Hey everyone, Dr. Boom here with Rising Stars Pediatric Dentistry & Orthodontics in Irving, TX. Today, let’s dive into a topic we get a lot of questions about: tongue ties. What are they? How do they affect your child? And when should we actually do something about them?
Let’s break it down in simple terms.
What Is a Tongue Tie?
A tongue tie is when the tongue is tightly tethered to the floor of the mouth. That tight tissue underneath the tongue is called a frenum (or sometimes “frenulum”). While many people assume tongue ties just mean you can’t stick your tongue out very far, it’s a bit more nuanced than that.
In the dental world, we often refer to these conditions more broadly as tethered oral tissues or tethered oral ties, because this tight tissue can also exist in the upper lip, cheeks, or even lower lip.
Everyone has these frenum tissues—they help anchor and support the soft tissues in your mouth. But when they’re too tight or restrictive, they can interfere with key functions like feeding, speaking, breathing, and even oral development.
In fact, the restriction caused by a tongue tie can lead to compensatory habits. For example, a child who can’t use their tongue properly may start relying on other muscles (like those in the cheeks or lips) to chew or speak, which can lead to muscle fatigue and even jaw discomfort.
Types of Tethered Oral Ties
There are three main types of frenum that can cause issues:
- Lingual Frenum (under the tongue): Restricts tongue movement, often affecting feeding and speech.
- Labial Frenum (inside the upper or lower lip): Can impact feeding, cause a gap between the front teeth, and even contribute to decay by trapping food or interfering with brushing.
- Buccal Frenum (connecting the cheeks to the gums): Less common, but when overly tight, it can pull on the gums and contribute to recession.
All of these can be overly restrictive and impact function. When that happens, we refer to it as a tethered oral tie.
Signs That a Tongue Tie May Be Causing Issues
We don’t treat tongue ties just because they look tight—we treat them when they cause functional problems. It’s all about symptoms over appearance.
Here are some common symptoms we see:
In Infants
- Difficulty latching to the breast or bottle
- Shallow latch or sliding off during feeding
- Hiccups or clicking sounds while feeding
- Falling asleep mid-feed due to inefficient nursing
- Excessive gas, colic, or reflux-like symptoms
- Milk leaking out of the sides of the mouth
- Poor weight gain or failure to thrive
- Frustration during feeds, including arching of the back or crying
- Upper lip tucking in or curling under during feeding
These feeding struggles often cause frustration for both baby and parents. Sometimes, infants with a tongue or lip tie may nurse for a long time but still be hungry shortly after, simply because they can’t get a full feed.
It’s also worth noting that these symptoms can lead to early weaning or difficulty maintaining a breastfeeding relationship, which can be an emotional and physical challenge for mothers.
In Older Children
- Speech delays or difficulty forming certain sounds (like “L,” “R,” “S,” or “T”)
- Challenges with fast or clear speech (especially in conversations or storytelling)
- Trouble swallowing properly or chewing certain foods
- Picky eating due to difficulty moving food in the mouth
- Chronic mouth breathing or snoring
- Difficulty licking an ice cream cone or playing wind instrument
- Persistent dental issues due to improper tongue posture or oral habits
Every child is different, but these symptoms are red flags that there may be a tethered oral tissue affecting how their mouth functions and develops.
How We Diagnose Tongue Ties
Diagnosis isn’t just about anatomy—it’s about function. At Rising Stars Pediatric Dentistry & Orthodontics, we take time to listen to your concerns, assess feeding or speech history, and perform a gentle but thorough exam.
Our evaluation includes:
- Visual examination of the frenum tissue
- Observation of tongue/lip function
- Review of medical, feeding, and speech history
- Breastfeeding assessment (if applicable)
We may also coordinate with other professionals such as:
- Lactation consultants to address latch issues and feeding mechanics
- Speech-language pathologists to support articulation or oral motor concerns
- Myofunctional therapists to retrain muscles and support healthy oral habits post-release
This collaborative approach ensures that we’re not just treating what we see, but helping your child thrive based on their unique needs.
When Should We Treat a Tongue Tie?
Here’s the key: we only treat when symptoms are present.
If a child has tight tissue but is eating well, speaking clearly, breathing normally, and has no symptoms? We likely don’t need to do anything.
But if that tight tissue is causing:
- Poor latch or painful breastfeeding
- Slow weight gain
- Speech articulation issues
- Sleep disturbances or snoring
- Difficulty with oral hygiene or jaw development
…that’s when treatment becomes important. Our goal is to improve function and comfort — not just change appearance.
What Is a Frenectomy?
To release a tongue tie (or any tethered oral tissue), we perform a procedure called a frenectomy.
A frenectomy involves removing or reducing the tight frenum that’s restricting movement. This allows better mobility of the tongue or lip, which can greatly improve feeding, speech, and comfort.
You may also hear the term frenotomy used. Here’s the difference:
- Frenotomy: A partial cut or release of the tissue
- Frenectomy: A more complete removal of the restrictive tissue
What to Expect During a Frenectomy
We use gentle techniques, age-appropriate comfort strategies, and plenty of patience. Whether your child is a newborn or school-aged, we take every step to ensure they feel safe and supported throughout the procedure.
Depending on the age and case, treatment may include:
- Topical or local anesthetic (and infant-safe numbing techniques)
- Swaddling and comforting positions for babies
- Distraction tools or screens for older children
- Use of a laser for a quick, clean release
We’ll walk you through the entire process ahead of time, and provide all the aftercare guidance you need—including stretches, feeding support, and follow-up therapy if needed.
Post-Procedure Healing & Aftercare
Healing from a frenectomy is typically quick, especially in infants. However, active aftercare is crucial to prevent reattachment and ensure optimal outcomes.
We’ll teach you how to:
- Perform simple stretches to maintain mobility
- Support new feeding techniques
- Encourage natural oral movements as healing occurs
You’re never left to figure it out alone—we offer step-by-step guidance, check-ins, and referrals to therapists when appropriate.
Why Early Intervention Matters
When tethered oral tissues are left untreated, they can cause long-term issues including:
- Speech impediments
- Improper jaw and airway development
- Dental crowding and orthodontic complications
- Mouth breathing and related health concerns
The sooner we identify and treat a problem, the easier it is to correct it—and the sooner your child can thrive. Addressing these ties early can also reduce or eliminate the need for more invasive interventions down the road.
Every Child Is Unique
At Rising Stars Pediatric Dentistry & Orthodontics in Irving, TX, we don’t believe in one-size-fits-all care. Every child’s anatomy, symptoms, and goals are different. That’s why we look at the whole picture before recommending any treatment.
If you suspect your child has a tongue tie, lip tie, or any other concern related to tethered oral tissues, let’s talk. We’re here to answer your questions, evaluate gently, and guide you toward the right next step—even if that step is to wait and watch.
Because every kid deserves a smile that works just as well as it shines—and a team that treats them like family every step of the way.