Buccal tie,
cheek ties
Buccal ties are restricted frenula within the cheeks, small bands of tissue connecting the inner cheek to the upper or lower gum on each side. They are less widely known than tongue or lip tie, and are frequently missed on routine examination. They are almost always found alongside tongue tie or lip tie, rarely in isolation.
Understanding the cheek frenula
The buccal frenula sit in the upper and lower buccal sulcus, the groove between the cheek and the gum, on each side of the mouth. In most people, these are similar in appearance to the web of tissue between your thumb and first finger: thin and unrestricted. When these bands of tissue become short and inelastic, or when they are particularly deep, extending a long way down from the gum edge and out onto the cheek, they can become problematic.
At present, there is little to no research establishing what individual contribution buccal ties make to feeding difficulties, or what their long-term impact might be. This is an area where we are cautious about drawing firm conclusions.
One clinical observation we are confident in is a reluctance to comply with teeth cleaning at the back of the mouth. A toothbrush can catch on the frenulum, and the discomfort this causes makes a child or adult reluctant to brush that area properly.
Buccal ties often co-occur with tongue tie and lip tie. Fascia forms a continuous system throughout the body rather than being confined to the midline, so finding restriction in one area increases the likelihood of finding it elsewhere. A comprehensive assessment evaluates all frenula together.
If feeding has improved but not fully resolved after a tongue tie release, the first step is reassessing tongue function and structure, not assuming buccal tie. A restriction may have reattached, or may not have been fully released or assessed the first time. Buccal tie is one possibility among several once that reassessment has been done.
How buccal ties are assessed and treated
At NTTC, the assessment evaluates all frenula, lingual, labial, and buccal, as part of a whole oral examination. Buccal ties are specifically palpated and assessed for thickness, number, attachment level, and functional impact on lateral cheek mobility.
For infants, watching a feed is essential. Cheek dimpling, the pattern of suction breaks, and the quality of the seal give real-time information about whether buccal restriction is a factor in feeding difficulty.
Dr. Roche reviews findings and advises whether buccal frenuloplasty is indicated, and whether it should occur at the same time as any other planned frenular release. The decision is based on clinical significance, not all buccal frenula require treatment.
Where buccal frenuloplasty is indicated, the procedure is performed using CO2 laser, the same technique used for tongue and lip frenuloplasty at NTTC. Post-operative stretches maintain the release and prevent scar tissue re-attachment.
Frequently asked questions
I have never heard of buccal tie. Is this a well-recognised condition?
Buccal tie is less widely known than tongue or lip tie, and its clinical significance is still the subject of evolving evidence. However, it is identified and assessed by experienced clinicians working in tongue tie, myofunctional therapy, and feeding support, and is included in comprehensive oral assessments by those trained in the full range of frenular restriction. A 2024 survey of 466 healthcare providers working with tethered oral tissues found that the great majority assess for buccal restriction as standard practice, even though widely accepted diagnostic and treatment guidelines are still lacking.Baxter R, Merkel-Walsh R, Lahey L, Knutsen C, Zaghi S. The buccal frenum: trends in diagnosis and indications for treatment of buccal-ties among 466 healthcare professionals. J Oral Rehabil. 2024. At NTTC we assess all frenula routinely and treat buccal ties only when clinical significance is clearly established.
My baby had tongue tie released but is still clicking. Could this be buccal tie?
The first step is to look at tongue function again: has feeding changed, and in what way? A repeat evaluation of both function and structure is needed, because the cause could be reattachment of the original release, or a restriction, tongue, lip, or buccal, that was not fully released or not assessed in the first place. Buccal tie is one possibility among several, not the first place to look.
Will my GP or public health nurse know about buccal ties?
Awareness of buccal tie varies significantly among general practitioners and allied health professionals. It is a niche area within an already specialist field. If you have concerns, a free Concerns Call is a good starting point: it is a conversation to talk through what is going on and help you decide whether attending the clinic for a full evaluation is worthwhile, not an assessment in itself. A structural and functional assessment can only be carried out in person, not by phone or video call.
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Relevant services at NTTC
Book a free Concerns Call
Talk to a NTTC clinician. We assess the full oral environment, tongue, lip, and cheek frenula together, and advise clearly on what is present and what, if anything, needs to be done.