Tongue and Lip Ties

Tongue Tie and Lip Tie, The Great Debate

There has been an ongoing discussion in the medical field regarding tongue ties with respect to breastfeeding and speech issues for the last 30+ years. In general, a tongue tie can be defined as a thin fibrous tissue that connects the tongue to the base of the mouth. This can be in various degrees of severity defined as either minimal, moderate, or severe.

In the last few years, there are several clinicians including ENTs, pediatric dentists and pediatricians that have begun to describe something called a posterior tongue tie. To help distinguish the between the different types some have termed the traditional tongue tie as an “anterior tongue tie”. A “posterior tongue tie” is described as a fibrous band of tissue that is within the normal anatomically placed location of the mucosal membrane under the tongue.

There have developed two camps that promote different opinions, one camp declaring that the “anterior tongue tie” is the only tongue tie that exists, and another camp declaring that every anterior has a posterior tongue tie. With a varied opinions in between.

One thing that is not debated is that, yes, tongue ties can cause issues with breastfeeding but not every baby that struggles to breastfeed has a tongue tie. Again, the devil is in the details, the amount of babies in each group is hotly debated.

One of the main reasons for such discussion is the lack of defined objective data that can be used in controlled studies to determine the effect of a potential posterior tongue tie. Often it is left to clinical judgment which can be subjective. Contrary to an “anterior tongue tie” or traditional tongue tie that can be clearly observed and can be defined by how far out the membranous tissue extends on the tongue. Some traditional tongue ties extend to the very tip of the tongue and are classified as severe.

The treatment for each type of tongue tie is also different. In the anterior tongue tie a simple procedure with minimal side effects can be affected at the bedside or in an office where the thin membrane is cut with sterile scissors. Often with minimal bleeding or other side effects. With a posterior tongue tie the procedure is usually done with a more extensive surgery that cuts into the floor of the mouth. Because of the more intensive nature of the procedure for a posterior tongue tie the risk of scarring, oral aversion, infection, and bleeding is higher than a traditional tongue clipping.

As time goes on hopefully the data will become clearer and we can give a firmer recommendation. Currently, as the data stands, given the higher risk of side effects with a posterior tongue clipping, we would encourage you to exercise caution when perusing this treatment option and discuss with your provider if you are concerned or if you and your baby are struggling to breastfeed.

In regards to lip ties, the current data indicate that a lip tie is not a significant contributor to breastfeeding difficulties. Occasionally, as teeth come in, there can be problems with brushing that can lead to cavities or cosmetic issues. We would also recommend discussing this with your provider if you have concerns.