In this interview, I go over treatment and assessment of tongue tie. Here are some of the questions I answer and topics I cover:

What kind of assessment do you recommend- informal or formal?

I recommend a conglomeration of formal measures and informal observations.

Components of my assessment include :

-- a very in-depth case history

-- functional observations with feeding/speech, standardized articulation test (if indicated)

-- oral motor assessment (I use Beckman Oral Motor Protocol)

-- manual inspection of the oral cavity.

-- There are several protocols including the TAP, ATLFF, Carole Dobrich’s Assessment, and Lingual Frenulum Protocol by Martinelli and Marchesan as well. I do these in that order to avoid bias. If truly an oral restriction is present, all signs/symptoms, functional observations, testing, and oral motor findings add up to what I visibly see and feel in the mouth.


How do you determine severity of the tongue and/or lip tie and if a child needs surgical intervention?

Severity is based upon the level of impaired function, symptoms, and impact on quality of life. One of the common misconceptions is about the classification of tongue and lip ties. I tell my patients that this is only a descriptor of the placement of the attachments and not like cancer where class 4 is worse than class 1. I may have a child failing to thrive with a class 1 tie or a child that is a picky eater with a class 4 tie and vice versa.