A lip tie is a condition involving the maxillary labial frenulum, the band of tissue connecting the center of the upper lip to the gum line above the two front teeth. While this tissue is present in everyone, a lip tie occurs when the frenulum is unusually thick, short, or tight, restricting the movement of the upper lip. This restriction is often referred to as a tethered oral tissue.
This anatomical variance is classified into different grades, or classes, based on where the frenulum attaches to the gum tissue. For instance, a Class 1 tie is a minimal attachment high above the gum line, while a Class 4 tie is the most restrictive, extending down to the palate or the base of the gums. The classification system helps professionals describe the severity of the attachment, but the visual class does not always directly correlate with the degree of functional impairment a baby experiences during feeding.
The Mechanism of Impaired Latch and Feeding
Lip ties significantly interfere with effective breastfeeding because a proper latch requires the infant’s upper lip to flange, or curl outward, to create a wide, secure seal around the breast. When the labial frenulum is too restrictive, it tethers the lip, preventing this necessary flanging motion. This inability to form a deep, lasting seal forces the baby to latch shallowly, primarily compressing the nipple rather than taking in enough areola tissue.
The shallow latch leads to symptoms in both the infant and the mother. In the baby, a poor seal causes them to swallow excessive air, resulting in gassiness, colic-like symptoms, and audible clicking noises during nursing. Inadequate milk transfer can also cause the baby to tire quickly, fall asleep frequently during feeds, and demonstrate slow or poor weight gain, despite long or frequent nursing sessions.
For the nursing parent, the constant compression and friction from a shallow latch cause significant nipple pain, trauma, and cracking. This chronic pain and inefficient milk removal can lead to secondary maternal complications, such as blocked milk ducts, breast engorgement, or mastitis. These persistent difficulties can also affect the parent’s milk supply over time.
Assessment and Treatment Options
Determining whether a lip tie is causing functional problems involves a comprehensive assessment by trained healthcare professionals, such as pediatricians, lactation consultants, or specialized dentists. The diagnosis is not based solely on the visual appearance or classification of the frenulum but on its functional impact on the baby’s ability to feed. Professionals assess the range of motion of the upper lip and look for physical signs of restriction, such as blanching of the gum tissue when the lip is gently lifted.
If the restrictive frenulum is deemed the cause of significant feeding difficulties, the primary treatment is a minor surgical procedure called a frenotomy, or “release.” This procedure involves precisely cutting the tight tissue to restore full mobility to the lip. The release can be performed quickly in an office setting using either sterile scissors or a soft-tissue laser.
Following the frenotomy, parents are instructed to perform post-procedure stretching exercises to prevent the tissue from reattaching as it heals. These exercises, combined with follow-up support from a lactation consultant, help the baby utilize the newly freed lip mobility to achieve a deeper, more effective latch. The goal of the treatment is to resolve the mechanical barrier and allow the baby to feed more comfortably and efficiently.
Long-Term Implications Beyond Nursing
If a lip tie is not addressed, consequences can extend beyond the immediate feeding period and influence other aspects of a child’s development. A primary long-term concern relates to oral hygiene, as a restrictive frenulum can make it difficult to properly brush and clean the area behind the upper lip. This difficulty in clearing food debris increases the risk of plaque buildup and potential tooth decay on the surfaces of the upper front teeth.
Another issue involves dental development, as a tight maxillary labial frenulum may contribute to the formation of a diastema, a persistent gap between the two front teeth. A large gap caused by the restrictive tissue may later require orthodontic intervention. Furthermore, some professionals suggest that the restriction may affect the proper formation of certain speech sounds later in childhood, though evidence is less certain.