Tongue-tie division: when it is needed in babies, children and adults

What is tongue-tie?

Tongue-tie (ankyloglossia) is a fold of tissue joining the tongue to the floor of the mouth that is shorter or tighter than usual and can restrict how the tongue moves. A Cochrane review states that it affects 4 to 11% of newborns; the figure depends on how, and by whom, the frenulum is assessed. A meta-analysis of 71 studies gives an average of 5%, 7% in infants, and from 2 to 20% depending on the diagnostic tool (Cruz et al., 2022).

The presence of a short frenulum alone does not mean there is a problem. NICE points out that many such frenula cause no symptoms and no difficulties, and the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), in a 2020 consensus statement, warns that ankyloglossia is diagnosed too often in babies and children, and that some children undergo unnecessary procedures.

The American Academy of Pediatric Dentistry (AAPD) shows the scale of the trend: between 1997 and 2012 the number of tongue-tie diagnoses rose by 834%. That is why the decision is based on function (feeding, speech, the health of the gum), not on the appearance of the frenulum alone.

Tongue-tie in a baby: which signs should you look out for?

In a baby, tongue-tie can make breastfeeding difficult. The UK’s National Health Service (NHS) lists signs that make it worth having feeding and tongue movement assessed.

• Difficulty latching on to the breast properly.
• Very long feeds.
• Choking or coughing during feeds and a lot of dribbling.
• Poor weight gain.
• A tongue that becomes heart-shaped when lifted.
• Sore nipples in the breastfeeding mother.

Does tongue-tie division help a baby feed? What the research says

Tongue-tie division (frenotomy) is a safe procedure, but the evidence that it improves feeding is limited. The UK’s NICE states that there are no major safety concerns and that limited evidence suggests an improvement in breastfeeding; the procedure should be carried out by an appropriately trained professional.

A 2017 Cochrane review (5 randomised trials, 302 infants) found that frenotomy reduced nipple pain in breastfeeding mothers in the short term, but did not bring a consistent improvement in the baby’s feeding itself. No serious complications were recorded, and the small number of studies and their methodological weaknesses limit how certain the conclusions can be.

Other position statements are also cautious. The American Academy of Pediatrics (AAP), in a 2024 report, writes that it is not clear whether releasing a tight frenulum in newborns improves breastfeeding, and the AAO-HNS points out that frenotomy is not always effective.

Upper lip tie: does it need to be released?

An upper lip frenulum in a baby is normal and is not in itself a reason for a procedure. According to the AAO-HNS consensus, its link with breastfeeding is unclear, upper lip tie is diagnosed too often, and releasing the frenulum while the baby teeth are in place will not prevent a gap between the front teeth (diastema).

The AAPD does not recommend surgical procedures on the upper lip frenulum before the permanent canines have erupted, and accepts them only after the gap has been closed orthodontically or in combination with orthodontic treatment; a procedure done too early may encourage the frenulum to return through scarring. The AAPD does not regard the appearance of the frenulum alone as an indication.

The timing of the procedure is not, however, settled uniformly: some authors accept it before, during or after closure of the gap, and there is no agreement on this among UK orthodontists. That is why, where there is a diastema, the decision is made together with an orthodontist, after the bite has been assessed.

The lower lip frenulum is a different matter. The AAPD accepts a procedure when the frenulum pulls on the gum margin, to prevent inflammation and recession; treatment of receding gums is described in the article on gum recession.

When does a frenulum matter in older children and adults?

In older children and adults, a frenulum is assessed mainly with regard to the gum and orthodontic treatment. The documented indications are a lip frenulum that pulls on the gum margin and encourages it to recede (recession), and the reopening of a closed gap between the front teeth during orthodontic treatment.

As for speech, the AAO-HNS consensus states that ankyloglossia does not usually affect speech. Indications related to a denture or to pronunciation in adults are described less often and are less well documented, so they need individual assessment, for example with the involvement of a speech and language therapist.

Polish authors described myofrenuloplasty in 6 adults in 2021: a procedure under local anaesthesia, with stitches, preceded by several months of exercises with a speech therapist and followed by tongue exercises and myofunctional therapy (Bargiel et al., 2021). The authors themselves call the work a preliminary report, so it describes a technique rather than proving effectiveness.

Division, frenuloplasty or myofrenuloplasty: how do the procedures differ?

The names of frenulum procedures are sometimes used interchangeably, but the extent of the work differs. The table sets out the terms you are most likely to come across.

In young babies, division is usually done without anaesthesia, with scissors, in about a minute, and the baby can be put to the breast straight after the procedure (NHS, Cleveland Clinic). Older children and adults need anaesthesia, local or general, and the type of procedure is matched to age and to how far movement is restricted.

How does healing go, and what complications are possible?

Complications after tongue-tie division in babies are rare; Cleveland Clinic lists bleeding, infection, scarring, reluctance to feed and damage to the salivary ducts or nerves. According to the same source, there is no evidence that stretching or massaging the wound after the procedure helps a baby heal.

After frenuloplasty with stitches in older children and adults, the clinician explains how to care for the wound and when to come back for a check. In the Polish series of myofrenuloplasties described above, tongue exercises began on the first day after the procedure and continued for 2 weeks, followed by ongoing myofunctional therapy.

If after the procedure bleeding does not stop despite pressure, the child stops feeding, or a fever or increasing swelling appears, contact the person who carried out the procedure, or a doctor, straight away.

How much does frenulum division and frenuloplasty cost?

The cost depends on which frenulum the procedure involves, its extent (a simple division or a frenuloplasty with stitches) and the type of anaesthesia. Where there is a diastema, orthodontic treatment is added, and the procedure is timed to fit with it.

In the clinic’s price list, tongue-tie division costs 450 zł, lip frenulum division 450 zł, and frenuloplasty of the upper lip, lower lip or tongue frenulum 400 zł. In the periodontology category, frenuloplasty of the frenula (upper lip, lower lip, cheek) costs 600 zł, and myofrenuloplasty of the tongue frenulum 1 000 zł. The final scope and cost are set at the consultation, and prices may change.

How it works at DentalBlue

At DentalBlue in Białystok, frenulum procedures appear in the price list under oral surgery and periodontology. Where the frenulum is linked to a gap between the teeth, the plan also includes orthodontics, which the clinic plans digitally on the basis of a cephalometric analysis from its own radiology unit. The indications for and scope of the procedure are decided at a consultation with an examination. A consultation can be booked by phone.