The lingual frenulum is the fold of tissue that connects the underside of the tongue to the floor of the mouth. It is considered short (ankyloglossia, or tongue-tie) when it restricts the tongue's movement. Not every tongue-tie needs surgery: it is only treated if it causes real problems with breastfeeding, speech or swallowing.
What Is the Lingual Frenulum
Everyone has a lingual frenulum. It is normal and helps to stabilise the tongue. The problem arises when it is too short, too thick or attached very close to the tip, so the tongue cannot lift or stick out normally.
Normal or Short Lingual Frenulum: How to Tell the Difference
One of the most widely used classifications (Kotlow) measures how much of the tongue is free in front of the frenulum:
| Type | Free tongue | Does it usually need treatment? |
|---|---|---|
| Normal | More than 16 mm | No |
| Mild (class I) | 12-16 mm | Rarely |
| Moderate (class II) | 8-11 mm | Depending on symptoms |
| Severe (class III) | 3-7 mm | Frequently |
| Complete (class IV) | Less than 3 mm | Yes, almost always |
A simple sign to check at home: if the tip of the tongue looks heart-shaped when it sticks out, or it can't get past the lip, it's worth having it checked by a professional.
At wiloo, we specialise in children's dental health. Find out how we work in paediatric dentistry and prevention.
Signs in Babies and Children
In babies:
- Difficulty latching on to the breast, or very long feeds.
- Clicking sounds while feeding and poor weight gain.
- Pain or cracked nipples for the mother.
In children:
- Difficulty pronouncing sounds such as R, L or the rolled RR.
- Being unable to lick their lips or touch the roof of the mouth with the tongue.
- Problems swallowing or chewing certain foods.
When Surgery Is Needed and What the Procedure Involves
The procedure is called a frenectomy (or frenotomy in babies) and involves releasing the frenulum. It is decided on when there are symptoms affecting feeding or speech, not just because of how it looks.
It is a short procedure carried out in the clinic under local anaesthetic. In older children it is usually assessed together with a speech therapist.
Recovery and Exercises
Recovery is usually quick, taking just a few days. Afterwards, it is important to do the tongue mobility exercises recommended, so that it does not heal again with limited mobility. In children, speech therapy helps correct sounds that had been learnt in a compensatory way.
Frequently Asked Questions
Who diagnoses tongue-tie?
It can be picked up by the paediatrician, the midwife, the paediatric dentist or the speech therapist. A functional assessment is what decides whether it needs treating.
Can the frenulum grow back?
It can heal again with limited mobility if the follow-up exercises are not done. That is why they matter so much.
At what age is it operated on?
In babies, if there are breastfeeding problems, it can be done in the first few weeks. In children, when the frenulum affects speech or swallowing.
Have questions about your child’s dental health?
Come and meet us at our clinics in Terrassa, Girona, Torrent and Vic. Your first visit is free.
