What Are the Specific Diagnostic Criteria for Tongue-Tie and Lip-Tie?

As parents, you might have heard about tongue-tie or lip-tie, especially if your little one has trouble breastfeeding or speaking clearly. But what exactly are tongue-tie and lip-tie, and how are they diagnosed? In this blog, our experienced Brisbane Paediatric Dentist will walk you through the specific signs, symptoms, and diagnostic criteria for tongue-tie and lip-tie, helping you understand when and why treatment might be necessary.

What Is Tongue-Tie?

Tongue-tie (or ankyloglossia) is a condition where the thin piece of tissue (lingual frenulum) under the tongue is too short, thick, or tight, which can restrict the tongue’s movement. This can make it harder for babies to breastfeed properly and may affect speech or oral development as they grow. If tongue-tie is causing feeding or speech issues, a simple procedure can often help improve tongue movement.

Specific Diagnostic Criteria for Tongue-Tie

Visual Inspection

One of the key ways our kids’ dentist diagnoses tongue-tie is by visually examining the tongue and how it’s attached to the floor of the mouth. Here’s what we look for:

Short, Thick, or Fibrotic Lingual Frenulum – We check for a lingual frenulum that is short, thick, or fibrous, which may restrict tongue movement.

Anterior Attachment – We look to see if the frenulum is attached near the tip of the tongue, as this can restrict how far the tongue can extend.

Heart-Shaped Tongue – When the tongue is lifted or stuck out, it may appear heart-shaped due to tension from the frenulum.

Notched Tongue Tip – A small cleft or notch at the tip of the tongue can indicate restricted tongue movement.

Tongue Mobility Assessment

Another key factor in diagnosing tongue-tie is evaluating how well the tongue moves. Our Dentist Brisbane will carefully assess different aspects of tongue movement, as any restriction may affect feeding, speech, and overall oral function.

• Restricted anterior and superior tongue movement – If the tongue struggles to lift or extend forward, it may indicate a problem with the frenulum.
• Limited tongue elevation and protrusion – We often see that restricted tongue elevation makes it difficult for babies to latch properly during breastfeeding.
• Side-to-side movement difficulty – Have you noticed your child having trouble moving their tongue from side to side? This could be linked to a tight frenulum.
• Assessment while crying or extending the tongue – Tongue movement is easier to evaluate when the baby is crying or attempting to extend their tongue.
• Muscle insertion and tongue mobility – The position of the frenulum attachment can influence how freely the tongue moves.

Free Tongue Length

Measuring the length of the tongue’s free movement is another important way to diagnose tongue-tie. We measure the distance from the tip of the tongue to where the frenulum attaches, as this helps determine the severity of the restriction.

• ≥16 mm: Normal – A free tongue length of 16 mm or more is considered normal, with no significant restriction.
• 12–16 mm: Mild ankyloglossia – When the free tongue length falls between 12 and 16 mm, it may cause slight difficulty with tongue movement but usually doesn’t require intervention.
• 8–11 mm: Moderate ankyloglossia – A free tongue length between 8 and 11 mm often limits tongue function, which may affect breastfeeding and speech development.
• 3–7 mm: Severe ankyloglossia – A tongue length of 3 to 7 mm typically causes significant restrictions, making feeding and speech more challenging.
• <3 mm: Complete ankyloglossia – When the free tongue length is less than 3 mm, tongue movement is severely limited, often requiring treatment.

Functional Impairment

Tongue-tie can lead to a range of functional issues that may affect feeding, speech, and overall oral development. Recognising these signs early can help address any challenges before they become more serious.

• Breastfeeding difficulties – Babies with tongue-tie may struggle to latch properly, which can lead to nipple pain for the mother and inadequate feeding for the baby.
• Speech issues – Difficulty pronouncing sounds like “t,” “d,” “l,” and “r” is common when tongue movement is restricted.
• Swallowing difficulties – A limited range of tongue motion can make it harder to swallow, especially when eating solid foods.
• Orofacial myofunctional problems – Tongue-tie can affect how the tongue rests in the mouth, potentially leading to issues with breathing, chewing, and overall facial muscle development.

Classification Systems & Assessment Tools

To accurately diagnose tongue-tie, dental professionals rely on specific classification systems and assessment tools. These methods help assess the severity of the condition and guide treatment decisions based on the degree of restriction and functional impact.

Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF)

The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) evaluates tongue-tie severity in newborns by scoring both tongue appearance (e.g., shape, elasticity) and function (e.g., lift, lateralisation) to assess its impact on breastfeeding. It provides a numerical score, with higher scores indicating better function and lower scores suggesting potential feeding difficulties that may require intervention.

Coryllos Classification

​The Coryllos Classification categorises tongue-tie based on the frenulum’s attachment point:​

• Type 1: The frenulum attaches at the tip of the tongue, significantly restricting movement.​
• Type 2: The attachment is 2–4 mm behind the tip of the tongue, causing moderate restriction.​
• Type 3: The frenulum attaches to the mid-tongue and the floor of the mouth, limiting movement.​
• Type 4: The frenulum is posterior or not visible, but tight fibres can be felt anchoring the tongue, severely restricting elevation and extension.

Tongue Range-of-Motion Ratio (TRMR)

The Tongue Range-of-Motion Ratio measures how well the tongue can lift and move relative to the mouth’s opening capacity. This is calculated by measuring the maximal interincisal mouth opening (MIO) and comparing it to the distance the tongue can lift to the roof of the mouth (MOTTIP). The ratio (TRMR) is determined by dividing MOTTIP by MIO and multiplying by 100, providing a clear indication of tongue mobility.

Clinical Assessment in Infants

When evaluating tongue-tie and lip-tie in infants, a detailed examination is essential to identify any functional limitations. Here’s how the assessment typically unfolds:

• Intraoral dental examination – A close look inside the baby’s mouth helps identify any tightness or unusual attachment of the frenulum that might restrict movement.
• Palpation of the frenulum – By gently feeling the tissue, the examiner can assess its thickness and tension, gaining insight into how it may affect tongue or lip function.
• Elasticity test by lifting the infant’s tongue – Lifting the tongue reveals how well it stretches and moves, highlighting any restrictions that could impact feeding or speech.
• Attachment to the floor of the mouth – Understanding where the frenulum connects helps determine the extent of movement limitations and whether intervention is needed.

What Is Lip-Tie?

Lip-tie is when the piece of tissue (labial frenulum) that connects the upper lip to the gum is too tight or thick, limiting the movement of the upper lip. This may make it difficult for babies to latch properly while breastfeeding, causing feeding issues and discomfort. If the lip-tie is severe, it may also affect speech development and oral hygiene as the child grows.

Specific Diagnostic Criteria for Lip-Tie

Visual Inspection

One of the key ways our kids’ dentists diagnose lip-tie is by visually examining the upper lip and the tissue (labial frenulum) that connects it to the gum. Here’s what we look for:

• Thick or Tight Upper Labial Frenulum – We check for a frenulum that is unusually thick or tight, as this can restrict lip movement and cause feeding difficulties.
• Attachment Near or Between the Upper Front Teeth – If the frenulum attaches too close to or between the front teeth, it may cause a gap (diastema) or interfere with proper tooth alignment.

Functional Impairment

Another important way our paediatric dentists diagnose lip-tie is by looking at how it affects everyday functions like feeding and oral health. When the upper lip’s movement is restricted, it can lead to several challenges, including:

• Breastfeeding Challenges – Babies with lip-tie may struggle to latch properly, leading to milk leakage and discomfort for both the baby and the mother.
• Difficulty Maintaining Suction – A tight frenulum can make it hard for the baby to create and maintain a proper seal while feeding.
• Lip Closure and Protrusion Issues – Restricted lip movement can prevent the lips from closing fully or flanging outwards during feeding.
• Oral Hygiene and Dental Problems – A tight frenulum can trap food and milk, increasing the risk of tooth decay and gum issues.

Classification System

Kotlow Classification of Upper Lip-Tie

To determine the severity of lip-tie, paediatric dentists use the Kotlow Classification system. This system helps identify how far the frenulum extends and how much it affects lip function.

• Class I – No significant attachment – The frenulum is thin and flexible, causing no functional issues.
• Class II – Attachment mostly into gingival tissue – The frenulum attaches to the gum, which may cause mild restrictions in lip movement.
• Class III – Attachment in front of the anterior papilla – The frenulum attaches closer to the teeth, which can interfere with proper feeding and may create a gap between the front teeth.
• Class IV – Attachment into the papilla or extending into the hard palate – The frenulum attaches deep into the gum or hard palate, causing significant lip restriction and feeding challenges.

How Are Tongue-Tie and Lip-Tie Treated?

When tongue-tie or lip-tie is affecting feeding, speech, or oral health, a simple procedure may be recommended to release the frenulum and restore proper function. Here’s a look at the two most common treatment options:

Frenotomy

A frenotomy is a quick and straightforward procedure used to treat mild to moderate cases of tongue-tie or lip-tie.

What It Is

A frenotomy involves making a small cut in the lingual or labial frenulum to release the tissue and improve movement.

How It Is Performed

• Performed using sterile scissors or a laser.
• The procedure takes only a few seconds.
• No anaesthesia is usually required for infants, but older children may receive a local anaesthetic.

What Cases It May Treat

• Mild to moderate tongue-tie or lip-tie affecting feeding or speech.
• Breastfeeding issues (poor latch, nipple pain).
• Speech articulation problems.

Suitable Age

It is most effective when performed in newborns or infants but can be done at any age if necessary.

Is It Painful?

• Minimal discomfort; babies may cry more from being held than from the actual procedure.
• If a laser is used, there is usually less bleeding and discomfort.

Recovery Period

• Quick recovery — babies can usually breastfeed immediately after the procedure.
• Mild swelling or discomfort may last for 24–48 hours.
• Stretching exercises may be recommended to prevent reattachment.

Frenectomy

A frenectomy is a more precise and involved procedure, typically used for more severe cases of tongue-tie or lip-tie.

What It Is

A frenectomy involves completely removing or reshaping the frenulum to provide more long-term relief.

How It Is Performed

• Performed with a scalpel, scissors, or a laser.
• Local anaesthesia is usually used for comfort.
• Stitches may be required if a significant amount of tissue is removed.

What Cases It May Treat

• Moderate to severe tongue-tie or lip-tie.
• Cases where a frenotomy was not successful, or tissue has reattached.
• Significant feeding issues or speech difficulties.

Suitable Age

It can be performed at any age but is more common in older infants, children, and adults when a frenotomy isn’t enough.

Is It Painful?

• Minimal discomfort with local anaesthesia.
• Laser procedures tend to cause less bleeding and discomfort.

Our Emergency Dentist Brisbane is always prepared to handle unexpected dental issues with a caring approach.

Recovery Period

• Recovery time is slightly longer than a frenotomy — around 3 to 7 days.
• Mild swelling and discomfort for a few days.
• Post-procedure stretching exercises are usually recommended to prevent tissue reattachment.

Can You Put My Child to Sleep for Tongue-Tie or Lip-Tie Release?

We offer sleep dentistry in Brisbane for tongue-tie and lip-tie release when it’s necessary or beneficial for your child’s comfort and safety. If your child is very young, extremely anxious, or has special needs, our experienced kids’ dentists may recommend using general anaesthesia to make the procedure stress-free and pain-free.

Sleep Dentistry allows your child to sleep comfortably while the procedure is performed, ensuring they remain still and calm throughout, according to Brisbane Dental Sleep Clinic. Our team will carefully assess your child’s medical history, age, and emotional needs to determine if sleep dentistry is the best option. Your child’s safety and comfort are always our top priority.

Ensure Optimal Oral Health for Your Child

Tongue-tie and lip-tie don’t have to stand in the way of your child’s comfort and development. Gentle, expert care can make feeding, speech, and oral function so much easier. Booking an appointment is simple — and to make things even easier, we offer flexible payment options through Humm and Supercare, so you can focus on what matters most. Call 07 3343 4869 today, and let’s take care of it together.