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Tethered Oral Tissues

What are tethered oral tissues?

  • Every child has multiple oral connective tissue attachments called frenums or frenulums, but in some children a short/tight/thick attachment can limit function and mobility of the lip and/or tongue.

  • When function is impaired, the frenae are known as symptomatic oral restrictions or tethered oral tissues.

  • Oral restrictions are remnants of embryonic tissue that should have receded at the 12th week in utero.

    • Tongue-tie (ankyloglossia)= attachment at midline beneath tongue and floor of mouth is tight enough to restrict normal tongue movement

    • Lip-tie= attachment of lip inserting into gingiva is tight enough that upper lip cannot flange outward normally

What are the benefits of a frenectomy?

  • A frenectomy, or release of a lip-tie or tongue-tie, can significantly impact a child’s quality of life by improving breastfeeding, bottle-feeding, solid feeding, sleep, and speech. Release of tethered oral tissues can also optimize dental and orthodontic outcomes.

  • The laser frenectomy procedure is a gentle, quick, and straightforward outpatient procedure that can be completed during the same visit as the initial assessment when desired. 

  • There is minimal risk for a laser frenectomy procedure and significant potential benefits.

  • We want our children to thrive, not just survive. 

How is it determined if a child may benefit from a frenectomy?

  • Symptoms/function is more important than appearance when determining if treatment is needed.

  • Infant symptoms:

    • Shallow latch at breast or bottle

    • Falls asleep while eating

    • Slides or pops on and off the nipple

    • Gagging, choking, or coughing when eating

    • Poor or slow weight gain

    • Gumming or chewing the nipple when nursing

    • Pacifier falls out easily or won't stay in

    • Snoring, noisy breathing, mouth breathing

    • Lip curls under when nursing or taking the bottle

    • Clicking or smacking noises when eating

    • Sucking blisters or callouses on lips

    • Reflux symptoms

    • Gassiness

    • Milk leaks out of the mouth when nursing

    • Restless sleep, short sleeping and waking often

    • Baby frustrated at the breast or bottle

    • Baby seems always hungry and not full

  • Maternal symptoms:

    • Creased, flattened or blanched nipples​

    • Lipstick shaped nipples

    • Blistered, cut, or bleeding nipples

    • Painful latch

    • Poor or incomplete breast drainage

    • Plugged ducts/engorgement/mastitis

    • Using a nipple shield

  • Child symptoms:

    • Speech (ex: frustration with communication, difficult to understand, difficulty speaking quickly, speech delay, stuttering, speech harder to understand in long sentences, mumbling, difficulty with certain sounds)​

    • Feeding (ex: frustration when eating, difficulty transitioning to solid foods, slow eater, packing food in cheeks, picky with textures, choking or gagging on food, spitting out food, won't try new foods)​

    • Sleep (ex: sleeps in strange positions, sleeps restlessly, wakes easily of often, wets the bed, wakes up tired and not refreshed, grinds teeth while sleeping, sleeps with mouth open, snores, gasps for air (sleep apnea)

What healthcare professionals are involved in diagnosis and treatment?​

  • A frenectomy alone may not result in adequate resolution of symptoms. Pre-op and post-op therapy with appropriate therapists is necessary for optimal results. 

  • At Twelve Corners Orthodontics and Pediatric Dentistry our pediatric dentists work with a team of allied health care professionals including lactation consultants, feeding therapists, speech therapists, bodyworkers, and myofunctional therapists in order to ensure the best possible results for each child. We will let you know which of these services may be indicated for your child.

Contact our team

  • We are happy to answer any and all questions. Please call our office at 585-244-1177 or you can reach our clinical team directly at

Photo credit: Dr. Richard Baxter, Alabama Tongue-Tie Center

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