Why is tongue tie missed?
Tongue tie assessment in the newborn period is inconsistent. Posterior tongue ties or mid-tongue restriction in particular are frequently missed because the tongue tip appears free and able to extend, while the restriction is deeper in the submucosal tissue. Routine newborn checks rarely include functional assessment of the tongue, and unless a specialist is looking for it, a significant restriction can go unidentified.
Many adults presenting to us have never been told they have a tongue tie: only that they had breastfeeding difficulties, or speech that needed therapy, or teeth that needed multiple rounds of orthodontic treatment.
Common presentations in older children who were not treated in infancy
- Persistent articulation difficulties despite speech and language therapy
- Orthodontic treatment that keeps relapsing
- Chronic mouth breathing and altered facial development
- Dental crowding and a high arched palate
- Difficulty with eating certain textures
- Poor tongue mobility on clinical assessment
- A history of breastfeeding difficulties in the newborn period that were never investigated
- Snoring or sleep-disordered breathing
Common presentations in adults with undiagnosed tongue tie
- Chronic jaw tension and temporomandibular dysfunction
- Persistent neck and shoulder tension
- Tension headaches, particularly suboccipital
- Sleep-disordered breathing or snoring
- Difficulty swallowing, particularly certain textures or tablets
- A restricted or thick-feeling tongue
- Dental crowding or orthodontic relapse
- A vague sense that eating, speaking, or breathing has always felt effortful
It is not too late
Adult frenuloplasty, performed with appropriate preparation and followed by dedicated myofunctional rehabilitation, can make a significant difference. The tissues are less pliable than in infancy and rehabilitation takes longer, but the functional gains are real, and we see them every week in our clinic. We will give you an honest, detailed assessment of what is likely achievable in your specific case.
Our approach: Release Restrictions, Retrain Function, Relieve Tension, is designed for exactly this presentation, where compensatory patterns are established and the whole tensional network needs to be addressed, not just the tether.
The National Tongue Tie Centre was established in 2007 as Ireland's first clinic dedicated entirely to the assessment and treatment of tongue tie. The centre treats over 1,000 patients per year and receives patients from across Ireland and internationally.
Led by Dr. Justin Roche (Consultant Paediatrician, FRCPCH, FRCPI, IBCLC), Kate Roche (Chartered Physiotherapist, IBCLC, Feeding Therapist). Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frequently asked questions
The definitive answer requires clinical assessment. However, signs that suggest a tongue tie may be present include inability to touch the roof of the mouth with the tongue, inability to stick the tongue out past the lower lip, a notched or heart-shaped tongue tip when extended, restricted lateral tongue movement, and the clinical picture of symptoms described across this website. An assessment by a specialist experienced in functional evaluation is essential.
A previous division may have been incomplete, either because it was a simple division that did not address a posterior component, or the wound may have reattached. We see this regularly. Please contact us for an assessment; we will evaluate current tongue function and scar tissue and advise on whether revision is indicated.
Yes. We treat adults across the full age range. The degree of functional gain depends on the severity of the restriction and your commitment to rehabilitation, but it is not age-dependent in any absolute sense. Many adults in their 40s and 50s describe meaningful improvement in jaw tension, sleep, and swallowing following treatment.
You can contact us directly. Self-referral is entirely appropriate for tongue tie assessment. If we identify a clinical picture that requires medical co-management, for example significant sleep apnoea or complex dysphagia, we will advise on appropriate parallel referrals.
Initial contact by phone or online enquiry; a consultation with our team to take a full history and conduct a functional assessment; a clear discussion of findings and recommendations; pre-operative preparation including bodywork and myofunctional exercises where indicated; the procedure itself; and a structured post-operative rehabilitation programme. We will explain every step before you commit to anything.
Book a comprehensive assessment at the National Tongue Tie Centre. Our clinical team will complete a comprehensive functional assessment, explain what we find, and give you an honest discussion of what frenuloplasty is likely and unlikely to achieve in your case. Call us, complete our online enquiry form, or visit www.tonguet.ie. Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frenuloplasty is a surgical procedure. Risks, benefits, and individual expectations will be discussed in full at your assessment appointment before any decision to proceed is made.
