Detecting Tongue Tie (Ankyloglossia)
A tongue tie is detected by examining the lingual frenulum's attachment point, length, and how it restricts tongue mobility, not simply by noting the presence of tissue connecting the tongue to the floor of the mouth, as everyone has this structure.
Understanding Tongue Tie vs. Normal Anatomy
Everyone has a lingual frenulum (the tissue connecting the tongue to the floor of the mouth), but in tongue tie (ankyloglossia), this tissue is abnormally short, tight, or thick, causing functional limitations. The key is to assess function rather than just anatomy.
Clinical Assessment Parameters
When examining for a possible tongue tie, evaluate:
Frenulum Length and Attachment Point:
- Measure the distance between the uppermost point of the lingual frenulum and its insertion into the oral floor
- A measurement of <1.5 cm is associated with inadequate tongue movement 1
Tongue Mobility and Function:
- Ability to elevate the tongue tip to the palate
- Lateral tongue movement
- Extension of tongue beyond the lower lip
- Ability to touch the upper gum ridge
Appearance of Tongue During Movement:
- Heart-shaped or notched tongue tip when protruded
- Blanching of tissue when tongue is elevated
- Visible tethering or restriction
Standardized Assessment Tools
The Bristol Tongue Assessment Tool (BTAT) provides an objective, clear, and simple measure of tongue tie severity 2. This tool evaluates:
- Tongue tip appearance (heart-shaped, slight cleft, or round)
- Tongue tip elevation with mouth wide open
- Tongue extension over lower gum/lip
- Lateral tongue movement
Functional Impact Assessment
A comprehensive evaluation should include assessment of:
- Speech articulation difficulties (especially with sounds requiring tongue tip elevation)
- Feeding challenges (in infants and children)
- Oral hygiene limitations
- Swallowing difficulties
Common Misconceptions
- Misconception: If you can see tissue connecting the tongue to the floor of mouth, it's a tongue tie
- Reality: The presence of a lingual frenulum is normal; it's the restrictive quality and functional impact that defines a tongue tie
Clinical Implications
Ankyloglossia can cause:
- Breastfeeding difficulties in infants
- Speech and articulation problems
- Periodontal issues and malocclusion
- Potential impact on airway and sleep in some cases 3
Early clinical assessment, diagnosis, and appropriate treatment are beneficial for patients with significant functional limitations 4. Surgical intervention (frenuloplasty) may be considered in cases with clear functional impairment.
Remember that the prevalence of true ankyloglossia is relatively low, and in some cases, it remains undiagnosed or doesn't cause significant functional problems requiring intervention.