How Are Tongue-Ties Classified?

Tongue-ties are fairly common conditions that affect roughly 5 – 10% of all newborns. But what does this condition actually entail, and how is it classified? Continue reading below to learn a little more about this condition and how it’s often classified, so that you can ensure you’re making an informed decision about seeking treatment for your child.

What Are Tongue-Ties?

A tongue-tie, also referred to as ankyloglossia, is a problem with the tongue that’s present from birth. It involves the frenulum, which is a small fold of tissue that reaches from the floor of the mouth to the underside of the tongue; it’s easy to spot if you look under your tongue in a mirror.

Sometimes, this tissue is too short or too tight at birth, or the frenulum may attach to the tip of the tongue instead of attaching further back like it’s supposed to. If the frenulum is too restricted in movement, the tongue can’t move around normally. This might cause a child to have trouble sticking out their tongue, moving it from side to side, or bending it to touch their teeth. Needless to say, this restriction in movement greatly affects oral functions such as speech development and the ability to breastfeed.  

How Are Tongue-Ties Classified?

Keep in mind that tongue-ties are different for every child, and the condition is often divided into categories based on the tongue’s mobility. One way that tongue-ties are classified involves measuring the distance of the tie from the tip of the tongue. This is referred to as Kotlow’s assessment:

• Class 1: Mild, 12 – 16 mm
• Class 2: Moderate, 8 – 11 mm
• Class 3: Severe, 3 – 7 mm
• Class 4: Complete, less than 3 mm

Another type of classification considers the type of frenulum:

• Type II: The frenulum is fine and elastic, anchoring the tongue 2 – 4 mm from the tip to the floor of the mouth.
• Type III: The frenulum is thick and stiff, anchoring the tongue from the middle of the underside to the floor of the mouth.
• Type IV: The frenulum is posterior or not visible, but tight fibers can be felt when touching the area with the fingertips.

The location of the tie can also be used to classify a tongue-tie as anterior or posterior: all four classes of Kotlow’s assessment are anterior, meaning they’re visible and measurable. On the other hand, posterior tongue-ties are more difficult to see, since they lie beneath the mucous membranes in the bottom of the mouth.

How Are Tongue-Ties Treated?

It’s possible for tongue-ties to cause symptoms so mild that they end up going away with time, but if the issue is causing problems for your little one, treatment is fairly accessible. Often, a simple surgery called a frenectomy is a viable option; this process involves removing or reshaping the frenulum as needed, to allow for proper tongue movement. There are some variations of this procedure, but all of them are aimed at carefully adjusting the frenulum, often with a soft tissue laser to ensure rapid recovery and unparalleled patient comfort.

In any case, talking with your child’s provider about their tongue-tie will shed further light on the issue and allow you to make an informed decision about treatment.

About the Author

Dr. Maggie Davis isn’t just a pediatric dentist; she’s also a mother, which means she knows firsthand just how precious your little one’s smile is! Dr. Maggie is a Board-Certified Pediatric Dentist and Diplomate in the American Academy of Pediatric Dentistry, and she holds her certification in Infant and Pediatric Tongue Ties and Lip Ties from the American Board of Laser Surgery. Her practice in Palm Harbor offers laser frenectomies for children of all ages with lip and tongue ties. To learn more about her practice or to schedule an appointment for your child, feel free to reach out online or by telephone for assistance: (727) 786-7551.