Tongue/Lip Ties
After the birth of her first child, Dr. Rebecca Pikos personally experienced the challenges of breastfeeding caused by her daughter’s tongue tie. After countless lactation appointments, poor weight gain, irritability, and weeks of agony, a lingual frenectomy (tongue tie release) procedure was suggested by her lactation consultant. This procedure truly saved her breastfeeding journey, and Dr. Rebecca Pikos became committed to educating herself to help other mothers and babies in need.
It’s a known fact that Dr. Rebecca Pikos loves learning, and she didn’t even wait for maternity leave to end before she dove headfirst into continuing education regarding tongue ties during naptimes! After learning about tongue and lip ties in infants, her knowledge expanded into children, adolescents, and teens.
Lip Tie vs. Tongue Tie
What is a tongue tie? The lingual frenum (aka lingual frenulum) is a piece of soft tissue that attaches the tongue to the floor of the mouth. A tongue tie occurs when the frenum is too short or too tight and functional symptoms result. A diagnosis is based on function, not appearance alone.
What is a lip tie? The maxillary labial frenum (aka labial frenulum) is a piece of soft tissue that attaches the upper lip to the upper gums. A lip tie occurs when the frenum inserts too far on the gum tissue and the lip cannot move freely. Lip ties commonly occur with tongue ties, and both may require treatment.
Why does this occur?
There are genetic factors involved, and tongue/lip ties often run in families. Releasing tight lingual or labial frena is not a fad. It’s debated whether the increase in treatment is due to growing awareness or a true rise in ankyloglossia (tongue tie). As breastfeeding rates increase in the U.S., more mothers and babies encounter difficulties related to tongue or lip ties. There may also be an association between folic acid and thicker midline structures (like frena), as folic acid supports midline development (brain, spine, heart).
Tongue Tie Symptoms
Breastfeeding mother’s symptoms:
- Shallow and/or painful latch
- Difficulty maintaining latch
- Mastitis, clogs or incomplete emptying of breast
- Nipple pain and/or changes in nipple shape
- Prolonged nursing sessions
Infant symptoms:
- Slow or poor weight gain
- Clicking, clucking, or smacking at breast or bottle
- Irritability
- Frequent nighttime waking to eat
- Gassiness, reflux, constipation
- Nasal congestion, noisy breathing
- Frequent hiccups
Child symptoms:
- Snoring
- Mouth breathing
- Speech delay
- Trouble with sounds or mumbling
- Slow eater
- Picky eater
- Restless sleeper
Adolescent/adult symptoms:
- Headaches
- Neck/shoulder tension
- TMJ pain
Lip Tie Symptoms
- Lip curls under when nursing or bottle feeding
- Milk dribbling out of mouth due to poor anterior seal
- Difficulty brushing front teeth
- Distress when lifting upper lip
- Diastema (space) between front teeth
My Child Has a Lip or Tongue Tie — What’s Next?
Frenectomy: A frenectomy is the release or removal of the tongue or lip tie. Simply put, it’s a tongue or lip tie release. A frenectomy is a low-risk intervention with the potential for significant benefits at all ages.
Frenuloplasty: A frenuloplasty is a rearrangement of tissues under the tongue. It involves releasing the tongue in a horizontal plane and placing sutures in a vertical plane. This may be indicated for older children, adolescents, and adults.
FAQs
How is it done?
We begin with an age-appropriate questionnaire and a thorough extraoral/intraoral exam to evaluate frenum appearance, insertion point, range of motion, palate shape, and function. If a functional deficit is present and release is recommended, we review the treatment plan and obtain consent. A topical or local numbing agent is applied and a CO2 laser is used for a precise release—typically under one minute of laser time, with minimal bleeding or discomfort. For older children, adolescents, or adults, laughing gas and additional anesthesia may be used; sedation is rarely required due to the quick nature of the procedure.
What are the risks?
Medical risks are low and may include temporary discomfort and minor bleeding. While most patients experience improvement or full resolution, outcomes can vary and some may see less improvement than hoped.
How fast can I expect results?
With breastfeeding, about half notice immediate improvement. Others may have a brief nursing disruption for 1–2 days—this is temporary as baby relearns suckling and swallowing with support from a lactation consultant. For children, some improvements are immediate but not always typical. Success often requires a team approach (speech/feeding/myofunctional therapy and/or bodywork such as chiropractic, PT, OT) to help unlearn compensations developed over time.
