One of the biggest misconceptions surrounding tongue-ties today is that every restrictive frenulum should be released.
I don’t believe that’s true.
Over the years, I’ve evaluated thousands of infants, children, and adults with suspected tongue-ties. Some clearly benefited from treatment. Others did not need a procedure at all. One of the most important parts of my job isn’t performing a laser frenectomy. It’s determining whether a laser frenectomy is actually the right recommendation.
As awareness of tongue-ties continues to grow, more families are seeking evaluations, and more healthcare providers are looking for education on the subject. That’s encouraging. At the same time, it’s important that we don’t replace underdiagnosis with overdiagnosis. We want to get right in the middle.
Good healthcare begins with asking the right questions, not assuming we already know the answer.
Also Read: What I Wish Every Pediatrician Knew About Tongue-Ties
A Frenulum Is Normal
Almost every person has a lingual frenulum.
The presence of a frenulum alone does not constitute a diagnosis of tongue-tie.
That’s an important distinction because I often meet parents who have been told, “Your baby has a frenulum, so they need a release.”
A frenulum is simply a normal anatomical structure. The real question is whether that tissue is restricting normal tongue function and contributing to meaningful symptoms.
Appearance alone is rarely enough to answer that question.
Not Every Tongue-Tie Needs Treatment
Get an Expert Evaluation Before Deciding on a Tongue-Tie Release
Function Matters More Than Appearance
One of the first things I teach in my courses is that I don’t diagnose a tongue-tie by looking at a photograph.
Instead, I evaluate function.
Can the tongue elevate? Can it extend appropriately? Can it cup effectively during feeding? Can it maintain suction? Is the tongue compensating in ways that suggest restricted movement?
Most importantly, do the patient’s symptoms make sense when viewed alongside the examination?
When those pieces fit together, treatment may be appropriate. When they don’t, it’s time to keep asking questions.
Not Every Feeding Problem Is a Tongue-Tie
This is one of the most important conversations I have with parents. Some babies struggle with breastfeeding because of a tongue-tie.
Others struggle because of:
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Low milk supply
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Prematurity
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Torticollis
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Body tension
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Neurologic conditions
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Oral motor immaturity
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Airway concerns
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Positioning difficulties
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Maternal factors
Many babies have more than one contributing factor.
My goal is never to find a tongue-tie. My goal is to determine why feeding isn’t going well.
Sometimes that leads to a recommendation for treatment. Sometimes it doesn’t.
When I May Recommend Waiting
Parents are often surprised when I recommend observation instead of immediate treatment.
There are situations where monitoring a child, working with an IBCLC, speech-language pathologist, occupational therapist, physical therapist, or another member of the healthcare team may be the best first step.
If a baby is feeding well, gaining weight appropriately, and showing no meaningful functional limitations, there may be little benefit to performing a procedure simply because a frenulum is present.
Likewise, if the symptoms don’t match the examination findings, I believe it’s worth slowing down and making sure we’re asking the right questions. However, some babies are really struggling, and it may be from a less obvious “posterior” tongue-tie that would be worth treating.
A thoughtful evaluation is far more valuable than a rushed procedure.
When I Do Recommend a Release
On the other hand, I don’t believe providers should dismiss tongue-ties simply because they can be difficult to recognize.
Many babies with significant feeding problems have already seen multiple healthcare providers before they arrive in my office. Parents often tell me, “Everyone said everything looked normal, but I knew something wasn’t right.” I’ve learned to pay attention when parents say that. In many of these situations, a careful functional examination reveals a tongue-tie that had simply gone unrecognized.
These babies often struggle with:
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Poor milk transfer
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Painful breastfeeding
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Clicking during feeding
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Swallowing excess air
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Prolonged feeding sessions
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Slow weight gain
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Persistent frustration during feeding
When the history, examination, and symptoms all point in the same direction, a release may significantly improve function.
Also Read: Two Ways to Tell if Your Child Has a Tongue-Tie
A Multidisciplinary Approach Often Produces the Best Results
One of the biggest changes in my own practice over the years has been recognizing that successful tongue-tie care is rarely about the procedure alone.
Many of the best outcomes occur when providers work together.
That team may include:
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Pediatricians
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Lactation consultants
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Speech-language pathologists
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Occupational therapists
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Physical therapists
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Chiropractors experienced with infants
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ENTs
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Pediatric dentists
Each provider contributes a different perspective.
When we communicate well, families benefit. A team approach is always best and gives the best chance of symptom improvement for families.
Also Read: Wound Care and Stretching After Tongue-Tie Release
Education Matters
One reason tongue-ties remain controversial is that many healthcare providers receive very little formal education on functional oral assessments. That isn’t a criticism. It’s simply the reality of how most professional training programs are structured.
As a result, some providers may overlook clinically significant restrictions, while others may focus primarily on anatomy without fully evaluating function. Neither approach serves patients well. The goal should always be a careful, individualized assessment that considers the entire clinical picture.
Learning to Make Better Clinical Decisions
One of the reasons I created Tongue-Tied Academy was to help healthcare providers move beyond simply identifying frenula and begin evaluating function with greater confidence.
The course is designed for dentists and physicians who want practical, evidence-informed training in tongue-tie assessment, diagnosis, laser treatment, and multidisciplinary care. If you’d like to strengthen your clinical evaluation skills, learn more about Tongue-Tied Academy.
If you’re a speech-language pathologist, occupational therapist, physical therapist, lactation consultant, chiropractor, or another therapist who works with tethered oral tissues, Tongue-Tied Academy LITE was created specifically for your role.
If you’re a parent reading this article because you’re concerned about your baby or child, remember that every situation is different. A careful evaluation is the best way to determine whether a tongue-tie is contributing to your child’s symptoms and whether treatment is appropriate. If you’d like to discuss your concerns, send us a message to schedule an evaluation. I’d be honored to help you find answers and determine the right approach for your child.
Frequently Asked Questions
Q1. Should every tongue-tie be released?
No. Treatment should be based on functional limitations and meaningful symptoms, not simply the presence of a frenulum. That being said, most patients who seek us out are already referred for treatment from another healthcare provider, so most patients that come see us do end up having a release at some point.
Q2. Can a baby have a tongue-tie and still feed normally?
Yes. Some babies compensate remarkably well and may not require treatment. Some kids have to-the-tip tongue-ties and perfect speech. But they could have sleep or feeding concerns that parents didn’t realize could be related to the tie. So it’s important to do a full assessment even if the baby is gaining weight, or there is no pain for the mother with nursing.
Q3. Why do different providers have different opinions?
Tongue-ties are an area where education and clinical experience vary considerably. Functional assessment techniques are not emphasized equally across all healthcare training programs. It’s not taught in dental school, medical school, and is minimally taught in lactation and speech programs! So it’s a systemic lack of education on the subject. That’s why I wrote the book Tongue-Tied, and we have our Tongue-Tied Academy course.
Q4. What is the most important part of a tongue-tie evaluation?
In my opinion, it’s understanding function. Anatomy matters, but the child’s function and related symptoms should guide treatment decisions.
Q5. Can other problems mimic a tongue-tie?
Absolutely. Feeding difficulties may be related to body tension, low milk supply, oral motor challenges, prematurity, airway concerns, or other conditions. That’s why a comprehensive evaluation is so important.
Assessment Before Treatment
