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A referral pathway built around your patient
The National Tongue Tie Centre offers multidisciplinary assessment and treatment for ankyloglossia across all age groups. We welcome referrals from GPs, IBCLCs, paediatricians, SLTs, orthodontists, osteopaths, and allied health professionals.
"We treat the functional restriction, not just the structural finding. Every patient receives a rehabilitation plan alongside any release."
Dr. Justin Roche & Kate Roche, Co-FoundersMultidisciplinary care, not single-operator assessment
The NTTC was founded in 2007 on the principle that tongue tie cannot be adequately addressed by release alone. Structural assessment and functional rehabilitation must occur together, with every patient seen by a clinician who integrates both.
Our model combines consultant paediatric expertise with physiotherapist-led feeding and oral motor therapy, delivered as a co-ordinated clinical pathway rather than a sequence of separate appointments.
Release Restrictions. Retrain Function. Relieve Tension.
Our three-part clinical philosophy underpins every assessment and treatment pathway, regardless of patient age or presentation.
CO2 laser functional frenuloplasty
Performed by Dr. Justin Roche (MB ChB, FRCPCH, FRCPI, IBCLC). We do not perform scissors frenotomy. The functional frenuloplasty technique is designed to optimise range of motion and tissue healing outcomes.
Physiotherapist-led rehabilitation
Led by Kate Roche (BSc Physiotherapy, MISCP, IBCLC, Feeding Therapist). Pre- and post-procedure functional work addresses feeding patterns, motor patterning, and oral function across all age groups.
Fascial and myofascial assessment
Where clinically indicated, we co-ordinate with osteopaths, craniosacral therapists, and bodyworkers to address tension patterns along the deep front line before or after release.
Who we see - and what to look for
We accept referrals across all age groups. Functional impact is our primary assessment criterion, not structural grade alone.
Infant feeding difficulties
- Ineffective latch or poor seal at breast or bottle
- Maternal nipple pain, distortion, or trauma during feeds
- Excessive wind, colic, or gulping during feeding
- Poor weight gain or slow transfer despite adequate supply
- Prolonged, frequent, or exhausting feeding sessions
- Inability to sustain a nutritive suck pattern
Ongoing feeding and transition concerns
- Persistent latch or transfer difficulties not resolving with IBCLC input
- Difficulties transitioning between feed types or initiating bottle feeding
- Unresolved maternal pain or recurrent mastitis without supply explanation
- Significant reflux or colic in the context of feeding dysfunction
- Sleep disruption associated with inefficient feeding
Weaning, speech, and oral motor development
- Difficulties with texture progression or food refusal at weaning
- Persistent gagging or vomiting with lumpy textures
- Speech and language delay with suspected oral motor contribution
- Mouth breathing pattern established in early childhood
- Dental crowding, narrow arch, or high palatal vault at dental review
- Drooling beyond expected developmental stage
Missed restriction in older patients
- Articulation difficulties or substitution patterns not resolving with SLT
- Orthodontic concerns - narrow arch, overjet, anterior open bite
- Sleep-disordered breathing or confirmed OSA with myofunctional component
- Temporomandibular joint dysfunction or chronic jaw, neck, or head pain
- Difficulty swallowing, food pocketing, or slow eating
- Adult presentation with history of untreated tongue tie in infancy
If you are unsure whether a patient is appropriate for referral, contact our clinical team directly before making a formal referral.
The referral and treatment pathway
No referral letter is required. Patients may self-refer or be referred by a clinician. The assessment is conducted from first principles regardless of any accompanying documentation.
Referral or self-referral
Patients book directly via tonguet.ie or are referred by a clinician. A letter is welcome but not required. Note whether you wish to receive a written report.
Combined assessment
The initial appointment includes both feeding therapy assessment and medical review in a single integrated session, using standardised instruments where age-appropriate.
Clinical decision
Recommendations are made on the day based on functional findings. Not all patients proceed to release. Where indicated, frenuloplasty is typically performed at the initial appointment.
Rehabilitation and review
All patients receive a structured rehabilitation plan with follow-up included. A written summary is provided to the referring clinician on request, with patient consent.
Conscious sedation service
For patients unable to cooperate with the procedure under local anaesthetic alone - including older infants, toddlers, and children with anxiety, sensory sensitivities, or complex presentations - we offer a conscious sedation pathway.
This service is provided under the medical supervision of Dr. Justin Roche, who holds consultant paediatric credentials and extensive procedural sedation experience in children. It significantly expands access for patients who would otherwise require general anaesthesia.
Learn more about this serviceSuitable for referral via this pathway
- Children aged 6 months and over where cooperation under local is unlikely
- Patients with autism, ADHD, or significant sensory processing difficulties
- High levels of dental or procedural anxiety
- Patients for whom general anaesthesia has been recommended or is under consideration
- Complex presentations requiring more extensive frenuloplasty
Who your patients will see
The founding team remains clinically active and involved in direct patient care. Every patient at the NTTC is seen by experienced clinicians.
Common questions from referring clinicians
Does the patient need a formal referral letter?
No. Patients can self-refer directly. A referral letter is welcome and will be reviewed as part of the assessment, but is not a prerequisite for booking. The assessment is conducted from first principles regardless of documentation provided.
Will I receive a written report after the appointment?
Yes, on request. We provide a written clinical summary for the referring practitioner's records. Please indicate when referring that you would like a copy sent to you, and ensure the patient has consented to this disclosure. Reports are sent by email in PDF format.
Do you treat posterior tongue tie?
Yes. Our assessment is function-led, not grade-based. A posterior restriction producing measurable functional impact on feeding, speech, airway, or orofacial development will be assessed and discussed with the family. We do not decline to assess based on tie classification alone.
What age groups do you see?
We assess and treat patients from birth through to adulthood. Specific pathways exist for newborns (0 to 12 weeks), infants (3 to 6 months), children (6 months and over), and adults. Our conscious sedation service extends access to older infants and children who are unable to cooperate under local anaesthetic alone.
How long is the wait for an appointment?
Wait times vary with demand. Current availability is visible at tonguet.ie/book. For urgent infant feeding presentations, please contact us directly and we will advise on the earliest available slot or cancellation list placement.
What is your position on the RCPI Faculty of Paediatrics consensus statement?
Dr. Justin Roche and Kate Roche co-authored a published response to the RCPI statement, which appeared in the Irish Medical Times. Our position is that the clinical significance of tongue tie - particularly posterior restriction and its impact on speech, sleep, dental development, and jaw function - is not adequately reflected in current national guidance. We are co-signatories of the 2026 international consensus statement on ankyloglossia.
Can I speak to a clinician before referring?
Yes. If you have questions about a specific presentation, contact our team by phone or through the clinical enquiry form. We are happy to discuss unusual or complex presentations in advance of a formal referral.
What do families need to bring to the appointment?
Families should bring the child's personal health record, any relevant previous feeding or clinical assessments, and - for breastfeeding families - the infant should be available to feed at the appointment if possible. An intake questionnaire is sent on booking confirmation.
Professional education and resources
The Tongue Tie Toolbox is our dedicated educational platform for clinicians working with ankyloglossia across disciplines.
Online courses, clinical guides, and a professional membership community for IBCLCs, physiotherapists, SLTs, paediatricians, and GPs. Evidence-based content grounded in the NTTC clinical model.
Visit the ToolboxThe PRIME Clinical Masterclass introduces the five-element feeding assessment and rehabilitation framework developed by Kate Roche at the NTTC. Relevant for feeding therapists, IBCLCs, and physiotherapists.
Learn about PRIMERefer a patient or make a clinical enquiry
We welcome direct contact from referring clinicians. If you have a complex presentation or want to discuss a case before referring, please use the clinical enquiry route.