Paediatric dentistry

Tongue-tied

Sir, ankyloglossia or 'tongue-tie' is a condition affecting the attachment of the tongue to the floor of the mouth via the lingual frenulum. It has a cited prevalence of up to one in ten newborns in the UK. Despite working in several oral and maxillofacial units in England and Wales over the past six years, it was not a condition I had routinely encountered, or even treated. Discussion with colleagues would often present a very mixed picture of opinions ranging from the die-hard proponents for swift surgical intervention, to those who believed there was no objective benefit from doing so.

It was only when I was presented with personal experience of the condition in our own newborn that the minefield of risks, benefits, treatment options and their sequelae facing parents and patients became evident. The range of professionals advertised as having a hand in this was also a potential for confusion; the Association of Tongue-tie Practitioners (ATP) lists ten types of healthcare professionals including dentists, doctors, registered midwives, registered nurses, advanced neonatal practitioners, lactation consultants and breastfeeding counsellors. Coupled with the sudden challenges a newborn can bring to a household, particularly for mothers trying to breastfeed, this can add an unwanted level of strain. Discerning who to contact for advice and who can provide the best care is not always straightforward, and that is speaking as someone working in the profession.

The decision to treat is based on early history and assessment, examining any feeding difficulty, mastitis, low milk production, dread of feeding time, latch problems and colic. A subsequent clinical examination will follow which often involves observation of feeding for signs such as clicking.

If treatment is indicated, it will commonly involve surgical division of the frenulum, either under local anaesthetic in the early months or under general anaesthetic after this. Common risks include pain, swelling, bleeding, infection, relapse and need for further treatment. I would advise that as ever the first port of call for new parents be your midwife or healthcare visitor, who will be best placed to refer you onto secondary care services if necessary.

There is however a wide range of excellent resources available that we can direct patients toward, including the NHS website, the ATP website, and professionally, the NICE guidance published in 2005 entitled 'Division of ankyloglossia (tongue-tie) for breastfeeding'. This is definitely an area in which I hope further rigorous research and evidence can be completed to aid both clinicians and parents in the consent process to quite an invasive procedure in their newborns.

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Correspondence to O. Rees-Stoner.

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Rees-Stoner, O. Tongue-tied. Br Dent J 229, 637–638 (2020). https://doi.org/10.1038/s41415-020-2418-5

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