A lip tie and a tongue tie occur when the movement of the lip or tongue is restricted by a band of connecting tissue called a frenulum. When the lingual frenulum (connecting the tongue to the floor of the mouth) or the labial frenulum (connecting the lip to the gum) is unusually short, thick, or tight, it is considered restrictive. These restrictions interfere with the full range of oral motion, impacting functions like sucking, swallowing, and speaking. The visual appearance of these ties often provides the first indication that a functional issue may be present.
Visual Characteristics of a Tongue Tie
A tongue tie, medically termed ankyloglossia, is characterized by an abnormal lingual frenulum that tethers the tongue to the floor of the mouth. Visual inspection focuses on the thickness, elasticity, and specific attachment points of this tissue band. The frenulum may appear short, thick, or fibrous, limiting the tongue’s ability to move freely.
The location where the frenulum attaches to the tongue and the floor of the mouth is a key visual sign. In a restrictive case, the attachment may be close to the tip of the tongue, sometimes even on the apex itself. The attachment to the floor of the mouth can also be abnormal, extending forward toward the alveolar crest or gum line.
When an individual attempts to lift the tongue toward the roof of the mouth or protrude it, the physical restriction becomes apparent. A significant tie can prevent the tongue from extending more than a millimeter or two past the lower gum line or teeth. The restrictive band may also prevent the tongue from lifting adequately to touch the upper teeth or palate.
The tension created by the short or tight frenulum often results in a distinct appearance of the tongue’s tip when movement is attempted. Instead of a smooth, rounded shape, the tongue may develop a notched or heart-shaped appearance as the central portion is pulled down. This indicates the tissue is restricting the tongue’s ability to flatten or cup. When the tongue is stretched, the frenulum may visibly blanch or turn white due to pressure.
Visual Characteristics of a Lip Tie
A lip tie involves the labial frenulum, the tissue connecting the inside of the upper lip to the gum tissue above the front teeth. Assessment focuses on the frenulum’s thickness and how far down the gum line it extends. This tissue band may appear unusually thick, tight, or rigid, restricting the natural flanging or rolling outward motion of the upper lip.
To check for restriction, the upper lip is gently lifted to assess its mobility and the resulting tension. Normally, the lip should be able to move freely and fully evert, or roll out, without causing tension on the gum tissue. A restrictive tie will often limit this movement, causing the tissue to appear taut.
A significant visual sign is the presence of blanching in the gum tissue when the lip is lifted. Blanching means the gum tissue turns pale or white, indicating that the tight frenulum is pulling on the gum tissue. The frenulum’s attachment may extend low, sometimes right up to or between the upper front teeth.
This low attachment can sometimes create a noticeable gap, or diastema, between the upper central incisors. A tie is diagnosed when the tissue is so prominent or tight that it physically restricts the lip’s ability to move. The restriction can also make it difficult to clean the area adjacent to the front teeth, potentially contributing to later oral hygiene issues.
Functional Signs Suggesting a Tie
Beyond the visual appearance, a restrictive frenulum often presents with functional and behavioral signs, particularly in infants. These indicators frequently prompt a caregiver to seek an oral assessment. One of the most common signs is difficulty with feeding, where the infant struggles to maintain a deep, effective latch during breastfeeding or bottle-feeding.
The inability to maintain a proper seal can lead to audible clicking sounds during feeding as the baby loses suction. This poor latch results in the infant swallowing excessive air, which can manifest as gassiness, reflux symptoms, or frequent fussiness. Feeding sessions may become prolonged, yet the baby may tire quickly and fall asleep out of exhaustion.
A significant functional concern is the impact on the infant’s nutritional intake and growth. Despite frequent feedings, the baby may exhibit poor weight gain or failure to thrive, as they are unable to effectively transfer milk. For the breastfeeding parent, functional signs include significant pain, nipple damage, or cracked nipples due to the baby’s ineffective latch and compensatory chewing.
Maternal symptoms can also include complications such as recurrent blocked milk ducts, breast engorgement, or mastitis, related to the ineffective removal of milk. These functional issues suggest that an anatomical assessment of the lingual and labial frenula is necessary. Their presence is often the first and most noticeable consequence of a restrictive tie.