Frequently asked
questions
We have gathered the questions we are most commonly asked - about tongue tie, about assessment, about our specific services, and about what treatment involves at every age. If you don't find your answer here, our free Concerns Call is the best next step.
What is tongue tie?
Tongue tie (ankyloglossia) is a congenital condition in which the lingual frenulum - the band of tissue connecting the underside of the tongue to the floor of the mouth - is too short, too thick, too tight, or attached too far forward. This restricts the tongue's normal range of movement. The restriction is present from birth and does not resolve on its own with age.
The tongue is involved in feeding, swallowing, speech, breathing, dental development, and postural function of the jaw and neck. A restriction that limits its movement does not stay local - its effects extend through connected structures and develop over time. Read our full guide to tongue tie →
Is tongue tie hereditary?
Yes. Tongue tie has a strong hereditary component and runs in families. The genetic basis involves genes associated with midline fusion during foetal development. It is not uncommon for a parent attending NTTC with their infant to recognise symptoms of undiagnosed tongue tie in themselves during the assessment process. If you have tongue tie, your children have a higher likelihood of having it too.
How common is tongue tie?
Estimates vary depending on the diagnostic criteria and clinical tools used, but tongue tie is generally considered to affect between 4% and 10% of newborns. It is approximately twice as common in males as females. Posterior tongue tie, which requires palpation rather than visual inspection to identify, is frequently missed at routine newborn checks - meaning the true prevalence is likely higher than reported figures suggest.
What is the difference between tongue tie, lip tie, and buccal tie?
Tongue tie refers to a restrictive lingual frenulum (under the tongue). A lip tie refers to a tight or short maxillary labial frenulum that restricts upper lip mobility - relevant to latch in infants and dental spacing in older patients. Buccal ties are tight frenulae connecting the cheeks to the gum, restricting cheek mobility. The collective term "tethered oral tissues" (TOTs) covers all three. They frequently co-exist and are assessed together at NTTC.
Does tongue tie always need to be treated?
No. Treatment is indicated only where the restriction is causing clinically significant functional difficulties for that individual. Where restriction is anatomically present but not functionally limiting, we would not recommend surgical intervention. Our assessment is designed specifically to make this distinction, and we will tell you honestly whether we believe treatment is indicated in your or your child's case.
Will tongue tie resolve on its own as my baby grows?
No. The structural restriction does not resolve with age. What changes is the functional impact - as the demands on oral function change across developmental stages, the effects of the restriction shift. Breastfeeding difficulties in a newborn become speech and eating difficulties in a child, and jaw pain, sleep disruption, and neck tension in an adult. The frenulum itself does not stretch, thin, or retract over time in a way that resolves the restriction.
My baby was checked at birth and told there is no tongue tie. Could that be wrong?
Yes, it is possible. Posterior tongue tie in particular is frequently missed at routine newborn assessment because it requires palpation of the floor of the mouth rather than visual inspection alone, and not all healthcare professionals performing newborn checks have been trained in posterior tie assessment. If your baby continues to have feeding difficulties despite a "no tie" assessment, a specialist evaluation is warranted.
Why don't you offer surgery at the first appointment?
A baby with a tongue tie has been adapting to that restriction from before birth, developing compensatory movement and tension patterns throughout the body. If we release the restriction without preparing the tongue and surrounding structures first, those compensatory patterns remain and outcomes are less predictable. Preparation - mouthwork, bodywork, and feeding support - builds the functional foundation that makes the procedure work. It is not a delay for its own sake; it is what produces better long-term outcomes.
In cases where weight gain is significantly compromised or there is a clinical reason not to delay, we discuss this individually and adjust the pathway accordingly.
Can tongue tie affect bottle-fed babies as well as breastfed babies?
Yes. Tongue tie affects the mechanics of feeding regardless of method. Bottle-fed babies with tongue tie may show slow or inefficient feeding, excessive wind or colic, fatigue during feeds, clicking sounds, milk leaking from the mouth, or preference for a fast-flow teat. We assess and treat both breastfed and bottle-fed infants.
My baby has reflux. Could tongue tie be contributing?
Tongue tie can contribute to reflux, colic, and wind through several mechanisms - poor seal at the breast or bottle leading to air ingestion, inefficient milk transfer causing the baby to work harder and swallow more air, and compensatory swallowing patterns that increase aerophagia. We see many infants where reflux improves significantly following tongue tie treatment and feeding rehabilitation. That said, reflux has multiple causes and we assess each baby individually.
What is the conscious sedation service and who is it for?
Our conscious sedation frenuloplasty service is for infants aged 12 weeks to 6 months. Conscious sedation means your baby is breathing independently and is relaxed throughout the procedure, and is kept comfortable with local anaesthetic. This approach avoids the risks associated with general anaesthetic and allows us to assess tongue function in real time during surgery. To our knowledge, this service is currently unique to the National Tongue Tie Centre in Ireland. Read more about conscious sedation →
How soon after birth can a baby be assessed?
We can assess from the first days of life. If your baby is struggling to feed and you are concerned, contact us as early as you feel it is appropriate. We would rather you contact us early than struggle for weeks waiting to see if things improve. A Concerns Call is a good first step if you are not sure whether an assessment is warranted.
My child had a tongue tie release as a baby. Can they be reassessed?
Yes. A release in infancy may have resolved the immediate feeding concern without fully addressing the functional restriction. As the child grows and the demands on oral function increase - speech, eating, breathing, dental development - a residual restriction can become more clinically apparent. We will assess the current functional status and advise on whether any further intervention is indicated.
Will treating tongue tie fix my child's speech?
If restricted tongue mobility is a functionally significant contributor to your child's speech difficulties, addressing the restriction creates the structural possibility for correct sound placement. The sounds themselves still need to be learned and established through speech therapy and myofunctional rehabilitation - the procedure alone does not retrain patterns that have been present for years. We can work in partnership with your child's speech and language therapist where one is involved, and we are clear about realistic expectations from the outset.
My child has been discharged from speech therapy with ongoing difficulties. What should we do?
If your child has persistent articulation difficulties after a course of speech therapy, a specialist tongue tie assessment should be sought if it has not already been completed. We see many children in this situation, and in a significant proportion a functionally relevant restriction is identified that was not previously considered. If progress hits a ceiling - because the structural restriction remains, progress will plateau at that ceiling.
My child is anxious about medical appointments. How do you handle this?
We are experienced in working with anxious children and with children who have had difficult previous medical experiences. The assessment appointment involves no surgical procedures, and we take as much time as is needed. For the procedure, the approach we use - including EMLA numbing cream applied well in advance and administration of sedation before your child enters the procedure room - is designed specifically to minimise distress. Please contact us before your appointment and we can advise on how to prepare your child well.
Could tongue tie be causing my child's snoring or poor sleep?
Yes, it can. A restricted tongue that cannot achieve a correct resting posture against the palate tends to rest low in the mouth, contributing to mouth breathing, open mouth posture, and restriction of the posterior airway during sleep. This can contribute to snoring, restless sleep, and sleep-disordered breathing in children. Read more about snoring and sleep in children →
I'm in my 30s / 40s / 50s. Am I too old for treatment?
There is no upper age limit. We treat adults across all age groups. Decades of compensatory patterns require a more committed rehabilitation phase post-surgery, but age itself is not a barrier. Many of our adult patients report that addressing tongue tie explains symptoms they have managed for their entire adult lives without a satisfactory explanation.
Can tongue tie cause jaw pain and TMJ problems?
Yes. The lingual frenulum connects through the floor of the mouth into the fascial system of the anterior neck and jaw. A restricted tongue that cannot achieve correct resting posture against the palate alters the resting mechanics of the jaw, contributing to muscular imbalance, altered bite forces, and jaw joint loading. Many adult patients with long-standing TMJ pain have an underlying tongue restriction that was never identified. Read more about jaw pain and tongue tie →
Can tongue tie cause sleep apnoea?
A restricted tongue that cannot achieve a correct resting posture against the palate tends to rest low and forward, contributing to posterior airway narrowing during sleep. This can be a contributing factor in snoring and obstructive sleep apnoea. We assess airway and breathing as part of the standard adult evaluation and include airway retraining in the post-operative rehabilitation programme where relevant.
I've had a tongue tie release before and it didn't help. Would revision be worthwhile?
This depends on what was done previously and what remains. We see many adults who had a release - as a child or more recently - without adequate preparation beforehand or rehabilitation afterwards. In some cases residual restriction was not fully released. In others, the restriction was adequately released but compensatory patterns were never addressed and functional improvement was not achieved. We will assess your current status honestly and advise whether further intervention is indicated.
My symptoms have been attributed to stress or posture for years. How do I know if tongue tie is relevant?
A specialist clinical assessment is the only reliable way to determine this. Tongue tie cannot be assessed from photographs or symptom checklists alone - it requires direct examination. If you have symptoms across multiple domains - jaw, sleep, neck, swallowing, speech - that have not been fully explained despite investigations elsewhere, a specialist evaluation is a reasonable next step. We will tell you honestly what we find.
What is the difference between a frenectomy and a frenuloplasty?
A frenectomy is a simple division or excision of the frenulum - typically without sutures, often performed under topical anaesthetic in young infants. A frenuloplasty is a more comprehensive surgical revision of the frenulum that allows deeper tissue release, wound closure with absorbable sutures, and a more controlled healing process with reduced risk of reattachment. At NTTC, we perform CO₂ laser frenectomy for infants under 12 weeks, and functional frenuloplasty for all older patients.
Why do you use CO₂ laser rather than scissors or electrocautery?
CO₂ laser provides precise, minimally traumatic tissue release with minimal bleeding and reduced post-operative inflammation compared to mechanical or cautery methods. It allows accurate release with a high degree of control. There is usually little to no bleeding, and the technique is well tolerated. Dr. Roche is a Fellow of the American Laser Study Club and has been performing CO₂ laser procedures since 2017.
Will the tongue tie come back after treatment?
Reattachment - where the released tissue heals closed - is the main post-operative complication and the reason our aftercare programme and Diamond Care protocol are in place. Frenuloplasty with suture closure significantly reduces the risk of reattachment compared to simple frenectomy. Adherence to the mouthwork exercises and wound care guidance post-operatively is important. We monitor healing at the aftercare appointment and six-week follow-up.
How important is the pre-operative preparation?
It is clinically essential, not optional. The restriction causes compensatory movement patterns that do not resolve automatically when the restriction is released. Pre-operative therapy begins the process of normalising these patterns before surgery, so that the tongue has a functional foundation to build on post-operatively. For older children and adults, it also provides clinical information that refines our surgical planning. Patients who complete the preparation phase achieve better outcomes.
How long does recovery take?
The surgical wound itself heals over two to three weeks. The functional rehabilitation - where the lasting gains are built - continues for longer, depending on age and the degree of compensatory adaptation. For young infants, the full pathway is typically completed within six to eight weeks of surgery. For older children and adults with more established patterns, the post-operative rehabilitation phase is longer. We will give you a realistic expectation at the assessment appointment.
Where are you located?
Our main clinic is in Clonmel, Co. Tipperary. We also run an outreach clinic at Vista Primary Care in Naas, Co. Kildare. We see patients from across Ireland and internationally. Clonmel clinic details → | Naas clinic details →
Who performs the procedures?
All surgical procedures are performed by Dr. Justin Roche, Consultant Paediatrician (MB ChB, FRCPCH, FRCPI, IBCLC). Dr. Roche has been treating tongue tie since 2007, is a Fellow of the American Laser Study Club, and has presented on tongue tie management at international conferences. Meet our team →
What makes NTTC different from other tongue tie services?
Several things distinguish our approach. We do not offer single-appointment surgery - we believe preparation before and rehabilitation after are clinically essential to outcomes. We offer the only frenuloplasty service under conscious sedation for infants aged 12 weeks to 6 months in Ireland. Our team includes seven IBCLCs across medicine, physiotherapy, nursing, and midwifery in one integrated clinic. We treat all age groups from birth to adulthood. And our methodology - Release, Retrain, Relieve - addresses the whole-body consequences of restriction, not the procedure alone.
Do I need a GP referral to attend?
No. You can self-refer by booking directly through our website or by calling the clinic. If your GP, midwife, PHN, or other healthcare professional has recommended assessment, a referral letter is welcome but not required. We will communicate with your GP or other practitioners where this is clinically helpful and with your consent.
Can I attend if I am travelling from outside Ireland?
Yes. We regularly see patients from the UK and internationally. Please contact us in advance so we can discuss the logistics and structure the pathway appropriately for patients who cannot attend multiple local appointments. We will advise on what can be managed remotely and what requires in-person attendance.
What does the initial assessment cost?
The initial evaluation appointment costs €350 for all age groups. This is a standalone clinical appointment - you are not committing to any procedure by attending, and the findings, clinical opinion, and feeding or functional advice from this appointment have value regardless of whether you proceed further.
What does the full pathway cost?
Costs vary by age group and individual pathway requirements. As a guide: CO₂ laser frenectomy for infants 0–12 weeks is from €850 (steps 2–5); frenuloplasty for infants 3–6 months is from €1,550 (steps 2–7); the full pathway for children 6 months to 16 years is from €3,150; and for adults the full pathway is from €3,150. Please see our fees page for current full details.
Is a payment plan available?
Yes. A payment plan is available. Please contact the clinic to discuss arrangements.
Does health insurance cover tongue tie treatment?
Coverage varies significantly between health insurance providers and plans. Lactation consultations (IBCLC) are covered by the majority of Irish health insurers. The medical consultation with Dr. Roche may be partially covered depending on your policy. A facility fee applies to surgical procedures, meaning the full procedure cost is not covered even where some cover exists. We recommend contacting your insurer directly to confirm. Please see our fees page for more information.
Our Concerns Call is the best next step
A free 15-minute call with a member of our clinical team. We will listen to what is going on, give you an honest initial assessment of whether our service is appropriate for your situation, and advise on next steps - whether that is booking an assessment with us or being directed elsewhere.
Frenuloplasty is a surgical procedure. All procedures carry associated risks. Full information on risks, benefits, and individual expectations is provided at assessment before any decision to proceed.