top of page

Tongue Tie (ankyloglossia), Lip Tie, Buccal Tie Assessment & Treatment

What is a tongue tie, lip tie, and or buccal tie? Before we describe what a tie is, we must first explain what is frenula. By definition, frenula (may also be termed frenum or frenulum) is a small fold of tissue that secures structures in the oral cavity and supports the motion of the tongue, lips, and/or cheeks. We all have frenula and the presence of this tissue provides stability of the structures of the mouth. Frenula is problematic when this tissue is tightened and/or restrictive resulting in tension and less mobility of the structures.

Why can restrictive frenula be problematic? 

If we think about the movement of muscles, any restriction, can cause impairment in the natural range of motion of the muscle it is adhering.  As a result of this restriction, other structures may be affected and cause maladaptive patterns that must compensate for this lack of movement. When this occurs, especially in the mouth, restriction and compensation can cause infant/children increased difficulty in structural development, breast and/or bottle feeding, spoon feeding, cup drinking, speech, breathing, and sleeping as well as impede growth and development of other structures such as the palate.


Identification of any oral restriction requires a physical and functional examination of the infant/child. Assessment begins with locating the restriction and identifying the amount of tension causing the underlying dysfunction. If it is determined that your child has a "tie" or restriction, we will thoroughly discuss a plan of care and the best treatment options.

Our therapists have advanced education and training in the assessment and treatment of oral restrictions. We are skilled in assessing and identifying oral restrictions that may be problematic in both the neuro-typical and neuro-atypical pediatric populations. As part of a national and international collaborative effort, we communicate, educate, and co-treat with many supporting professionals across the globe. We will help you build a "team" of skilled professionals to support you and your child and determine if other areas of concern need to be addressed.


Signs and Symptoms of Oral Restriction

Below are some of the signs and/or symptoms your infant/child may be experiencing in the presence of oral restrictions:

Breast and/or bottle feeding difficulties

  • Difficulty latching

  • Slips off breast easily (weak latch)

  • Shallow latch/poor latch

  • Refusing to nurse

  • ”Clicking” sounds while eating (breast or bottle)

  • Upper lip tucks in/under when feeding (lack of flaring out)

  • Colic/excessive crying

  • Failure to Thrive

  • Difficulty with the introduction of solid foods

  • Slow weight gain

  • Gas, fussiness, reflux

  • Gagging/spit up

Symptoms in an young children:

  • Open mouth breathing 

  • Open mouth posture

  • Sloppy/messy eating

  • Mastication difficulty

  • Reduced bolus control (inability to manage within oral cavity)

  • Errors in sound production

  • Poor oral hygiene

  • Delayed tooth eruption, dental crowding, malocclusions

  • Marked changes in face/jaw development

  • Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side

  • Trouble sticking out the tongue past the lower front teeth

  • A tongue that appears notched or heart shaped when stuck out

Symptoms in the older child:

  • Inadequate caloric intake due to inefficiency and fatigue

  • Tactile oral sensitivity or aversion

  • Difficulty progressing from feeding

  • Swallowing challenges

  • Picky eating 

  • Gagging and vomiting ​

(Calamusa, N., Hines, J.; Presentation-Athens, Greece. ​Foundational Skills for the Evaluation and Treatment Of Tethered Oral Tissues:A Multidisciplinary Approach. February 2019)

If your child is experiencing any of the symptoms listed above, please do not hesitate to contact us at 732-698-1100 or via email at

bottom of page