Tongue Tie & Lip Tie Treatment
Expert assessment and release (frenotomy) for newborns, children, teens and adults using Dr. Sigal's novel functional scissor release technique.
What are Tethered Oral Tissues (TOTS)?
Lesson #1: Understanding Frenums
Everyone has frenums and as long as the range of motion is not restricted, they are considered normal.
- Lingual (tongue) frenum: Normal embryonic piece of fibromucous membrane tissue (connective tissue without nerve innervation) in the midline of the under-surface of the tongue joining to floor of mouth
- Labial (lip) frenum: Normal embryonic piece of fibromucous membrane tissue in the midline of the under-surface of the upper lip joining lip to gums
Lesson #2: What is a Tongue Tie (Ankyloglossia)?
When the lingual frenum is short or inappropriately attached, restricting movement, rest position, and function.
Anterior Tongue Tie
Posterior Tongue Tie
- Anterior tongue tie: Frenum restricted towards tip of tongue
- Posterior tongue tie: Less visible, frenum restricted between floor of mouth and body of tongue, preventing optimized rest position
- Submucosal connective tissue fibers commonly present with posterior ties — critical that ALL restrictive fibers are identified and released
Lesson #3: What is a Lip Tie?
Labial Frenum
Lip Tie Classifications
When upper labial frenum is short or inappropriately attached, restricting mobility and function. Kotlow classification system (Classes 1-4) used alongside functional analysis.
A lip tie release may be discussed if presenting with:
- Notable breast or bottle feeding challenges
- Tautness puckering upper lip towards nose leading to open mouth posture
- Cosmetic concern creating >3mm space between top front teeth
How Ties Relate to Growth, Development, Airway and Function
Ankyloglossia Potential Problems
- Tongue positioned/held down unable to reach palate
- Collapse of upper jaw/palate to narrow, V-shaped, highly arched
- Compromised/reduced nasal airway
- Breastfeeding difficulties
- Feeding difficulties
- Minimal weight gain or failure to thrive
- Swallowing excess air (aerophagia) — presenting as colic, gassiness, reflux
- Frequent ear infections
- Tongue thrust swallow → anterior open bite
- Open mouth rest posture
- Mouth breathing development
- Inflamed/enlarged tonsils and adenoids
- Snoring / restless sleep / Sleep Disordered Breathing
- May affect speech
- Forward head posture with neck pain/stiffness, headaches, migraines
- Obstructive sleep apnea (if untreated with high arched narrow palate)
Upper Lip Tie Potential Problems
- Breastfeeding difficulties, poor latch
- Maternal painful breastfeeding, plugged ducts, mastitis risk
- Open mouth posture, loss of milk, drooling, mouth breathing tendency
- Diastema >3mm between teeth
Treatment Approaches
Tongue Tie — Newborns to 1 Year
Meet with new patient educator first. Dr. Sigal conducts an interactive assessment with parent involvement.
If diagnosed and impeding function, release is recommended — the earlier the better (we advocate within first 2 weeks).
The Procedure:
- Frenotomy performed in office, same day, infant awake
- NO sedation or freezing needed (connective tissue lacks innervation)
- Dr. Sigal's novel functional scissor release technique — most precise and accurate
- Releases only restrictive fibers, avoids surrounding vital structures
- Stretches and mobilizes tongue to ensure ALL tensions (including submucosal fascial tensions) released
- Sucrose provided before release for comfort (best analgesic under 12 months)
After Care:
- Resume breastfeeding/feeding after procedure
- Written hand out and instructional video provided
- Post-operative stretching required to prevent wound adherence
- Two follow-up appointments included with procedure cost
- May recommend bodywork (osteopathy) for residual tensions
Red flags for bodywork recommendation: nursing asymmetries, reflux-like symptoms, fussiness, gaze/breast preference, limited mouth opening, "trap door tongue"
Tongue Tie — Children, Teens, Adults
Meet with new patient educator first. For mild restrictions, we start with myofunctional exercises and re-evaluate. For significant restrictions, surgical release is recommended.
The Procedure:
- Ages 3-17: General anesthesia with medical anesthesiologist and two pediatric nurses in office
- Stitches used (acting as bandaid) for optimal healing and comfort
- Dr. Sigal's novel functional scissor release — quarter millimeter precision
- Dynamic procedure with constant palpation and function assessment
- Post-operative oral myofunctional therapy exercises required
Lip Tie — Newborns to 1 Year
- Same day release possible with infant awake
- If both tongue and lip ties present, both released at same appointment
- Dr. Sigal's functional scissor release technique
- Does NOT remove frenum (normal anatomy), removes restriction only
- Negligible inflammation or swelling
- Sucrose for comfort; post-operative stretching required
- Two follow-up appointments included
Lip Tie — Children, Teens, Adults
- Commonly provided at same time as tongue tie release under general anesthetic
- If lip only: may discuss awake with local freezing
- Stitches used for older patients
- Pre and post-operative myofunctional therapy exercises required
Frequently Asked Questions
Concerned About Tongue Tie or Lip Tie?
Schedule a comprehensive assessment with Dr. Sigal. No referral needed.*
*If you have government-sponsored dental coverage (i.e. ODSP), a referral is required.