Tongue Tie and Orthodontics UK

What is ankyloglossia (tongue tie)?

Ankyloglossia, commonly known as tongue tie, occurs when the lingual frenulum is abnormally short, thick, or tightly attached, limiting the tongue's range of motion. In a normal frenulum, the tongue can rise comfortably to the roof of the mouth, extend beyond the lower lip, and move freely from side to side. In tongue tie, these movements are restricted — sometimes mildly, sometimes severely. Posterior tongue tie, where the frenulum sits further back and is less visible, is frequently missed in infancy and not identified until orthodontic concerns arise in childhood or adolescence. UK prevalence estimates vary, but tongue tie affects approximately 4 to 11% of newborns, with a higher rate in males. Many cases go undiagnosed until functional or dental problems prompt investigation.

How tongue tie affects jaw development

The tongue exerts continuous low-level pressure against the roof of the mouth during swallowing, rest, and speech. This pressure is a key driver of transverse and vertical jaw development in children. When the tongue is tethered and cannot rest against the palate, the normal outward forces on the upper arch are reduced. The result is a narrower upper arch — a feature commonly seen in children with undiagnosed tongue tie. A narrow upper palate can lead to posterior crossbite, crowding, and inadequate space for permanent teeth. In the vertical dimension, a low tongue resting posture can contribute to anterior open bite, as the tongue pushes forward between the upper and lower front teeth during swallowing rather than being elevated. Children with tongue tie who also mouth breathe face compounding effects on jaw form. The lower jaw may also be affected: restricted tongue elevation can alter the way forces are transmitted through the lower arch during growth, though the upper arch narrowing is the more consistently documented finding. Identifying tongue tie early — ideally during childhood when growth is still occurring — gives the best opportunity to modify these developmental trajectories before they become fixed skeletal problems.

Speech problems associated with tongue tie

Speech difficulties are one of the most recognisable features of tongue tie, though not all affected children have them. Sounds that require tongue tip elevation — including /t/, /d/, /n/, /l/, /r/, and /th/ — can be distorted when the tongue cannot lift freely. Lisping, unclear articulation, and difficulties with rapid speech are common complaints. Some children develop compensatory articulation patterns that mask the underlying restriction but create secondary speech habits. Speech and language therapists can assess whether a specific sound error is likely to be anatomical (and would benefit from frenectomy) or habitual (and would benefit from therapy regardless of frenulum release). In practice, tongue tie management for speech often involves both: a frenectomy to remove the physical barrier, followed by speech and language therapy and myofunctional exercises to retrain the tongue and establish new movement patterns. An orthodontist who notices speech abnormalities should consider whether tongue tie is a contributing factor, particularly where there is also a forward tongue position or open bite.

Open bite, anterior thrust, and orthodontic complications

Two of the most clinically relevant orthodontic consequences of tongue tie are anterior open bite and forward tongue thrust during swallowing. An anterior open bite — where the upper and lower front teeth do not meet when the back teeth are together — can be maintained or worsened by a low resting tongue that repeatedly pushes forward between the incisors. In patients where tongue tie has not been addressed, orthodontic treatment to close the open bite is at high risk of relapse: the underlying tongue behaviour continues to separate the teeth after appliances are removed. Fixed braces or clear aligners can close an open bite mechanically, but if the tongue continues to press forward habitually, the bite will open again. This is why identifying tongue tie and addressing it — ideally before or during orthodontic treatment — is important for long-term stability. Tongue tie can also contribute to increased overjet in some cases, particularly where the tongue habitually rests against or pushes against the upper front teeth. Where tongue tie is suspected as a contributing factor to any of these presentations, referral for assessment is appropriate before finalising a treatment plan.

Frenectomy: timing relative to orthodontics

A frenectomy is the surgical release of the lingual frenulum and is the standard treatment for clinically significant tongue tie. It can be performed by an oral and maxillofacial surgeon, a specialist periodontist, an ENT surgeon, or a suitably trained dentist. The procedure in older children and adults is typically done under local anaesthetic and takes only a few minutes. Healing is rapid, though post-operative tongue exercises are important to prevent reattachment of the frenulum. The question of whether frenectomy should be done before or after orthodontic treatment depends on the clinical picture. If tongue tie is contributing to upper arch narrowing, a frenectomy combined with myofunctional therapy before orthodontic arch expansion may allow better tissue response during expansion. If open bite is the primary concern, releasing the frenulum and completing myofunctional therapy before closing the open bite orthodontically reduces the risk of relapse. If tongue tie is identified partway through orthodontic treatment, release followed by post-operative exercises is still beneficial and can improve final stability. In most cases, the recommendation is to address the tongue tie before completing orthodontic treatment rather than after, particularly where open bite or arch narrowing is present.

Myofunctional therapy and tongue retraining

Releasing the frenulum removes the physical restriction but does not automatically correct years of compensatory tongue behaviour. Myofunctional therapy — exercises aimed at retraining the tongue to rest in the correct position against the palate, to swallow correctly, and to use appropriate lip seal — is an important component of comprehensive tongue tie management. In the UK, myofunctional therapy can be provided by suitably trained speech and language therapists, specialist dental hygienists, and some orthodontists. Exercises typically include tongue elevation practice, suction exercises, and swallowing pattern retraining. For orthodontic patients, incorporating myofunctional therapy into the treatment plan significantly improves the chance of stable open bite closure and maintained arch width after treatment. Orthodontists who do not currently offer myofunctional therapy within their practice should have a referral pathway to a therapist, as the combination of frenectomy, myofunctional retraining, and orthodontic appliance treatment is consistently associated with better long-term outcomes than orthodontic treatment alone in patients with tongue tie.

What to tell your orthodontist

If you or your child has been diagnosed with tongue tie, or if you have concerns about tongue resting posture, open bite, narrow palate, or speech difficulties, it is worth raising this specifically at your orthodontic consultation. Key information to share includes: whether tongue tie was identified at birth and whether it was released at that time (partial release in infancy does not always address the frenulum fully); any history of breastfeeding difficulties or speech therapy; and whether the tongue is able to reach the roof of the mouth comfortably. Your orthodontist can assess tongue resting posture and swallowing pattern as part of a functional examination. Where tongue tie is suspected but not formally diagnosed, they can refer to an appropriate specialist for assessment. Raising this before treatment begins is far better than discovering it when an open bite fails to close or relapses after treatment.

NHS referral for frenectomy in the UK

In children, lingual frenectomy for tongue tie may be available on the NHS, particularly where there is clear functional impairment — feeding difficulty in infancy, significant speech problems, or documented effects on dental development. Referral is typically via the GP, health visitor, or paediatric dentist. For adults, NHS-funded frenectomy is less consistently available and may depend on local commissioning decisions. Private frenectomy in the UK is generally straightforward to access and costs approximately £200 to £600 depending on the provider and technique used. Laser frenectomy (using a soft tissue laser rather than scissors or a scalpel) is increasingly available and is associated with less post-operative discomfort and bleeding, though evidence on superior clinical outcomes compared to conventional technique is limited.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.