What is tongue-tie?

Tongue-tie is when a baby’s tongue can’t move as well as it should because a fold of tissue connects the bottom of their tongue to the floor of their mouth. This fold of tissue, called the lingual frenulum, is present in all children and usually harmless. But sometimes, a lingual frenulum that’s too tight or short can restrict the movement and function of a baby’s tongue. When this happens, healthcare providers diagnose a baby with ankyloglossia, more commonly known as tongue-tie.

Tongue-tie can sometimes pose challenges for breastfeeding. Babies with tongue-tie may have trouble latching on or removing milk. This can prevent them from getting enough nutrition. Latching difficulties can also cause pain or discomfort for you as you breastfeed, and you may feel you need to stop breastfeeding.

If this sounds familiar, don’t give up. Often, lactation consultants can help you adjust your breastfeeding position or your baby’s latch to overcome these challenges. If these methods aren’t enough, your baby may need a safe and quick procedure called a frenotomy. This involves clipping the lingual frenulum so your baby’s tongue can move freely.

Your lactation consultant and pediatrician will work with you to find the best solution so both you and your baby can feel better.

How common is tongue-tie?

Anywhere from 1% to 11% of newborns have signs of ankyloglossia, according to the American Academy of Pediatrics. The condition appears to be more common in boys.

What are the symptoms of tongue-tie?

Ankyloglossia symptoms in newborns include:

• Difficulty latching onto the breast at all or deeply. This might mean your baby doesn’t latch on or cries when trying to latch, makes clicking sounds or pops off the breast.
• Difficulty transferring milk when breastfeeding. This might mean your baby has poor weight gain, frequent feedings and/or a lack of swallow sounds.

If you’re breastfeeding, you may also have symptoms related to your baby’s tongue-tie, including:

• Cracked, sore nipples.
• Pain during nursing.
• Insufficient milk supply (if there are long-term transfer issues).

Keep in mind that these symptoms are what healthcare providers call nonspecific. That means they’re not unique to tongue-tie, specifically, and could occur for many other reasons. That’s why it’s important to see a healthcare provider with experience in managing breastfeeding issues. They’ll help identify the cause of your symptoms (whether it’s tongue-tie or something else) and find a solution.

What does tongue-tie look like?

Your baby’s tongue may appear to be heart-shaped or may have a notch in it. That’s because the lingual frenulum connects near the tip of their tongue and restricts its movement. In some cases, tongue-tie is barely noticeable. Healthcare providers look for signs of tongue-tie during a physical exam soon after birth.

What causes ankyloglossia?

Tongue-tie is congenital, which means your baby is born with it. Researchers aren’t exactly sure why some babies are born with tongue-tie, but there may be a genetic component. Some research suggests tongue-tie may be passed down within families, possibly in an X-linked pattern of inheritance.

How is ankyloglossia diagnosed?

Pediatricians typically diagnose tongue-tie soon after a baby is born. They work with lactation consultants, who can identify whether variations in a baby’s tongue anatomy may cause breastfeeding difficulties.

Just because a baby has a frenulum that’s tighter or shorter than usual doesn’t mean they have tongue-tie or need treatment. Healthcare providers only diagnose this condition in babies who have a restrictive lingual frenulum and limited tongue function.

To determine if your baby has tongue-tie, your providers will:

• Ask about your breastfeeding history. This includes any breastfeeding experiences with other children. If your baby has tongue-tie, you might notice that the latch feels different compared with other babies you’ve breastfed. Your providers will also ask how often you breastfeed, how long each session lasts and whether you pump and/or supplement with formula.
• Ask how you feel when breastfeeding. If breastfeeding is often uncomfortable for you, your providers need to know. This doesn’t necessarily mean your baby has tongue-tie. There are many causes of painful or difficult breastfeeding. But any discomfort you feel is one clue that can help them understand what’s going on.
• Review your baby’s medical history. Many different factors can affect your baby’s ability to breastfeed. These include neurological disorders, heart conditions and blockages in their nose or airways. Treating tongue-tie won’t help your baby with breastfeeding if other factors are also contributing to the difficulty.
• Give your baby a physical exam. As part of this exam, a pediatrician will closely examine your baby’s tongue and all areas of their mouth. They’ll look for signs of tongue-tie or other medical conditions.
• Directly observe breastfeeding. A lactation consultant will observe you and your baby during a breastfeeding session. They’ll look at your breastfeeding position (how you hold your baby during nursing) and how your baby latches on. In some cases, adjustments to positioning and latching can clear up the difficulties, even in babies with tongue-tie.

What tests will be done to diagnose tongue-tie?

Your baby doesn’t need any tests. Some healthcare providers use different grading systems or assessment tools that evaluate how well a baby’s tongue moves in their mouth. But they get the information they need just by looking at your baby’s tongue and feeling the lingual frenulum.

These grading systems help providers describe how a baby’s tongue looks and functions. This information can help providers reach a diagnosis.

What is the treatment for tongue-tie?

Healthcare providers manage tongue-tie by:

• Helping you with breastfeeding position and latch. This can help many tongue-tied babies breastfeed comfortably and successfully. Your lactation consultant will support you each step of the way and follow up with you to assess your progress.
• Doing a quick, in-office procedure (in some cases). This involves clipping the lingual frenulum under your baby’s tongue to help their tongue move more freely.

Does my baby need tongue-tie surgery?

Many babies with tongue-tie don’t need surgery. And if your baby does need treatment, you can rest assured it’s not major surgery. In fact, healthcare providers can often clip a baby’s lingual frenulum in a quick in-office procedure called a frenotomy.

Often, babies with tongue-tie don’t need this procedure at all. Providers only suggest a frenotomy if changes to your breastfeeding position and your baby’s latch don’t resolve the symptoms.

This safe procedure is the gold standard for treating infants with tongue-tie. Before doing a frenotomy, healthcare providers rule out or treat other causes of breastfeeding difficulty. When a frenotomy is necessary, it’s typically best when done within the first month of a baby’s life. This allows your baby to establish effective breastfeeding habits early on.

What are the disadvantages of clipping tongue-tie?

A frenotomy is generally a safe procedure and has a low risk of complications. Rarely, babies experience:

• Bleeding.
• Infection.
• Scarring.
• Feeding aversion.
• Injury to the saliva ducts in their mouth.

What can I expect if I have a tongue-tied baby?

Tongue-tie isn’t usually a cause for worry. It’s common and often manageable without doing a procedure. The key is seeking help early. Don’t wait or think the situation will get better if you just try harder. Breastfeeding difficulties aren’t your fault, and they’re very common. Even experienced mothers sometimes need expert advice to solve issues that come up.

Does tongue-tie affect bottle feeding?

Tongue-tie rarely poses problems with bottle feeding. Your baby’s tongue works differently when feeding from a bottle compared with feeding from a breast. If needed, a lactation consultant can modify the bottle’s nipple or flow to help with any issues that arise. If your baby continues struggling with bottle feeding, there may be other factors at work. Your lactation consultant and pediatrician will work together to find the cause.

Can tongue-tie be prevented?

There’s no known way to prevent tongue-tie. For more severe cases, early diagnosis and treatment can prevent issues with breastfeeding.

When should I see my healthcare provider?

If your baby has trouble with nursing, reach out to a healthcare provider. Whether or not tongue-tie is the cause, a lactation consultant can work with your pediatrician to give you the support you need.

Does tongue-tie cause sleep apnea?

There’s currently no evidence that tongue-tie causes sleep apnea in children, according to a clinical consensus statement published in 2020.

Does tongue-tie affect speech?

Experts agree that tongue-tie usually doesn’t affect a child’s speech. So, there’s no need for a baby to have a frenotomy in an attempt to prevent future speech disorders.

What is posterior tongue-tie?

The term posterior tongue-tie refers to a portion of the lingual frenulum that extends more into the substance of a baby’s tongue in the floor of the mouth, as opposed to closer to the tip. However, this is a controversial term. Some healthcare providers have suggested it’s anatomically inaccurate and recommend getting rid of it. They prefer just using the term tongue-tie regardless of the exact location of the lingual frenulum.

What is a lip tie?

A lip tie typically refers to the band of tissue that connects your baby’s upper gum with their upper lip. This band of tissue, called the maxillary labial frenulum, has many normal variations. Just because it connects farther down on your baby’s gumline or seems more prominent doesn’t mean it’s going to cause problems.

Still, lip tie is a controversial topic among healthcare providers. Some believe that a lip tie can cause breastfeeding issues or later dental issues. Others believe there’s not enough evidence to prove these connections.

When it comes to breastfeeding, the latest research shows procedures to treat lip tie aren’t necessary. There’s simply not enough evidence to show that releasing a lip tie improves milk transfer or eases nipple pain. However, if you’re concerned about your baby’s latch, talk to a lactation consultant.

Is there tongue-tie in adults?

Tongue-tie can affect some adults, but it’s usually diagnosed and treated in babies. The lingual frenulum (below the tongue) is just one example of a fold or band of tissue inside your mouth. Other tissues, like the buccal (cheek) frenula, provide support in other areas of your mouth. Depending on their size or location, they can make it hard to clean your teeth or gums fully. Your dentist can evaluate all the structures inside your mouth and let you know if there are any concerns.

What is a toothache?

A toothache refers to pain in or around your tooth. Minor toothaches can occur from a temporary gum irritation that you can treat at home. More severe toothaches result from cavities, infection or other dental conditions that won’t get better on their own. If you have a severe toothache, you’ll need professional dental treatment.

Unbearable tooth pain along with fever and chills means you’re having a dental emergency. Call a dentist or go to your nearest emergency room right away. Though it’s rare, infection in your mouth can spread to other areas of your body, including your brain and bloodstream.

Types of toothaches

There are different types of tooth pain depending on the underlying cause. Specific toothache symptoms can vary but may include:

• A dull ache that doesn’t go away.
• Sharp, jabbing tooth pain.
• Throbbing tooth pain.
• Teeth sensitivity.
• Swelling in your gums.
• Headaches.
• Fever.
• Chills.
• Bad breath or bad taste.

What causes a toothache?

There are many reasons why people develop tooth pain. Possible toothache causes include:

• Cavities.
• Abscessed tooth.
• Cracked tooth.
• A damaged dental restoration (like a filling or crown).
• Teeth grinding or clenching (bruxism).
• Gum disease.

How long does a toothache last?

There’s no way to know how long your toothache will last. It depends on the underlying cause. For instance, if you have temporary gum irritation, it should go away on its own in a day or two. But if you have a cavity or abscess, the pain may come and go somewhat, but it won’t go away completely.

How do dentists treat toothaches?

A dentist will perform an examination and ask about your symptoms. They may also take a dental X-ray to see if there are any issues going on beneath your gums.

There are several toothache treatments available. The one that’s right for you depends on the severity of your situation.

Toothache medicine

Antibiotics and pain relievers can ease toothache symptoms, but their effects are temporary. Even if an infection goes away after you take antibiotics, it will come back unless you treat the underlying issue.

However, while you’re waiting to see your dentist, you can take over-the-counter pain relievers (like acetaminophen and ibuprofen) to reduce pain and tenderness.

Dental fillings

If you have a small cavity — or if a small piece of your tooth has broken off — your dentist will probably recommend a dental filling. During this procedure, they’ll remove any damaged portions of your tooth, and then fill in the void with a strong dental filling material.

Dental crowns

A larger cavity or fracture may require a dental crown. This tooth-shaped “cap” fits over your entire tooth, strengthening it and reducing the risk of further damage.

Inlays or onlays

Sometimes, a cavity or crack is too big for a filling but not large enough to warrant a crown. In these instances, your dentist may recommend an inlay or onlay. This type of custom ceramic restoration fits into your tooth like a tiny puzzle piece.

Root canal therapy

If bacteria from a cavity or crack invade your tooth pulp, you’ll need a root canal. This procedure removes inflamed nerves, blood vessels and connective tissues from inside your tooth. Next, your dentist will clean the inside tooth surfaces, then fill your pulp chamber and root canals with a filling material. In most cases, you’ll also need a crown to protect and strengthen your tooth.

Tooth extraction

Most dentists prefer to save natural teeth when they can. But sometimes, it’s not possible. If your tooth is badly damaged, you may need a tooth extraction. During this procedure, your dentist will carefully remove your tooth from its socket and clean out any infection.

If you need a tooth pulled, talk to your dentist about replacement options. Once you’ve healed from your extraction, they can replace it with a dental bridge or dental implant. They can also make you a temporary tooth to wear until you get your permanent replacement.

Are there home remedies for toothaches?

Home remedies can offer some mild toothache relief. But if you have tooth pain that doesn’t go away, you’ll need to see a dentist for treatment.

If you have mild pain, there are a few toothache remedies you can try at home:

Saltwater rinse

Salt is a natural disinfectant. Rinsing with warm saltwater rinse can reduce inflammation, heal wounds in your mouth and offer toothache pain relief. Mix 1/2 teaspoon of salt into 8 ounces of warm water. Swish for 30 seconds, and then spit it out.

Hydrogen peroxide rinse

Rinsing with hydrogen peroxide can also ease tooth pain and inflammation. It helps heal bleeding gums, too. If you have a history of gum disease, this might be a good step to try.

You should never rinse your mouth with pure hydrogen peroxide. Be sure to dilute it with equal parts water. After swishing, spit it out in the sink. Don’t swallow.

Ice packs

Applying ice to the affected area helps shrink blood vessels and reduce pain and inflammation. You can wrap a bag of ice or frozen veggies in a clean towel, and then hold it against your outside jaw for about 20 minutes. Repeat several times a day.

Can I prevent toothaches?

You can’t always prevent toothaches. Sometimes, they occur for reasons out of your control.

But there are things you can do to reduce your risk:

• Brush your teeth two to three times a day using a fluoride toothpaste and a soft-bristled toothbrush.
• Floss between your teeth once a day.
• Use an antibacterial mouthwash twice a day.
• Limit your intake of sugary foods and drinks.
• Visit your dentist regularly for exams and cleanings.
• Ask your dentist about sealants and fluoride treatments.

When should I see a dentist?

Call a dentist right away if you develop:

• A toothache that lasts longer than two days.
• Swelling in your face or jaw.
• Pain when opening your mouth wide.

When should you go to the ER for a toothache?

You should head to your local emergency room if you have:

• Swelling below your eye or a knot on your jaw.
• Unbearable tooth pain that doesn’t get better with medication.
• Bleeding that won’t stop with applied pressure.
• A fever over 101 degrees Fahrenheit (38.33 degrees Celsius).

Can a toothache go away on its own?

Tooth pain can go away on its own in certain situations. For example, if you have irritated gums from biting into something hard, your discomfort will likely go away in a day or two. But a true toothache — pain that originates from the tooth itself — usually means you have an issue that needs treatment.

If you have a toothache — whether it comes and goes or lingers — you should see a dentist as soon as possible. Treating the issue early can keep it from getting worse or causing more pain.

How can you tell what kind of toothache you have?

The short answer is that you can’t know for sure until you see a dentist. But generally:

• A dull, persistent toothache could mean you have an infected tooth. It could also be a sign that you grind your teeth when you sleep.
• A sharp, stabbing pain might mean that you have a cavity or crack in your tooth. Sometimes, it means there’s an issue with an existing filling or crown.
• Severe, throbbing pain could mean that infection has invaded your tooth pulp.
• Sensitivity to heat and cold could indicate a number of things, including cavities, cracks or gum disease. If the pain goes away quickly, it could mean that you have worn enamel.

How do I prepare for the screening?

There’s nothing you need to do to prepare for an oral cancer screening. The exam usually takes place during a routine dental or physical checkup.

What should I expect during my oral cancer screening?

Your healthcare provider may use a combination of oral cancer screening methods, including a visual exam, palpation, and oral screening dyes and lights. They may also take photos of any abnormal areas so they can monitor them. In general, screenings take less than five minutes.

Visual exam

During this portion of the exam, your healthcare provider will look for lesions (areas of abnormal tissue) in your mouth and throat. These abnormalities may include leukoplakia (thick white patches) and erythroplakia (abnormally red areas).

Palpation

Your healthcare provider will also use their fingers to feel (palpate) for lumps or bumps around your face, neck and jaw. Be sure to let them know if you have areas that are sore or tender.

Oral cancer screening dye

Many healthcare providers use oral cancer screening tools — like toluidine blue dye — to look for signs of oral cancer. They’ll coat any lesions with the dye, which can help identify areas that are likely to become cancerous.

Oral cancer screening light

There are also special lights that can help identify abnormal tissues in your mouth. To use this tool, your healthcare provider will ask you to rinse your mouth with a fluorescent mouthwash. Next, they’ll shine a special light in your mouth, which makes healthy tissue look dark and abnormal tissue look white.

What happens after the oral cancer screening?

As mentioned above, screenings look for signs of cancer. But you’ll need more testing to get an official diagnosis.

After your oral cancer screening, your healthcare provider will share their findings with you. If the screening indicates that cancer could be present, your provider will refer you to a specialist for further assessment. Tests may include:

• Cytology. A provider collects cells from your mouth with a brush, piece of cotton or wooden stick. Then, a pathologist looks at the cells under a microscope to see if they’re abnormal.
• Biopsy. During this test, a provider removes a portion of the abnormal tissue and sends it to a pathologist for analysis.

Your healthcare provider may also recommend a follow-up visit in a week or so to see if the lesion has changed or healed on its own.

When should I know the results?

Your healthcare provider can share their findings with you immediately after your oral cancer screening.

If you undergo more testing — such as a biopsy — it typically takes three to five days to get your results.

When should I call my healthcare provider?

If you develop mouth pain or notice any new lumps, bumps or lesions, call your healthcare provider right away. Early detection is key, so if you think something isn’t quite right, don’t wait to seek medical care.

Can I screen for oral cancer at home?

Some healthcare providers recommend screening yourself at home for oral cancer once a month. However, a self oral cancer screening isn’t a substitute for bi-annual screenings at your healthcare provider’s office.

Ask your provider how to perform a screening at home. Here are some general guidelines:

• Look in the mirror and check your face for any recent changes, including swelling, lumps, rashes or moles.
• Run your fingers along your jawline and down the sides of your neck. Check for swelling and any areas of asymmetry.
• Pull each lip away from your teeth. Look for any discoloration and feel for any lumps or bumps.
• Gently pull your cheeks outward. Look for patches of red or white. Feel along your inner cheeks to check for lesions or areas of tenderness.
• Use your thumb and index finger to feel along your gum line. Be sure to check the tongue side, too.
• Carefully pull your tongue out and check for any swelling or discoloration. Touch the tip of your tongue to the roof of your mouth. Check for any abnormalities under your tongue.
• Next, tilt your head back to look at the roof of your mouth. Take note of any discoloration or mouth ulcers.
• Finally, lift your tongue and feel the floor of your mouth for tenderness, ulcers or swelling.

A lump found in the neck can be a sign of advanced oral cancer, so feeling your neck for masses or swelling is important. Make note of anything questionable and call your healthcare provider for further instructions.

What is oral surgery?

Oral surgery refers to any mouth operation. It includes procedures done on your teeth, gums, tongue or any other area inside your oral cavity.

There are several types of oral operations done each year. Some of the most common include:

• Wisdom tooth removal to treat or prevent pain and infection.
• Tooth extractions to remove decayed or damaged teeth.
• Dental bone grafts to increase the volume and density of your jawbone.
• Dental implants to replace missing teeth.
• Gum grafts to treat thinning or receding gums.

What conditions are treated with oral surgery?

There are many reasons why you might need surgery in your mouth. Your dentist might recommend it if you have:

• Abscessed teeth.
• Broken teeth.
• Bone loss in your jaw.
• Extensive tooth decay.
• Impacted teeth.
• Loose or missing teeth.
• Oral cancer.

What’s the difference between oral surgery and maxillofacial surgery?

Oral surgery and maxillofacial surgery overlap, but they’re not the same.

Oral surgery treats conditions that affect your teeth, gums and any other part of your mouth. Common procedures include tooth extractions, dental implants and gum grafting. Oral surgeons usually do treatments in a clinical setting (like an outpatient surgery center). Or they might do the procedure in a hospital if you need general anesthesia.

Maxillofacial surgery treats conditions that affect your face, mouth, jaws and neck. Common procedures include jaw surgery and cleft lip and palate repair. Maxillofacial surgeons can do many of the same procedures that oral surgeons do. But they also do cosmetic facial surgeries and reconstruct broken facial bones. Healthcare providers always do these procedures in a hospital setting.

It’s important to note that oral surgeons and maxillofacial surgeons have the same educational pathway and credentials. If you need your wisdom teeth removed, you’ll probably see an oral surgeon. But if you have facial injuries from a car accident, you’ll see a maxillofacial surgeon.

Procedure Details

How should I prepare for oral surgery?

How you prepare for oral surgery depends on a few factors like what type of surgery you’re having and whether you choose sedation.

Your healthcare provider will give you pre-op instructions if necessary. But here are some things to consider, especially if you’re having sedation:

1. Arrange for a friend or family member to drive you to and from your appointment.
2. Avoid eating or drinking anything for several hours before your procedure. Your provider will tell you how long.
3. Pick up any prescriptions ahead of time.
4. Take a few days off work to recover. Your provider will give you an idea of how long healing should take.

What happens during oral surgery?

Depending on your situation, you might have your procedure at an outpatient surgical center or a hospital. What happens during oral surgery depends on the type you need. But here are some general things you can expect the day of your appointment:

• A healthcare provider will give you local anesthesia to numb your mouth for oral surgery. They may also give you sedative medications to help you relax or sleep through your procedure.
• They’ll make an incision inside your mouth. The location of the incision depends on the affected area(s).
• Your oral surgeon will do the surgery using small, specialized instruments. Depending on your needs, this step might include removing teeth, placing implants or reshaping bone or tissue. You shouldn’t feel any pain.
• Once your oral surgeon completes your procedure, they’ll close the incision with stitches.

How long your procedure takes depends on what type of oral surgery you need and how many teeth require treatment. A one-tooth extraction usually takes about 30 minutes, while a more involved procedure — like a gum graft — takes at least one to two hours.

Your healthcare provider will monitor you while the sedatives and/or anesthesia wear off. They’ll also give you post-op instructions explaining how to care for yourself and a list of soft foods to eat after oral surgery. Following these guidelines will reduce your risk of bleeding, infection and other complications.

What are the benefits of oral surgery?

Oral surgery can correct conditions that nonsurgical treatments can’t. Benefits include:

• Better health. In combination with routine dental care, oral surgery can treat conditions that cause infection, like tooth decay and gum disease. Better oral health means improved overall health.
• Enhanced aesthetics. The appearance of your teeth can have a big impact on anxiety and how comfortable you feel in social situations. Oral surgery can help address these concerns.
• Improved function. Oral surgery can help replace damaged or missing teeth, reducing issues with eating and speaking.
• Pain relief. Oral surgery can correct painful issues like broken teeth, extensive decay and sore, bleeding gums.
• Prevention. Preventive treatments like wisdom teeth removal can help you avoid potential problems later.

What are the risks or complications of oral surgery?

Like any procedure, oral surgery comes with risks. Possible complications include:

• Infection.
• Injury to neighboring teeth.
• Dry socket.
• Numbness.
• Tooth fragments left behind.
• Sinus perforation (a hole in your sinus membrane).

What is the recovery time?

Healing times vary, but most people feel like themselves again in about two to three days. The more extensive your oral surgery, the more time it will take to recover. You shouldn’t have severe pain after oral surgery. But you’ll have some degree of discomfort. Your provider will give you medications to keep you comfortable.

After oral surgery, your mouth will continue to heal even after you feel better. Soft tissues usually heal in about one month. Bone could take up to six months to heal.

Recovering from oral surgery

Taking good care of yourself after oral surgery can reduce your risk of complications. Here are some general recommendations:

• Avoid spitting and vigorous swishing. They can disturb healing.
• Give yourself at least 48 hours before exercising. You’re more prone to bleeding when your blood pressure and heart rate increase.
• Keep your head elevated for the first few days to minimize swelling.
• Stock your pantry with soft foods like yogurt, soup, pasta, mashed potatoes, pudding, eggs and rice.
• Take all medications exactly as prescribed.
• Use heat and cold therapy. Ice packs (applied to your outer jaw) can help reduce swelling. A warm washcloth can stimulate blood flow to the area.

When should I call my healthcare provider

After oral surgery, call your healthcare provider if you develop these signs of infection:

• Severe pain that doesn’t go away with medication.
• Fever of 102 degrees Fahrenheit (38.9 degrees Celsius) or higher.
• Pus coming from your incisions.