Patient's Guide to Tongue Ties
We have recently had an unusually high number of people in our practice asking questions about tongue ties. This article aims to provide information so that patients and parents can better discuss this topic with their doctors.
Who are the experts when it comes to tongue ties?
As of 2023, perhaps the most authoritative article on tongue ties is the Clinical Consensus Statement: Ankyloglossia in Children, published by the American Association of Otolaryngology in 2020. Otolaryngologists (ENTs) are the experts in this field, and this paper represents their current "standard of care" for diagnosing and treating these problems.
What is the lingual frenulum?
The lingual frenulum is a normal structure found in 99.5% of infants at birth. It is the curtain of tissue that extends from the floor of the mouth to the bottom of the tongue when the tongue is lifted. The lingual frenulum is not a separate midline structure but rather a dynamic elevation of a fold in the normal tissues of the floor of the mouth (the oral mucosa and underlying fascia) that becomes visible as the tongue is lifted, placing this tissue under tension. The lingual frenulum is NOT a “tongue tie,” and its presence is not pathological.
What is a tongue tie (ankyloglossia)?
A tongue tie, formally known as ankyloglossia, is a condition of limited tongue mobility caused by a restrictive lingual frenulum. A diagnosis of ankyloglossia is not purely anatomical or appearance-based; limited tongue mobility must also be present. Anatomical dissection has found no cord, string, or submucosal band of connective tissue responsible for ankyloglossia. The Consensus statement does not support the concept of a "posterior tongue tie."
Is the attachment location alone responsible for ankyloglossia?
The most popular grading systems used by dentists in diagnosing ankyloglossia (Kotlow and Coryllos) describe the location of the attachment of the lingual frenulum on the underside of the tongue as a critical diagnostic feature. However, the point of attachment alone is insufficient to diagnose or define the severity of ankyloglossia, as there is a wide range of variability in patients with normal tongue mobility. Conversely, limited tongue mobility can also be present in patients with "normal" attachment locations.
What factors besides attachment location affect ankyloglossia?
While the location of attachment of the lingual frenulum is one factor affecting tongue mobility, others must be considered for an accurate diagnosis. These include tissue thickness and elasticity, muscle tone, and neuromuscular function.
What is the prevalence of ankyloglossia?
The prevalence of ankyloglossia in the general population is reported to be between 2.8% and 10.7%. It was the opinion of the specialists in the Consensus statement that frenotomies are now recommended more often because of the recent emphasis on the benefits of breastfeeding, more information on the Internet, and an increase in the number of doctors, particularly dentists, offering these procedures.
Key points about tongue ties from the Consensus Statement
According to the Consensus Statement from the American Association of Otolaryngologists: 1) The lingual frenulum is a normal structure, 2) The size, shape, and attachment of normal frenula vary between patients, 3) A tongue tie is a condition of limited tongue mobility caused by a restrictive lingual frenulum, 4) Tongue ties exist in only 3% to 11% of patients, and 5) Not all tongue ties require surgery.
(NOTE: This is the first of two articles on tongue ties and tongue release surgery. Click HERE for the second half)
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho and Albuquerque, New Mexico. He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen's 30+ years of specialty practice and 10,000+ finished cases qualify him as an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. The opinions expressed here are protected by copyright laws and can only be used with the author's written permission.
