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Tethered oral tissues often called tongue-tie or lip-tie are conditions where a thin band of tissue restricts the movement of a baby’s tongue or lip. For parents, these words can sound scary, but tethered oral tissues are common and usually treatable. This guide explains what they are, how to spot them, why they matter, and what to expect from diagnosis and treatment. I’ll also include tips for finding care, including how to look for the best dentists in Gaithersburg MD who treat these issues.

What exactly are tethered oral tissues?

Inside the mouth are small folds of tissue that connect the tongue and lips to the floor of the mouth or gums. These folds are normal. A tethered oral tissue means that one of these folds is shorter, thicker, or tighter than usual. That can limit how the tongue or lip moves.

Common types:

• Tongue-tie (ankyloglossia): the tissue under the tongue (lingual frenulum) is short or tight and limits tongue movement.
• Lip-tie: the tissue that connects the upper lip to the gum (labial frenulum) is tight or attached low on the gum.
• Buccal ties: less common, these involve tissue connecting the cheeks.

Not every short or visible frenulum causes problems. The key question is whether it affects feeding, speech, dental health, or comfort.

How common are they?

Tethered oral tissues are fairly common. Estimates vary because definitions and diagnosis differ. Many newborns have a visible frenulum and only some will have symptoms that matter. The good news is most babies with tethered tissues do well after proper assessment and care.

Signs and symptoms parents should watch for

Tethered oral tissues show up differently depending on the child’s age and the severity of the tie.

In newborns and infants:

• Trouble latching during breastfeeding
• Painful or damaged nipples for the nursing parent
• Long, noisy, or inefficient feeding sessions
• Poor weight gain or slow weight gain
• Clicking sounds while nursing
• Gassiness and fussiness after feeds

In older babies and toddlers:

• Trouble sticking out the tongue or lifting it to the roof of the mouth
• Trouble forming a good seal around a bottle or sippy cup
• Difficulty transferring food across the mouth during solids
• Speech delays or difficulty with certain sounds, though ties are not the sole cause of speech problems

In children and adults:

• Gapped front teeth or dental spacing problems
• Food getting stuck between the lip and gums
• Trouble with oral hygiene
• Sleep or breathing issues in some cases, though links are complex

If you notice feeding trouble, slow weight gain, or persistent pain while nursing, it’s worth asking your pediatrician, lactation consultant, or a dentist about tethered tissues.

How are tethered oral tissues diagnosed?

Diagnosis usually begins with a careful history and physical exam. A lactation consultant, pediatrician, pediatric dentist, ENT specialist, or a trained family dentist can assess the mouth. They look at:

• The appearance of the frenulum
• How the tongue or lip moves
• How the baby feeds and gains weight
• Any pain the parent experiences while nursing

Some clinicians use standardized scoring systems to rate tongue function. Video of a feeding can be helpful. Imaging is rarely needed.

It’s important to get an evaluation from someone experienced in infant feeding. Many cases are straightforward, but assessment should consider the whole picture feeding mechanics, weight, and family concerns not just how the tissue looks.

Treatment options

Treatment depends on how much the tissue affects function. Options include:

1. Conservative care and support
   • Lactation consultant help with latch, positioning, and milk supply
   • Feeding therapy with a speech language pathologist for older infants
   • Time and monitoring, since some infants adapt and improve
2. Frenotomy or frenectomy
   • A simple procedure that releases the tight tissue
   • In infants, frenotomy is often quick and done in the office with minimal bleeding
   • For older children or more complex ties, a frenectomy using scissors, laser, or electrocautery may be performed under local or general anesthesia
3. Follow-up therapy
   • After release, therapy and stretching exercises may be recommended to promote full movement and prevent reattachment
   • Continued support from feeding specialists helps most babies adjust

Risks are low for simple releases, but all procedures have potential complications such as bleeding or infection. Discuss benefits and risks with your provider.

Will releasing the tie fix everything?

A tie release can improve tongue mobility and often makes breastfeeding easier and less painful. However, it is not a magic fix for every problem. Feeding difficulties can have many causes. If a child has other medical or oral issues, they may still need therapy even after a release.

Speech issues are complex. Releasing a tie may help certain sounds if the tie was a limiting factor, but many speech concerns require work with a speech therapist.

Questions to ask your provider

When you see a clinician about tethered oral tissues, consider asking:

• How is my baby’s latch and weight gain related to this tie?
• What are the benefits and risks of releasing the tissue now versus waiting?
• Who will perform the procedure and what experience do they have with infants?
• What follow-up care and therapy will we need?
• How likely is it that the tie will reattach?

Practical tips for parents right now

• If breastfeeding hurts, get help early from a lactation consultant. Small changes in latch can make a big difference.
• Track feeds and weight. Bring this information to appointments.
• Record a feeding video to show your provider. It helps with diagnosis.
• Ask about non-surgical support first if you prefer to try conservative care.
• If a release is recommended, make sure you understand follow-up exercises and therapy.

Final thoughts

Tethered oral tissues are a common cause of feeding and oral function problems, but they are treatable. Early assessment by a skilled team — including pediatricians, lactation consultants, and experienced dentists or ENTs — gives the best chance for a good outcome.