What is a tongue tie?
A tongue-tie, medically known as ankyloglossia, is a physical condition in which the tongue’s movement is restricted due to an attached lingual frenum that is too tight, thick or short. A frenum is a is a piece of connective tissue found between the tongue and the floor of the mouth. Everyone has a lingual frenum. However, in approximately 25% of the population, the frenum fails to shorten in utero and instead remains attached and restricted, which is known as a tongue-tie.
How to diagnose a tongue tie?
A tongue-tie diagnosis and treatment recommendation should be made based upon a true functional restriction. Rather than a tongue tie, we commonly refer to it as a “functional tongue restriction”, as simply seeing a frenum under the tongue does not necessarily mean it is restricting the tongue's range of motion. A comprehensive assessment is needed, including an evaluation of the anatomical presentation and associated symptoms.
There are three potential diagnoses when evaluating a tongue.
Normal frenum – This occurs when there are no symptoms and little to no restriction of tongue movement present. No treatment is indicated.
Asymptomatic tongue restriction – This diagnosis is given when a tongue appears restricted, but the patient is not having any symptoms. No treatment is indicated but it is recommended to monitor for symptoms.
Symptomatic tongue restriction (tongue-tie, ankyloglossia) – This occurs when both restriction and symptoms are present. A laser frenectomy treatment is recommended.
How are restrictions classified?
Release providers use several types of classification systems to effectively diagnose the severity and type of tongue-ties. Experts do not all agree on diagnostic criteria but many use two main methods of classifying – severity and location.
The primary classification system used to classify the severity of a tongue tie is Kotlow Classification, which classifies the restriction based on the amount of free tongue, which is defined as the length of the tongue from the insertion of the lingual frenum into the base of the tongue to the tip of the tongue. Clinically acceptable, normal range of free tongue is greater than 16mm. The Kotlow Classification is:
Class 1 (Mild tongue-tie): 12-16mm
Class 2 (Moderate tongue-tie): 8-12mm
Class 3 (Severe tongue-tie): 3-7mm
Class 4 (Complete tongue-tie): Less than 3mm
Another way we classify tongue-ties is by identifying the location of the tie:
Anterior tongue-tie: Visible and measurable, which allows for easier diagnosis. Anterior tongue ties would be all four classes mentioned above in the Kotlow Classification.
Posterior tongue-tie: Less visible and only diagnosed by touch, as it lies beneath the mucous membranes at the bottom of the mouth.
By better understanding the basics of a tongue tie, you are more equipped to identify and address potential issues related to your child’s oral development, as well as setting your little one up for an accurate diagnosis and effective treatment.
If your child is experiencing symptoms from a tongue tie, schedule a consultation with Dr. Allie at Arlington Tongue Tie Center.
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