A tongue-tie or lip-tie is a piece of tissue — called a frenulum — that’s tighter or shorter than normal, restricting how freely the tongue or lip can move. When one of these ties is significant, it can influence how a child swallows, speaks, and rests their tongue, and over time that altered function can shape the bite. A frenectomy is the simple procedure that releases an overly tight frenulum, and orthodontists often flag the need for one during an early evaluation, even though the procedure itself is usually performed by a dentist, oral surgeon, or ENT.
How a Tongue-Tie or Lip-Tie Can Affect the Bite
A healthy tongue rests up against the roof of the mouth, and that resting posture actually helps guide the upper jaw to widen properly as a child grows. When a tongue-tie restricts how high or how far forward the tongue can reach, that resting posture changes — the tongue may sit lower or push against the front teeth during swallowing, which can contribute to an open bite, a narrow palate, or a forward tongue-thrust swallowing pattern.
A lip-tie, meanwhile, can pull on the gum tissue between the upper front teeth, sometimes contributing to a persistent gap there. Neither issue is automatically a problem — many people have some degree of tongue- or lip-tie with no functional effect at all — but when the restriction is significant, it’s worth evaluating.
Signs Worth Mentioning to Your Orthodontist or Dentist
- Difficulty with certain speech sounds, especially ones that need the tongue tip to lift (like “t,” “d,” or “l”)
- A visible gap between the upper front teeth that doesn’t close on its own
- A tongue that looks heart-shaped or notched at the tip when stuck out
- Trouble with certain foods, or a history of feeding difficulty as an infant
- A forward tongue-thrust pattern noticed during a dental or orthodontic exam
What Does a Frenectomy Involve?
A frenectomy releases the restrictive tissue, and for a straightforward tongue- or lip-tie in a child, the procedure is typically quick, often performed with a laser, and involves minimal discomfort and downtime. In many cases, a short course of stretches or guided tongue exercises follows the procedure to help the tongue or lip learn its new, freer range of motion — sometimes with the support of a myofunctional therapist or speech therapist.
Does a Frenectomy Fix the Bite on Its Own?
Not by itself. A frenectomy removes the physical restriction, but any bite changes that already developed — a narrow palate, an open bite, a persistent gap — usually still need orthodontic treatment to correct. Releasing the tie is about removing an ongoing cause, so that whatever orthodontic correction follows has a better chance of holding long-term instead of being undone by the same tongue or lip pattern that helped create it.
If our team notices signs of a tongue- or lip-tie during your child’s evaluation at Davis & Goldberg Orthodontics, we’ll talk through what we’re seeing and, when appropriate, coordinate with your pediatric dentist or an oral surgeon on next steps — always as part of a broader plan, not an isolated fix.
Myofunctional Therapy After a Frenectomy
Simply releasing a tight frenulum doesn’t automatically teach the tongue or lip a new resting posture or movement pattern — muscles that have compensated for a restriction for years often need guided practice to learn their new range of motion. Myofunctional therapy is a series of targeted exercises, often guided by a speech therapist or myofunctional therapist, that retrains tongue posture, swallowing pattern, and in some cases speech articulation after the physical restriction is gone. This step is frequently what determines whether a frenectomy’s benefits actually translate into improved function, rather than just a technically freer tongue that still moves out of old habit.
Tongue-Ties in Infants vs. Older Children
A tongue-tie identified in infancy is usually flagged because of feeding difficulty — trouble latching or nursing effectively — and addressed by a pediatrician, lactation consultant, or pediatric dentist well before orthodontic concerns are even relevant. A tongue-tie noticed later, at an orthodontic evaluation age, is more often flagged because of its effects on speech, swallowing pattern, or an emerging bite issue rather than feeding, since feeding challenges would typically have surfaced years earlier. Both scenarios can call for a frenectomy, but the reasoning and the professionals involved often differ.
How We Screen for Tongue- and Lip-Ties
A tongue- or lip-tie isn’t always obvious at a glance, which is why it’s part of what our orthodontists specifically check for during an early evaluation at Davis & Goldberg Orthodontics. We look at range of motion — how far the tongue can lift toward the palate and extend forward — alongside how the front teeth and gum tissue look, and we ask about speech and feeding history where relevant. If something looks restrictive enough to matter, we’ll explain exactly what we’re seeing and why, and help coordinate a referral to the right provider for the release procedure itself.
Coordinating Care Across Providers
Because a frenectomy, myofunctional therapy, and orthodontic treatment often involve three different types of providers, good communication between them matters. We routinely share our findings and imaging with the dentist, oral surgeon, or therapist involved in a child’s care, and we like to stay looped in on their progress too, so that by the time any orthodontic treatment begins, we have a clear picture of whether the tongue or lip restriction has actually been resolved and how well the new function has taken hold.
Frequently Asked Questions
Do all babies with a tongue-tie need a frenectomy?
No. Many tongue-ties cause no functional problems at all. A frenectomy is generally considered only when the tie is actually restricting feeding, speech, or oral function in a meaningful way.
Can a tongue-tie be missed until orthodontic evaluation age?
Yes, especially milder cases that didn’t cause obvious feeding problems as an infant but become more noticeable once speech and swallowing patterns are established.
Who performs a frenectomy — an orthodontist or a dentist?
Orthodontists typically identify the tie and its effects on the bite, but the release procedure itself is usually performed by a general or pediatric dentist, oral surgeon, or ENT, depending on the case.
Is a frenectomy painful for a child?
Most children tolerate it well, especially with modern laser techniques, and recovery is typically brief with only mild, short-term discomfort.
Does releasing a tongue-tie improve speech right away?
Not always immediately — while the physical restriction is resolved right away, speech patterns that developed around the old restriction often benefit from a period of guided exercises or speech therapy to fully catch up to the tongue’s new range of motion.
Can a mild tongue-tie be left alone if it isn’t causing problems?
Yes — many mild ties never cause a functional issue, and a frenectomy is generally recommended only when there’s a clear effect on feeding, speech, swallowing, or bite development worth addressing.
Can a lip-tie affect baby teeth as well as permanent teeth?
Yes — a significant lip-tie can contribute to a gap between baby front teeth too, and while some of these gaps close on their own as permanent teeth come in, persistent or wide gaps are worth monitoring at regular checkups.
Disclaimer: The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.