Referring a patient
to NTTC
The National Tongue Tie Centre accepts referrals from GPs, midwives, public health nurses, speech and language therapists, orthodontists, IBCLCs, physiotherapists, and other healthcare professionals. No formal referral letter is required - patients can also self-refer directly. This page provides everything you need to refer confidently.
Who can refer - and for what
We accept referrals from all healthcare professionals, and patients can also self-refer directly. A formal referral letter is not required, though it is always welcome. Below are the most common referring professionals and the typical presentations they refer for.
- Infant feeding difficulties
- Failure to thrive or slow weight gain
- Persistent reflux or colic
- Adult jaw pain, headaches, neck tension
- Sleep-disordered breathing in adults
- Post-orthodontic relapse
- Breastfeeding pain or poor latch not responding to support
- Nipple trauma or damage
- Infant not gaining weight adequately
- Suspected posterior tongue tie at newborn check
- Maternal feeding distress
- Persistent articulation difficulties with restricted tongue mobility
- Plateau in speech progress despite therapy
- Suspected lingual restriction contributing to dysarthria
- Dysphagia assessment in adults
- Children discharged with residual difficulties
- Post-orthodontic relapse
- Restricted tongue posture affecting palate development
- Open bite with suspected tongue thrust
- Bruxism in context of restricted oral function
- Pre-orthodontic tongue tie assessment
- Gum recession with high labial frenulum attachment
- Suspected tongue or lip tie not resolving with positioning and latch support
- Maternal nipple pain and damage
- Infant feeding aversion
- Recurrent mastitis or blocked ducts
- Low milk supply with suspected mechanical cause
- Persistent jaw or neck tension with suspected oral restriction
- Infant postural asymmetry with feeding difficulty
- Adult TMJ dysfunction not resolving with standard physiotherapy
- Sleep-disordered breathing with suspected tongue restriction
How to refer a patient
Referring to NTTC is straightforward. No formal referral documentation is required. The most direct route is for the patient to contact us directly - by phone or by booking a Concerns Call - having been advised to do so by you. Alternatively, you can contact us on behalf of your patient.
If you are sending a referral letter or email, the following information is helpful but none of it is mandatory - your patient can attend without any accompanying documentation and we will assess from first principles:
- Patient name, date of birth, and contact details
- Brief summary of presenting symptoms and duration
- Relevant clinical history - previous tongue tie assessments or releases, feeding history for infants, relevant investigations
- Your clinical impression and reason for referral
- Any relevant co-morbidities or medications
- Whether you would like a reply letter following assessment
Our pathway - what to tell your patient
Understanding what your patient will experience at NTTC helps you refer with confidence and prepare them appropriately. Our approach is integrated and multi-stage - it differs significantly from single-appointment release services.
We do not recommend surgery unless we are confident it is clinically indicated. If we assess a patient and believe surgery is not warranted, we will tell the patient that clearly and provide a written assessment summary. Referral to us does not commit your patient to a procedure.
Credentials and clinical leadership
All surgical procedures are performed by Dr. Justin Roche. All assessments involve both a chartered physiotherapist and a medical consultation. Our team of seven IBCLCs spans medicine, physiotherapy, nursing, and midwifery.
Consultant Paediatrician. Specialist Division Paediatrics, Medical Council of Ireland (No. 171584). Fellow of the Royal College of Paediatrics and Child Health. Fellow of the Faculty of Paediatrics, RCPI. Fellow of the American Laser Study Club. Former board member, International Consortium of Ankyloglossia Professionals (ICAP). Treating tongue tie since 2007. International conference presenter.
Chartered Physiotherapist registered with CORU and ISCP. International Board Certified Lactation Consultant. Feeding Therapist. Clinical Director, National Tongue Tie Centre. Co-founder, Tongue Tie Toolbox educational platform. International presenter and educator in tongue tie assessment and treatment methodology.
Common questions from referring clinicians
Does the patient need a formal referral letter to attend?
No. Patients can self-refer directly. If you wish to provide a referral letter, it is welcome but not required. The assessment is conducted from first principles regardless of accompanying documentation.
Will I receive a written report following assessment?
Yes, on request. We are happy to provide a written assessment summary for the referring practitioner's records. Please indicate when making the referral that you would like a copy, and ensure the patient has consented to this.
What is your position on the RCPI Faculty of Paediatrics consensus statement on ankyloglossia?
Dr. Justin Roche and Kate Roche co-authored a published response to the RCPI Faculty of Paediatrics consensus statement, which appeared in the Irish Medical Times. Our position is that the clinical significance of tongue tie is frequently underestimated in guidelines that focus primarily on anterior tie presentations in breastfed newborns, and that the evidence base for the impact of posterior tie and for the effects of untreated restriction on speech, sleep, dental, and jaw function in older patients is not adequately reflected in current national guidance. We are committed to evidence-based practice and to transparent communication about the limits of what tongue tie treatment can and cannot achieve.
Can you liaise directly with my patient's other practitioners?
Yes. We are happy to liaise with GPs, SLTs, orthodontists, physiotherapists, and other practitioners involved in a patient's care, with the patient's consent. For children receiving speech and language therapy, we recommend continued collaboration with their SLT during and after the post-operative rehabilitation period and will communicate directly where this is helpful.
How long is the waiting time for an assessment?
Waiting times vary. Please contact the clinic directly for current availability. For infants with significant feeding difficulties or weight gain concerns, please indicate this when booking and we will endeavour to prioritise accordingly.
The Tongue Tie Toolbox is the educational platform founded by Kate and Justin Roche, providing structured professional development for IBCLCs, feeding therapists, physiotherapists, bodyworkers, and other practitioners working with tongue tie patients. Courses cover assessment methodology, functional evaluation, pre- and post-operative management, and the integrated care approach developed at NTTC over nearly two decades of specialist practice.
Explore the Tongue Tie Toolbox →Contact us to discuss a referral
We are happy to discuss a patient's suitability for assessment before a formal referral where this is helpful. Call the clinic or use our contact form. For straightforward referrals, your patient can book directly online or by phone.
National Tongue Tie Centre, Clonmel, Co. Tipperary and Naas, Co. Kildare. Medical registration: Dr. Justin Roche, Medical Council of Ireland No. 171584.
