The question of whether everyone has a tongue tie stems from a misunderstanding of a normal anatomical structure. Every person is born with a lingual frenulum, a small band of tissue connecting the underside of the tongue to the floor of the mouth. While this structure is a natural part of the oral anatomy, it is only considered a “tongue tie” if it causes a functional restriction. Clinical ankyloglossia, the medical term for a true tongue tie, occurs when the frenulum is too short, thick, or tight, limiting the tongue’s necessary range of motion.
Anatomy and Clinical Definition of Ankyloglossia
The lingual frenulum is a midline fold of mucous membrane that helps anchor the tongue within the oral cavity. Its normal function is to stabilize the tongue without impeding the extensive movement required for eating, swallowing, and speech. Ankyloglossia is specifically defined as a condition of limited tongue mobility caused by a restrictive lingual frenulum.
The restrictive tissue prevents the tongue tip from elevating or protruding properly past the lower gum line. Clinicians often categorize the condition based on the frenulum’s attachment point. Anterior ankyloglossia, the classic “tongue tie,” is visible and attaches at or near the tongue tip, clearly restricting mobility. Posterior ankyloglossia refers to a frenulum that is less visible or submucosal, but still restricts the tongue’s movement and function.
Prevalence and Common Misconceptions
Only a small percentage of people have clinical ankyloglossia. Estimates for the prevalence in newborns vary widely, ranging from 0.1% to over 10%. This broad range exists because different medical professionals use various diagnostic criteria and classification systems.
A major misconception is that the mere presence of a visible frenulum constitutes a tongue tie. The diagnosis of ankyloglossia is based on restriction of movement and functional impairment, not just the presence of the tissue. Many infants with a short frenulum can still feed normally, demonstrating that the tongue’s ability to move is more important than the frenulum’s appearance. The number of diagnoses and subsequent interventions has significantly increased in recent years, which may reflect growing awareness or a lowering of the clinical threshold.
Functional Impact on Infants and Children
When the tongue’s movement is restricted, it can have consequences across different developmental stages, particularly in infancy. The most frequently reported issue for newborns is difficulty with breastfeeding. A restricted tongue cannot extend and elevate sufficiently to create the proper seal and suction needed for an effective latch on the breast, potentially leading to inefficient milk transfer.
For the mother, this can result in significant nipple pain and trauma due to the infant chewing or gumming the nipple instead of using a proper wave-like sucking motion. In the infant, poor milk transfer can lead to slow weight gain or a failure to thrive, although most infants with ankyloglossia can breastfeed successfully.
As the child grows, a restricted tongue may interfere with the ability to clear food debris from the teeth and manipulate a food bolus during the introduction of solids.
Later in childhood, ankyloglossia can potentially affect the articulation of specific sounds requiring precise tongue-tip elevation, such as “l,” “r,” “t,” “d,” and “s”. While the link to speech disorders remains a subject of debate among specialists, the restriction can limit the range of motion necessary for these specific sounds. The severity of functional impact varies greatly, and many children adapt to the restriction without long-term issues.
Diagnosis and Intervention Procedures
A comprehensive assessment is required when a restrictive frenulum is suspected of causing functional problems. Diagnosis is often made by a team that may include pediatricians, lactation consultants, and dentists. Assessment tools, such as the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), evaluate both the anatomical appearance and the functional movement of the tongue. A low score on this tool, combined with documented feeding problems, helps justify the need for intervention.
The most common procedure to treat symptomatic ankyloglossia is a frenotomy, a simple surgical release of the frenulum. In newborns, this procedure is quick, often performed in an office setting with minimal or no anesthesia, sometimes using oral sucrose for comfort. The frenulum is divided using sterile scissors or a laser. For more complex or older cases, a frenuloplasty may be performed, which is a more extensive surgical revision requiring sutures. Following the procedure, parents are encouraged to perform post-operative exercises to prevent the tissue from reattaching and maximize the newly gained tongue mobility.