What is
tongue tie?
Tongue tie - or ankyloglossia - is a structural restriction of the tongue present from birth. It affects feeding in infants, speech and eating in children, and contributes to jaw pain, sleep disruption, and whole-body tension in adults. It is more common than most people realise, more significant than it is often given credit for, and more treatable at any age than is generally understood.
Ankyloglossia - the clinical definition
In plain terms: the lingual frenulum is the band of tissue that connects the underside of the tongue to the floor of the mouth. In a tongue tie, this tissue is too short, too thick, too tight, or attached too far forward - restricting the tongue's range of movement. The restriction is structural and present from birth. It does not resolve on its own with age.
The tongue is one of the most functionally important structures in the body. It 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 effect can extend through connected structures and develop over time.
Types of tongue tie
Tongue tie is not a single, uniform condition. There is significant variation in how the restriction presents, where the frenulum is attached, how much movement is restricted, and how clinically significant the restriction is for that individual. Classification systems attempt to capture this variation, though clinical function matters more than anatomical type.
Posterior tongue tie (Mid-tongue restriction) is the most commonly missed type. Because it is not visible without lifting the tongue and palpating the floor of the mouth, it is frequently not identified at a standard newborn check or GP assessment. Many patients who come to us, of all ages, have been told they do not have a tongue tie, when this restriction has simply not been assessed.
How tongue tie affects different ages
The clinical significance of tongue tie changes as the demands on oral function change. The same structural restriction that causes breastfeeding difficulty in a newborn is the same restriction that contributes to jaw pain and snoring in an adult - the body simply adapts and compensates differently at each stage.
- Breastfeeding pain and poor latch
- Nipple damage
- Inefficient milk transfer
- Slow weight gain
- Reflux, colic and wind
- Jaw and neck tension
- Persistent feeding difficulties
- Unresolved reflux or colic
- Ongoing weight gain concerns
- Established compensatory patterns
- Introduction of solid foods approaching
- Speech and articulation difficulties
- Fussy eating and chewing problems
- Mouth breathing
- Snoring and poor sleep
- Dental crowding
- Open mouth posture
- Jaw pain and TMJ problems
- Headaches, neck and shoulder tension
- Snoring and sleep apnoea
- Difficulty swallowing
- Dental crowding and gum recession
- Speech and articulation issues
Assessment is inconsistent - and that matters
Despite being a congenital condition with a known ICD code and established classification systems, tongue tie assessment in Ireland and the UK is not standardised. There is no mandatory training requirement for healthcare professionals assessing tongue tie, no universal screening protocol, and significant variation in clinical practice between practitioners.
In newborns
Anterior ties are more likely to be identified at the newborn check, but posterior ties are often missed. The significance of the restriction is often underestimated: a tie that does not affect breastfeeding immediately may still be functionally significant as the child develops.
In older children and adults
There is no routine screening equivalent to the newborn check for this age group. Children adapt to their restriction - developing compensatory speech patterns, altered swallowing mechanics, and postural adaptations - that can mask the underlying restriction. Symptoms are attributed to articulation delay, ENT issues, stress, or posture. The restriction is not looked for because it is not expected.
The fascial connection - beyond the mouth
The lingual frenulum does not exist in isolation. It is part of a continuous fascial system that connects the tongue to the floor of the mouth, the hyoid bone, the anterior neck musculature, and through connective tissue to structures throughout the body. This is why tongue tie does not produce only local symptoms - its effects travel along fascial lines.
In infants, this can manifest as jaw tension, head preference, and postural asymmetry that directly affects feeding mechanics. In adults, the same fascial connections contribute to jaw pain, headaches, neck and shoulder tension. Addressing the restriction without also addressing the whole-body tension it has created - through physiotherapy and bodywork - can produce incomplete results. This is why our methodology is built around three pillars: Release, Retrain, Relieve.
How tongue tie is assessed and diagnosed
Tongue tie assessment is a clinical skill. It requires direct examination - observation and palpation of the lingual frenulum, assessment of tongue range of motion and pattern of movement, and functional evaluation of how the restriction affects the patient's specific presentation. Visual inspection alone is insufficient, particularly for posterior ties.
At the National Tongue Tie Centre, every assessment involves both a functional evaluation (IBCLC or Physiotherapist) and a medical examination by Dr. Justin Roche, Consultant Paediatrician. We assess structure and function together. Tongue tie is not diagnosed from photographs, questionnaires, or self-referral documentation alone. We examine every patient in clinic before making any recommendation.
The most widely used assessment tools for lingual frenulum function include the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) and the Bristol Tongue Assessment Tool (BTAT) for infants, and clinician-developed functional assessment protocols for older children and adults. At NTTC, assessment integrates standardised tools with the clinical experience of a team that has assessed and treated tongue tie since 2007.
When and how tongue tie is treated
Not every tongue frenulum requires treatment. Clinical significance depends on how much the restriction limits function for that individual - the same anatomical restriction may be clinically significant in one patient and not in another. We assess function, not anatomy alone, and we recommend treatment only where we believe it is genuinely indicated.
Where treatment is indicated, the approach varies by age:
In all cases, surgery without preparation and rehabilitation is an incomplete approach. The restriction causes compensatory patterns that do not resolve automatically when the restriction is released. Preparation before and rehabilitation after surgery are clinically essential components of the outcome, not optional extras.
Common questions about tongue tie
Is tongue tie hereditary?
Yes. Tongue tie has a strong hereditary component and runs in families. It is not uncommon for a parent who comes to NTTC with their infant to recognise symptoms of undiagnosed tongue tie in themselves during the assessment process. The genetic basis involves several genes associated with midline fusion during foetal development. This intergenerational patterning is an area of active clinical interest for our team.
Does tongue tie always need to be treated?
No. Treatment is indicated where the restriction is causing clinically significant functional difficulties. Where restriction is present but not functionally limiting, we would not recommend surgical intervention. Our assessment is designed to make exactly this distinction - we will tell you honestly whether we believe treatment is indicated in your or your child's case.
My baby was checked at birth and told there was 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 rather than visual inspection to identify, and because there may not be symptoms at birth. If your baby continues to have feeding difficulties despite a "no tie" assessment, a specialist evaluation is warranted.
Can adults really have tongue tie treated at this stage?
Yes. There is no upper age limit for assessment or treatment. We see adults across all age groups, including those in their forties, fifties, and beyond. Decades of compensatory patterns require a more committed rehabilitation phase post-surgery, but age itself is not a barrier. Many adult patients report that addressing tongue tie explains symptoms they have managed for their entire adult lives.
What is the difference between a frenectomy and a frenuloplasty?
A frenectomy is a simple division or excision of the frenulum - often performed with scissors, laser, or electrocautery with no sutures placed. A frenuloplasty is a more comprehensive surgical revision of the frenulum, the wound is closed with sutures to achieve a more controlled healing process. At NTTC, we perform frenuloplasty for all patients except the youngest infants, where frenectomy is appropriate. Frenuloplasty produces more complete functional release with less risk of reattachment.
How do I know if my symptoms are related to tongue tie?
The honest answer is that a clinical assessment is the only reliable way to determine this. Tongue tie cannot be assessed from a photograph or a symptom checklist alone - it requires direct examination of tongue function by a trained clinician. If you have symptoms across multiple domains - feeding, speech, sleep, jaw, or neck - that have not been fully explained elsewhere, a specialist assessment will give you a definitive answer.
Is tongue tie the same as ankyloglossia?
Yes. Ankyloglossia is the medical term for tongue tie. The two terms refer to the same condition. The ICD-10 code is Q38.1. You may also encounter the term "tethered oral tissues" (TOTs), which is a broader term covering tongue tie, lip tie, and buccal ties together.
Ireland's original dedicated tongue tie clinic
Established in 2007. Led by Dr. Justin Roche (Consultant Paediatrician, FRCPCH, FRCPI, IBCLC) and Kate Roche (Chartered Physiotherapist, IBCLC, Feeding Therapist). Over 1,000 patients treated annually across infants, children, and adults. Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frenuloplasty is a surgical procedure. All procedures carry associated risks, and individual outcomes vary. Full clinical information is provided at assessment before any decision to proceed.
