Is Ankyloglossia Associated with Speech Problems?
The evidence shows that ankyloglossia is NOT consistently associated with clinically significant speech problems in most children, and surgical intervention (frenotomy) does not reliably improve speech articulation or intelligibility. 1, 2
Evidence Against a Significant Association
The most recent and highest quality evidence demonstrates no meaningful relationship between ankyloglossia and speech disorders:
A 2024 prospective cohort study found that 87.9% of speech errors in children referred for ankyloglossia-related speech concerns were age-appropriate developmental errors, not caused by tongue restriction. 2
The same study showed no improvement in standardized speech articulation scores (GFTA-2) or intelligibility ratings after tongue-tie release (pre-release score 85.61 vs. post-release 87.54, P=0.5). 2
A 2023 systematic review by a cleft and orofacial specialist concluded there is no evidence that ankyloglossia causes speech disorders, noting that children typically develop simple compensations that result in normal speech acoustics. 1
Only 28% of children referred specifically for ankyloglossia-related speech concerns had abnormal lingual-alveolar and interdental sounds, suggesting the vast majority had normal tongue-dependent articulation. 2
Contradictory Evidence Requiring Consideration
Two older studies suggest potential benefit, but with important limitations:
A 2002 study reported that 9 of 15 children showed improved articulation after frenuloplasty, with significant improvements in tongue mobility (protrusion: 14.2mm to 25.8mm; elevation: 5.2mm to 22mm). 3 However, this study lacked a control group and used subjective parent ratings rather than standardized speech assessments.
A 2024 randomized trial found improved speech production in children aged 3-5 years after surgical intervention, but notably found no benefit in children aged 2-3 years, suggesting that observed improvements may reflect natural developmental maturation rather than surgical effect. 4
Clinical Algorithm for Management
For children under 3 years with ankyloglossia and parental speech concerns:
- Adopt a "watch and wait" approach, as physiological growth of the lingual frenulum occurs naturally. 4
- Reassure parents that most children develop compensatory articulation strategies. 1
- Avoid early surgical intervention, as it provides no demonstrable benefit in this age group. 4, 2
For children 3-5 years with persistent articulation errors:
- Obtain formal speech-language pathology evaluation using standardized testing (e.g., GFTA-2) to distinguish age-appropriate errors from true articulation disorders. 2
- Identify whether errors are specifically lingual-alveolar or interdental sounds (the only sounds theoretically affected by tongue restriction). 2
- If surgical intervention is considered, optimal timing is 4-5 years of age. 4
- Frenotomy should be recommended sparingly and rarely for speech disorders alone. 1
For all ages:
- Recognize that the most common speech errors in children with ankyloglossia are phonological substitutions (80%) and gliding errors (56%), which are typically developmental and not mechanically caused by tongue restriction. 2
- Understand that isolated tongue mobility problems do not consistently produce speech articulation errors. 2
Critical Pitfalls to Avoid
Do not attribute age-appropriate developmental speech errors to ankyloglossia, as this leads to unnecessary surgical intervention without benefit. 2
Do not perform frenotomy based solely on parental concern about speech without objective speech-language pathology assessment, as parent perception does not correlate with standardized outcomes. 2
Do not assume improved tongue mobility translates to improved speech, as the 2002 study showed dramatic mobility improvements without consistent articulation benefits. 3
Avoid surgical intervention in children under 3 years for speech concerns, as natural compensatory mechanisms and frenulum growth make intervention both premature and ineffective. 4, 1