No. Many tongue ties never cause a problem and need no treatment at all.
If you have been told your baby or child has a tongue tie, that single sentence is probably the most useful thing you can know. A tongue tie is not automatically a problem to be fixed. It is a piece of anatomy that may or may not be affecting how your child’s mouth actually works — and the only way to know is a proper functional assessment.
Everyone has a frenulum
The small band of tissue under the tongue is called a frenulum, and every single person has one. You can feel your own with your tongue right now. It is normal anatomy, not a defect.
What matters is not whether the frenulum exists, or even how it looks. What matters is whether it restricts function.
Appearance does not predict function
This is the principle that guides every assessment at Tooth Town, and it is worth stating plainly because so much advice online does the opposite.
You cannot tell from looking whether a tongue tie matters. Two children can have frenulums that look almost identical, and one may be feeding beautifully while the other cannot latch. Equally, a restriction that barely shows on inspection can significantly limit how the tongue moves.
A related point: the grade or classification of a tie does not tell you how severe its effect will be. Anatomy tells you what is there. Function tells you whether it matters.
The myth that causes the most confusion
If you take one thing from this page, make it this one.
“If she can stick her tongue out, it’s not a tie” is not true.
Poking the tongue out past the lips — protrusion — is the movement people check most often, and it is one of the least important. The movement that actually matters for feeding is elevation: the ability to lift the mid and back of the tongue up to the palate to create suction.
A baby can have perfectly good protrusion and still be unable to elevate. Plenty of children have been reassured on the basis of a tongue they could poke out, while the movement that was actually causing the problem was never checked.
So when might treatment be appropriate?
Treatment is considered when a restriction is genuinely limiting function and releasing it is likely to help. That means looking at what the tongue can and cannot do, and at what is actually happening for your child and, in the case of a baby, for you.
The tongue needs to be able to extend, elevate, cup, move side to side, spread, and control a swallow. Restriction of any one of those can affect feeding.
If your child’s tongue is doing its job, a visible frenulum is not a reason to intervene.
Watching and waiting is a real option
Active monitoring — keeping an eye on things, with support, without rushing to a procedure — is a legitimate choice, and it is one we discuss openly with families. Some babies adapt. Not every tie causes a functional problem.
What we would gently steer you away from is passive waiting, where a real difficulty is left unsupported in the hope that it resolves itself. If feeding is painful, if a child is not managing food, or if therapy is not progressing, that deserves a look — even if the answer turns out to be that no procedure is needed.
And sometimes a release is not the answer even when function is restricted
A tongue tie is not the only reason a tongue may not work well. Mouth breathing, nasal obstruction or allergies, low muscle tone, the shape of the palate and other differences can all produce a similar picture.
That is a large part of what a functional assessment is for: working out what is actually driving the difficulty. Sometimes it is a tie. Often it is a combination of things. Sometimes it is something else entirely, and the right next step is a different professional altogether — an ENT specialist, a lactation consultant, a speech pathologist or an orofacial myofunctional therapist.
What about lip ties?
We are deliberately cautious here. There is currently no evidence that releasing a lip tie in infancy prevents a gap between the front teeth, and lip ties are not released routinely at Tooth Town.
Lip ties are assessed in consultation with the allied health professionals already involved in your child’s care, rather than in isolation. For a baby, that is usually a lactation consultant. For an older child, a myofunctional therapist or speech pathologist may well be the person who raises the concern in the first place. Their observations of how the lip is actually working matter more than how it looks, and we would not assess or treat a lip tie on appearance alone.
If you have seen marketing suggesting otherwise, it is reasonable to treat it with some scepticism.
What we will and will not promise
We will give you a careful, honest assessment and a clear explanation of what is realistic for your child.
We will not tell you a release is needed when it is not. We will not promise that a procedure will resolve feeding, speech, sleep or any other concern, because these things usually have several contributing factors and a tie is only ever one of them. And a consultation does not mean treatment has already been decided — for many families, the assessment is reassurance that nothing needs doing.
Common questions
Does a tongue tie always need to be treated?
No. Many ties never cause a problem and need no treatment. Treatment is only considered when a restriction is genuinely affecting function and a release is likely to help.
My baby can poke her tongue out — does that rule out a tie?
No. Protrusion is one of the least functionally important movements. Elevation — lifting the tongue to the palate — is what breastfeeding depends on, and the two are independent of each other.
Does a higher grade mean it is more serious?
Not necessarily. Grade describes anatomy, not effect. A small anterior tie can cause significant feeding difficulty, and a higher-grade posterior tie may have little impact in a different child.
Will a release fix my child’s speech or sleep?
We would not promise that. Speech, feeding and sleep are complex and usually have several contributors. Your dentist will give you an honest picture for your child rather than a guarantee.
If we come for an assessment, will you recommend a procedure?
Not necessarily, and often not. The consultation is an assessment first. Many families leave reassured that no treatment is needed.
Function is looked at in every consultation, not just this one
You do not need to book a tongue tie assessment for someone to notice a problem.
Every consultation at Tooth Town looks at how your child’s mouth is working, not only at their teeth. All clinicians consulting at Tooth Town — including the general dentists — consider function as part of a routine visit, and will refer you through for a full functional assessment with Dr Helen Fung if something warrants a closer look.
So if your child comes in for a check-up and there is something worth investigating, you will hear about it. You do not have to spot it yourself, and you do not have to ask for it.
What to do next
If you would like clarity about your child’s tongue movement, a functional assessment with Dr Helen Fung is the most useful step — whether or not it leads to treatment.
Book a tongue and lip tie assessment, or read more on our tongue and lip ties service page.
This guide is general information and does not replace an individual assessment. Your child’s clinician will confirm what is appropriate for them.