Tongue-tie (ankyloglossia) is a condition that affects around 4-10% of newborns and a smaller but meaningful percentage of older children and adults. It can affect breastfeeding in infants, speech in children, and a range of oral functions in adults. At Dentist Pymble, we assess and treat tongue-tie for patients across the Ku-ring-gai region, and the right answer depends on the severity, the age of the patient, and the symptoms. This page covers what tongue-tie is, the signs in babies, kids, and adults, when a frenectomy is recommended, what the procedure involves, and recovery.

What is tongue-tie (ankyloglossia)?

Tongue-tie, or ankyloglossia, is a congenital condition in which the lingual frenulum (the band of tissue that connects the underside of the tongue to the floor of the mouth) is abnormally short, thick, or tight. This restricts the movement of the tongue, sometimes severely enough to affect feeding, speech, and oral hygiene.

Tongue-tie exists on a spectrum. Some people have a mild restriction that has no functional impact and never needs treatment. Others have a severe restriction that affects feeding from day one and may need intervention in the newborn period. The key is to assess the functional impact rather than the appearance alone — a tongue that looks tied but moves freely is not a problem; a tongue that looks normal but cannot move freely is.

Signs of tongue-tie in babies, kids, and adults

The signs vary by age:

Babies:

• Difficulty latching during breastfeeding
• Prolonged feeding times with poor weight gain
• Clicking sounds during feeding (losing suction)
• Maternal nipple pain and damage during feeding
• Reflux symptoms related to inefficient swallowing

Children:

• Speech difficulties, particularly with sounds that require tongue elevation (t, d, l, r, th)
• Difficulty licking an ice cream or a lollipop
• Difficulty cleaning food from the teeth with the tongue
• A noticeable gap between the lower front teeth
• Restriction visible when the child tries to stick out their tongue

Adults:

• Difficulty with certain sounds in speech
• Difficulty kissing or licking
• Restriction in playing wind instruments
• A persistent gap between the lower front teeth
• Gingival recession on the lower front teeth from the abnormal pull
• Social or self-consciousness about the restriction

The signs are usually picked up by parents, lactation consultants, speech pathologists, or the dentist at a routine check-up. The diagnosis is clinical, and the severity grading (from mild to severe) is based on the appearance and the functional restriction.

When is a frenectomy recommended?

The decision to do a frenectomy is based on the functional impact, not the appearance alone. The most common reasons for recommending the procedure:

• Breastfeeding difficulties in a newborn — when the tongue-tie is clearly affecting the baby’s ability to latch and feed effectively, and conservative measures (lactation consultant support, different feeding positions) have not resolved the issue
• Speech difficulties in a child — when the tongue restriction is clearly affecting the production of sounds that require tongue elevation, and speech therapy alone has not been enough
• Functional restriction in an adult — when the tongue-tie is causing significant functional or cosmetic issues that the patient wants addressed
• Periodontal concerns — when the abnormal pull of the frenulum is contributing to gum recession on the lower front teeth

For mild tongue-tie with no functional impact, no treatment is needed. For more severe cases where the functional impact is clear, a frenectomy is usually the right answer.

What happens during a frenectomy?

A frenectomy is a short procedure (usually 10-15 minutes) to release the tight frenulum. The technique depends on the age of the patient and the severity of the tie:

• Newborns and young babies — the procedure is often done with scissors or laser, with no anaesthetic needed. The baby can feed immediately afterwards.
• Older children — the procedure is usually done under local anaesthetic, with or without sedation. Sutures are sometimes needed.
• Adults — the procedure is done under local anaesthetic, often with sedation for anxious patients. Sutures are usually placed, and dissolvable sutures are common.

Laser frenectomy has become increasingly popular, particularly for infants and young children. The laser cuts and seals the tissue at the same time, reducing bleeding and often reducing post-operative discomfort. The traditional surgical technique (scissors or scalpel with sutures) is still used in many cases, particularly for more complex tongue-ties.

Recovery after a frenectomy

Recovery is usually straightforward:

• Discomfort — mild to moderate for a few days, managed with over-the-counter pain relief (paracetamol or ibuprofen as appropriate for age)
• Swelling — usually minor, peaks at 24-48 hours
• Bleeding — minimal, particularly with laser frenectomy
• Feeding — babies can usually feed immediately after the procedure; older children and adults can eat normally within a day or two
• Exercises — for older children and adults, gentle tongue exercises are often recommended to prevent the frenulum from reattaching tightly during healing
• Follow-up — a review appointment 1-2 weeks after the procedure to check healing

Most patients are back to normal within a few days. The functional improvement (easier feeding, clearer speech, better tongue mobility) often becomes apparent within the first week, and continues to improve over the first month as the tissues settle.

Our sedation and sleep dentistry service is available for patients (children and adults) who need extra support to tolerate the procedure.

If you live in Pymble, Gordon, Turramurra, Wahroonga or anywhere else in the Ku-ring-gai area and you have a question about tongue-tie (for yourself or your child), call our practice. We see neighbouring Gordon patients and other nearby families, and we will always involve the relevant other professionals (lactation consultant, speech pathologist) in the decision.

Frequently asked questions

Is tongue-tie always a problem? No. Many people have a tongue-tie that causes no functional impact and never needs treatment. The decision to treat is based on the symptoms, not the appearance alone.

At what age should a tongue-tie be treated? If treatment is needed, the earlier the better. For breastfeeding difficulties, the newborn period is the right time. For speech difficulties, when the issue is identified (often 3-5 years old). For adults, whenever the patient decides to address it.

Does a frenectomy hurt? For newborns, the procedure causes minimal discomfort and the baby usually settles quickly with feeding. For older children and adults, the area is numbed with local anaesthetic, and post-operative discomfort is managed with over-the-counter pain relief.

Will a frenectomy fix my baby’s breastfeeding? Often, but not always. The tongue-tie may be one factor among several, and lactation consultant support is usually needed alongside the procedure to address the other factors (positioning, latch technique, supply issues).

Will the frenulum grow back? In some cases, particularly if the post-operative exercises are not done, the frenulum can reattach. The exercises (gentle tongue movements to keep the area mobile during healing) are an important part of the recovery, particularly for older children and adults. The risk of reattachment is much lower in newborns, whose tissues heal more quickly and adapt more readily.