Ask the Expert: What Are Oral Ties? Causes, Symptoms & Developmental Impact — Part 1
As parents, we’re constantly watching for signs that our children are developing as they should. Sometimes, feeding, speech, sleep, or dental issues can be linked to something many families don’t know about: oral ties. Lip and tongue ties are more common than many people realize and can present in subtle or unexpected ways. Maybe you’ve experienced breastfeeding pain, feeding challenges, or noticed speech difficulties in your child.
Understanding how oral ties work, what signs to watch for, and when to seek help can make a big difference for your child’s development and your family’s well-being.
This blog was created in collaboration with Dr. Jackie and Dr. Katie, board-certified pediatric dentists and founders of Tied.
Meet Our Experts: Dr. Katie & Dr. Jackie
As boy moms who have personally navigated tongue and lip ties in their own families, they bring both professional expertise and real-life experience to the conversation. Their firsthand understanding of how tethered oral tissues can impact feeding, speech, facial growth, and airway development has shaped their patient-centered, collaborative approach to care.
Today, they’re here to answer your most common questions about oral ties.
What are Oral Ties?
In every mouth, there are typically seven small bands of tissue called frenula, which help stabilize key parts of the mouth (upper and lower lips, tongue, and cheeks). These are completely normal parts of the mouth that develop before birth. As your baby’s mouth forms in the womb, different areas grow and pull apart, leaving behind small bands of tissue called frenula.
The seven small bands of tissue:
Maxillary and mandibular labial frenums (found under the upper and lower lips), lingual frenum (under the tongue), and four buccal frenula (inside the cheeks).
Sometimes, however, these frenula don’t stretch or break down as expected, and instead restrict movement. This is what’s known as an oral tie. A tongue tie (medically called ankyloglossia) or lip tie occurs when one of these tissue bands is too tight or short, limiting movement and causing challenges for a child. While often overlooked, oral ties are relatively common. Research shows that tongue ties may affect 4–10% of newborns, and lip ties around 2–5%.
How do oral ties affect a child’s overall development?
A lip or tongue tie can impact the oral motor development of a child which can interfere with a child’s: feeding, speaking, breathing, and dental development. Tethered oral tissues can interfere with oral development and growth of the upper and lower jaws, which can lead to dental, as well as airway and orthodontic concerns.
How can oral ties impact feeding skills?
During both breastfeeding and bottle feeding, the position and movement of the tongue and lips are essential for a baby to feed effectively. The front to mid portion of the tongue helps draw in and cup the breast or bottle, while the mid-back portion of the tongue creates the suction needed to extract milk. At the same time, the lips must flare outward to form a tight seal around the nipple.
When a baby has a lip tie, the upper lip may not move freely enough to achieve a full latch.
This can lead to:
Incomplete latch
Nipple pain or soreness for the nursing parent
Painful feedings
Increased risk of blebs or mastitis
A tongue tie can interfere with the baby’s ability to move their tongue properly, causing issues such as:
Shallow or ineffective latch
Difficulty gaining weight
Milk leaking from the mouth
Swallowing air (which can lead to gas, discomfort, and fussiness)
Gagging or choking
Feeding inefficiency and longer feeding sessions
Later on, picky eating due to trouble moving food side-to-side (lateralizing the food bolus)
Together, these challenges can make feeding frustrating and painful, not just for the baby, but for the entire family.
What other effects can oral ties have?
Lip and tongue ties can also impact oral hygiene, jaw development, and even sleep. When it comes to oral hygiene, a tight upper lip tie can trap food and plaque around the front teeth, making it harder to keep the area clean. This can weaken the tooth enamel and increase the chance of cavities, especially on the upper front teeth. That’s why gently lifting the lip while brushing is so important. The tongue also helps naturally clean the mouth by moving food away from the teeth and cheeks. But if a tongue tie limits side-to-side movement, food can get stuck, which can lead to more tooth decay.
Beyond hygiene, tongue ties can also influence jaw development and breathing. At rest, the tongue should sit gently against the roof of the mouth, where it helps guide the growth of the upper jaw. If a tongue tie prevents this natural resting posture, it can interfere with proper jaw and facial development over time. Additionally, a low tongue position caused by a tie may lead to mouth breathing, snoring, or disrupted sleep patterns because the tongue isn’t able to direct airflow through the nose as it should.
Evaluation and Diagnosis
Figuring out if your child has an oral tie isn’t just about looking under the lip or tongue. Some ties are easy to see, but others can be hidden or less obvious. That’s why just how it looks isn’t enough to know if it’s causing a problem. A proper diagnosis looks at how well your child’s tongue and lips move, along with any related symptoms or functional challenges they’re having, such as feeding issues, speech delays, or sleep concerns.
Rather than focusing solely on the structure, providers look for true functional limitations that affect a child’s daily life. To help guide this process, many clinicians use a Functional Assessment Screening Questionnaire, which allows parents to share observations about their child’s feeding, speech, breathing, and more. This comprehensive approach ensures that any recommendation for treatment is based on how the tie is impacting the child, not just how it looks.
Oral ties can have a big impact on your child’s feeding, growth, and overall well-being. Understanding the signs and knowing when to ask for help is the first step in getting the right support for both your child and your family. In Part 2 of our Ask the Expert series, we’ll discuss treatment, what to expect during a frenectomy, and how to support your child before and after the procedure.
Be sure to check out Tied for more resources. At Tied, Dr. Jackie and Dr. Katie are passionate about creating a safe, supportive space where families can ask questions and get clear, functional guidance on diagnosing and treating oral ties. They’re honored to be part of your child’s care journey and hope this resource helps you feel informed, supported, and empowered.
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