Tongue-Tie and Lip-Tie: How We Diagnose Them

A restricted tongue or lip might seem like a small issue, but it may quietly disrupt everything from feeding to speech. Diagnosing tongue-tie and lip-tie is crucial because these are more than just anatomical quirks—they may, in some cases, interfere with essential functions like breastfeeding, swallowing, and talking. The key to effective treatment starts with proper diagnosis. In this article, our kids dentist will show you how tongue-tie and lip-tie are usually identified, from visual clues to hands-on assessments and classification systems used by our professionals.

Diagnosing Tongue-Tie

Visual Clues

When diagnosing tongue-tie and lip-tie, our Brisbane Paediatric Dentist will carefully evaluate specific physical signs that may point to a restricted frenulum. Here’s what we assess during an examination:

• Thick frenulum – We check for a short, thick, or fibrous lingual frenulum that may restrict tongue movement.
• Tip attachment – We examine the attachment near the tongue tip to see if it creates a cleft or indentation.
• Notched tongue – A heart-shaped or notched appearance at the tongue tip, when extended, can indicate a restriction.
• Blanching – We observe for visible tension or blanching at the frenulum when the tongue is lifted.

Mobility Checks (Functional Movement)

Beyond appearance, how the tongue moves can reveal important clues about tongue-tie. Evaluating tongue mobility helps us determine how much the restriction affects function. Here’s how our Dentists Brisbane assess tongue movement:

• Extension – We check how far the tongue can extend outward without strain or discomfort.
• Elevation – Our dentists evaluate how high the tongue can lift toward the roof of the mouth.
• Lateral movement – We assess the tongue’s ability to move side to side smoothly and without restriction.
• Cry response – Our kids dentists observe whether the tongue lifts or curls downward when the baby cries, which can indicate a functional limitation.

Functional Concerns

Restricted tongue or lip movement doesn’t just affect how things look — it can also create real challenges with feeding, speech, and overall oral function. Here’s how our dentists assess functional issues related to tongue-tie and lip-tie:

• Breastfeeding issues – We evaluate for problems with latching, gasping for air, or early fatigue while feeding, which may indicate a restricted tongue or lip.
• Speech difficulties – We assess for trouble with articulation, especially with sounds like “t,” “d,” “l,” “r,” and “th,” which may suggest limited tongue mobility.
• Swallowing problems – Our professionals check for difficulty swallowing or trouble clearing food from the mouth, which may point to a functional restriction.
• Resting position – Dentists observe the tongue’s position at rest to see if poor placement is affecting jaw development or overall oral posture.

Practical Assessment (Hands-On)

A thorough diagnosis of tongue-tie often requires a hands-on evaluation. Our paediatric dentists assess the tongue’s structure and movement to identify any restrictions. Here’s how our professionals diagnose tongue-tie through practical examination:

• Tightness or restriction – Dentists gently lift the tongue to feel for tightness or any restricted movement.
• Blanching or tension – Our professionals check for blanching or visible tension at the frenulum when the tongue is lifted.
• Attachment site – Our dentists note whether the frenulum attaches near the tongue tip or deeper in the mouth, which can affect mobility.
• Elasticity and thickness – We test the tongue’s elasticity and the thickness of the frenulum to determine the level of restriction.

Classification Systems

To ensure a precise diagnosis, we use established classification systems to assess the severity and type of tongue-tie. These tools help us evaluate both the structure and function of the tongue and frenulum. Here’s how our professionals classify tongue-tie:

Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF)

We use this tool to rate both the appearance and function of the frenulum in newborns.

Coryllos Classification

Our professionals classify tongue-tie based on the location of the frenulum attachment:

• Type I – Attachment near the tongue tip.
• Type II – Attachment slightly behind the tip.
• Type III – Attachment to the middle of the tongue.
• Type IV – Submucosal or hidden attachment.

Tongue Range-of-Motion Ratio (TRMR)

Our dentists will also measure the maximum mouth opening compared to tongue elevation. A low ratio suggests restricted tongue movement.

Diagnosing Lip-Tie (Maxillary Midline Frenum)

Visual Clues

When diagnosing lip-tie, our dentists evaluate the upper lip and frenulum for physical signs that may indicate a restriction. Here’s how our professionals identify lip-tie during an examination:

• Thick frenulum – We assess whether the upper labial frenulum is thick or tight, which may restrict the natural movement of the lip.
• Gum attachment – We check if the frenulum extends into the gum tissue or even the palate, which may limit lip flexibility and cause discomfort.
• Gap between teeth – Our dentists look for a visible gap (diastema) between the upper front teeth, which may be a sign of a tight or short frenulum.

Functional Concerns

Lip-tie may create some challenges with feeding, speech, and overall oral function in some children. Here’s what is typically evaluated during a professional assessment:

• Breastfeeding issues – We assess for poor latch or a shallow latch, which may indicate limited lip movement.
• Flanging difficulty – Trouble curling the upper lip while feeding is a common sign of lip-tie.
• Speech challenges – Our dentists evaluate for difficulty with articulation or forming rounded sounds due to restricted lip movement.
• Lip closure problems – Incomplete lip closure may affect swallowing and resting posture.

Kotlow Classification

To accurately diagnose the severity of lip-tie, the Kotlow Classification system can be used. This system helps determine how the attachment impacts function and guides treatment decisions:

• Class I – Minimal attachment that typically doesn’t cause significant functional issues.
• Class II – Mild attachment with some degree of functional limitation.
• Class III – Moderate restrictions that may lead to challenges with feeding or speech.
• Class IV – Severe attachment extending deep into the palate, often requiring intervention.

The Best Treatment Option after Diagnosing Tongue-Tie and Lip-Tie

After diagnosing tongue-tie or lip-tie, the next step is to decide on the most effective treatment based on the severity and functional impact. The goal is to restore proper tongue and lip movement while improving feeding, speech, and overall comfort. Here are the most common treatment options:

• Frenotomy – A quick and straightforward procedure where the frenulum is clipped using sterile scissors or a laser to release the restriction. Healing is usually fast with minimal discomfort.
• Frenectomy – A more involved procedure to remove the frenulum when the restriction is deeper or more severe. This may require sutures and a slightly longer healing period.
• Aftercare and Therapy – Post-procedure care may include stretching exercises, feeding therapy, or speech therapy to support proper healing and prevent reattachment.
• Collaborative Care – Depending on the case, a referral to a lactation consultant or speech therapist may help address any lingering functional issues.

Frequently Asked Questions

Helping Little Mouths Move Freely

Tongue-tie and lip-tie may make feeding and speaking harder than it should be — but it doesn’t have to stay that way. At Pure Dentistry, our paediatric dentists provide expert, gentle care to restore natural movement and comfort.

Is your kid scared of the dentist? We’ve got you covered! According to Brisbane Dental Sleep Clinic, Sleep Dentistry Brisbane can offer a tranquil and anxiety-free dental care experience.

Flexible payment options through Humm and Supercare make it easier to get started. Call 07 3343 4869 to book an appointment today.