The tongue tip can’t be lifted to touch the roof of the mouth.
• The tongue can’t be moved sideways to the corners of the mouth.
• The tongue tip may look flat or square instead of pointy when extended.
• The tongue tip may look notched or heart-shaped when extended.
• In some cases, the front teeth in the lower jaw may have a gap between them.

Signs that a baby could be tongue-tied include:

• The mother has sore nipples during and after breastfeeding.
• The mother has flattened-looking nipples after breastfeeding.
• The mother has a white compression mark on the nipple after breastfeeding.
• The baby has low weight gain or does not feed well.

The mother may notice that the baby:

• Has difficulty attaching to the breast (comes on and off the breast).
• Gets tired quickly during breastfeeds.
• Makes a clicking sound when sucking.

Tongue-tie and baby feeding problems

Breastfeeding issues can be associated with tongue-tie, but the condition can be hard to diagnose in newborns and many of the symptoms of a tongue-tie also occur with other feeding issues. Therefore, it is important to see your doctor, a maternal and child health nurse, or a lactation consultant if you are having trouble breastfeeding.

It is important to remember that most breastfeeding problems are not caused by tongue-tie and can be solved with the right support.

Tongue-tie and speech problems

A small number of children may develop speech problems because of tongue-tie. Tongue-tie in toddlers is less common than in babies, which suggests that a short frenum can resolve itself as the child grows.

In persistent cases of tongue-tie, the child may have speech problems. They may have difficulties creating certain sounds that need the tongue or tongue tip to:

• touch the roof of the mouth – such as the t, d, n, l, s and z sounds
• arch off the floor of the mouth – such as the ‘r’ sound.

Treatment for tongue-tie

Tongue-tie can fix itself in early childhood if the frenum moves back during growth, allowing the tongue to move freely for eating and speech.

Seek support from a qualified lactation consultant or other appropriately qualified health professional to address baby feeding issues.

Surgical treatment may be considered if tongue-tie has been diagnosed by a trained health professional and other methods have not been successful. Surgical treatment often means snipping the frenum with surgical scissors or laser. The medical term for this procedure is frenectomy.

Where to get help:

• Your GP (doctor)
• Paediatrician
• Your maternal and child health nurse
• Lactation consultant
• Speech pathologist
• Your dentist or other dental practitioner
• Oral Health Victoria – emergency dental care is available to all Victorians through the through the Royal Dental Hospital Of Melbourne and community dental clinics for eligible people. For more information about public dental services call (03) 9341 1000, or 1800 833 039 outside Melbourne metro.
• Australian Dental Association ‘Find a Dentist’ or call (03) 8825 4600