You left the appointment with two diagnoses and one plan: your baby has a tongue tie and a lip tie, and both should be released. Maybe it was a dentist. Maybe a lactation consultant flagged it and a pediatrician shrugged. What almost nobody told you is that those two diagnoses do not sit on the same evidentiary footing — not remotely — and that the professional organizations that have looked hardest at this say so in writing.
This page is about the difference. Not just the anatomy, which is simple, but the far more useful distinction underneath it: one of these conditions has a definition clinicians agree on, and the other does not.
The Anatomy Takes One Paragraph
There are roughly seven frenula in the mouth. The American Academy of Pediatric Dentistry's policy on frenulum management lists them: "the maxillary labial frenulum, the mandibular labial frenulum, the lingual frenulum, and 4 buccal (cheek) frenula," and notes that "their primary function is to provide stability of the upper lip, lower lip, and tongue."
A tongue tie involves the lingual frenulum — the band running from the floor of the mouth to the underside of the tongue. The AAPD defines ankyloglossia as "a congenital developmental anomaly of the tongue characterized by a short, thick lingual frenulum resulting in limitation of tongue movement."
A lip tie refers to the maxillary labial frenulum (MLF), which attaches the center of the upper lip to the gum between the two front teeth. That is the whole anatomical story. Two different bands of tissue, two different structures they tether, two different functional jobs.
Only One of Them Has a Definition
Here is where the comparison stops being about anatomy.
In 2020 the American Academy of Otolaryngology–Head and Neck Surgery published a clinical consensus statement on ankyloglossia in children, developed by a panel of pediatric otolaryngologists running 89 candidate statements through three rounds of a modified Delphi process. Forty-one statements reached consensus.
On the tongue, the panel agreed on a definition: "ankyloglossia is a condition of limited tongue mobility caused by a restrictive lingual frenulum." They agreed that "anterior ankyloglossia is a potential contributor to infant feeding problems." They also agreed that "in some communities, infants and children are being over-diagnosed with ankyloglossia" — so this is not a document that waves surgery through.
On the upper lip, the statements that reached consensus read differently:
- "Presence of an upper lip frenulum is normal in an infant."
- "Upper lip tie is an inconsistently defined condition."
- "Upper lip tie has an unclear relationship to breastfeeding difficulties."
- "In some communities upper lip tie is being overdiagnosed."
Notice what is missing: a definition. The panel could agree that the term is used inconsistently, but not on what it means. The statement that a symptomatic lip tie "may be diagnosed when the lip is restricted from flaring around the breast" was put to the panel and failed to reach consensus. So did the statement that a tongue tie should be released first and the lip assessed afterward, and so did the statement that the two should be released at the same time. The experts do not agree on the sequence because they do not agree on the diagnosis.
The AAO-HNS panel went further in its discussion, noting that the Australian Collaboration for Infant Oral Research "has challenged the notion that 'tie' of the lip even exists and suggested that the term be retired."
What the Research Shows for Each
Tongue tie. The evidence here is real but narrower than the internet suggests. The AAO-HNS panel agreed that frenotomy can improve breastfeeding in infants with ankyloglossia, and also that "maternal pain and poor infant latch can be caused by ankyloglossia but these symptoms can also be present with other etiologies of breastfeeding difficulties." The AAP's 2024 clinical report on ankyloglossia tells clinicians to "reserve frenotomy for cases where significant functional impairments are observed and nonsurgical interventions have failed," and co-author Maya Bunik, MD, MSPH, put the headline plainly: "most difficulties with breastfeeding, including pain, are not due to ankyloglossia." On older children, the panel's consensus is blunt: "ankyloglossia does not typically affect speech."
Lip tie. A 2019 systematic review in Breastfeeding Medicine by Nakhash and colleagues searched the literature from 1946 to 2018 and reported its result in one sentence: "No RCT were found, and the evidence for routine ULT release in infants with breastfeeding difficulties is poor." The same review found that the Kotlow grading system most commonly used to classify lip ties "has not been found reliable both in terms of inter and intraobserver agreement and in terms of predicting the severity of the breastfeeding difficulties."
A 2021 prospective study in the Laryngoscope by Shah and colleagues at the University of Rochester examined 100 healthy newborns on days three to seven of life and had two independent reviewers grade the maxillary frenulum. Inter-rater agreement on the Kotlow scale was only fair (κ = 0.302). Their conclusion: "There was no correlation between maxillary frenulum grade and comfort with breastfeeding, pain scores, or latch."
That same study tested the assumption that bundles the two diagnoses together, and found "a modest inverse correlation in the degree of tethering for the tongue and lip," concluding that "tongue tie and lip tie may not cluster together in infants." If one underlying problem produced both, they should travel together. In 100 newborns, they did not.
The AAPD's policy summarizes the position this way: "With the lack of understanding of the function of the labial frenulum, the universality of the labial frenulum, and level of attachment in most infants, the release of the maxillary frenulum based on appearance alone cannot be endorsed."
Why Appearance Is the Wrong Test
Every classification system for the upper lip frenulum grades how high the tissue inserts. Two trained clinicians looking at the same baby frequently disagree about the grade — and even when they agree, the grade does not predict how feeding goes.
The AAPD points at what would be more useful: "future studies focusing on assessment of upper lip flexibility and the ability to flange rather than just anatomical point of insertion may provide more information." That is the functional question, and it is a different question from how the tissue looks. A lip that cannot flange out around the breast is worth assessing. A photograph of a frenulum is not a diagnosis.
The Numbers Behind the Trend
This matters because diagnosis rates have moved in a way biology cannot explain.
A Johns Hopkins analysis of US inpatient data by Walsh and colleagues found ankyloglossia diagnoses rising from 3,934 in 1997 to 32,837 in 2012, with frenotomies rising from 1,279 to 12,406 over the same period. The authors noted that children diagnosed were disproportionately male, privately insured, and from higher-income zip codes, and concluded that "this broad variation may reflect local practice patterns or imply cultural and socioeconomic bias."
A 2026 cohort study in JAMA Otolaryngology–Head & Neck Surgery tracked all 656,240 infants born in Denmark between 2014 and 2024 and found 8.6% had a frenotomy in their first year, with the annual rate climbing from 5.3 to 12.1 per 100 infants. The detail that should stop you: by municipality, the 2024 cumulative incidence ranged from 4.2 to 36.1 per 100 infants. A nearly ninefold difference in how often the same procedure is performed, inside one small country with universal health care, is a fact about local practice — not about babies.
The Gap in the Front Teeth
The other reason families are sent for a lip tie release is a gap between the upper front teeth. The AAO-HNS panel reached consensus here: "upper lip frenotomy in infants or children with primary dentition will not prevent the occurrence of an upper interincisor diastema."
The AAPD agrees and adds the timing: most gaps in the baby and mixed dentition "are normal, are multifactorial, and tend to close with maturity," so "any surgical manipulation of the frenulum is not recommended before the permanent canines erupt." The consensus statement notes something worth knowing before an early procedure — that scarring from a childhood release "may actually make diastema more likely in the permanent dentition."
While we are here: the panel also reached consensus that "surgery to release a 'buccal tie' should not be performed," because no criteria exist for deciding whether a cheek frenulum is restrictive in the first place.
So What Do You Do With Two Diagnoses?
Start with the function, not the tissue. Both the AAO-HNS panel and the AAP point the same direction: a careful history including the lactation history, a physical exam with inspection and palpation, and a look at other causes before a procedure. The panel specifically listed nasal obstruction, airway obstruction, laryngopharyngeal reflux, and craniofacial anomalies as things to rule out first in an infant with feeding difficulty.
Practically, that means a feeding assessment comes before a decision about tissue. Our page on feeding therapy for infants covers what that assessment weighs — latch, suck-swallow-breathe coordination, milk transfer, positioning — and who else belongs on the team.
For older children referred because of a specific sound, the panel's position is directly relevant: ankyloglossia does not typically affect speech, and "a consultation with a speech pathologist is encouraged before frenotomy/frenuloplasty in an older child who is undergoing the procedure for speech concerns." A sound error needs articulation therapy on its own terms, whether or not anything gets released.
And if a release has already happened, the functional question is still open. New range of motion is not a new habit — our guide to what happens after a tongue tie release covers which weeks belong to the provider who performed it and how the retraining is sequenced, and myofunctional therapy exercises walks through the stages themselves.
One more distinction worth keeping straight, because the names collide: a tongue tie is a structural restriction, while a tongue thrust is a learned swallowing pattern. Families are frequently told one when they mean the other.
What Bloom Does and Does Not Do
Bloom does not diagnose ankyloglossia, does not decide whether a release is warranted, and does not perform frenectomies. Those are decisions for a dentist, ENT, or oral surgeon, together with your pediatrician, and we will say so rather than guess.
What Laura Friedman, MS, CCC-SLP, QOM assesses is function: tongue mobility and elevation, lip seal and the ability to flange, resting oral posture, nasal breathing, and the swallow. That assessment is useful before a procedure, useful after one, and useful when the answer turns out to be that no procedure is needed. Orofacial myofunctional therapy runs in person at our Dallas office or through online myofunctional therapy nationwide.
Frequently Asked Questions
What is the difference between a lip tie and a tongue tie?
They involve two different pieces of tissue. A tongue tie — ankyloglossia — involves the lingual frenulum under the tongue, defined by the AAPD as "a short, thick lingual frenulum resulting in limitation of tongue movement." A lip tie refers to the maxillary labial frenulum connecting the upper lip to the gum above the front teeth. The difference that matters more than the anatomy: tongue tie has an agreed clinical definition and a body of research, while the AAO-HNS panel reached consensus that "upper lip tie is an inconsistently defined condition."
Is a lip tie real?
Every infant has a maxillary labial frenulum — the AAO-HNS panel agreed that "presence of an upper lip frenulum is normal in an infant." What is contested is whether a particular frenulum's appearance makes it a diagnosable condition. Some infants genuinely struggle to flange the upper lip, and that is worth assessing. The leap from "the frenulum looks tight" to "this is the cause" is where the evidence runs out.
Does releasing a lip tie help breastfeeding?
No randomized trial has shown that it does. The 2019 systematic review in Breastfeeding Medicine concluded that "no RCT were found, and the evidence for routine ULT release in infants with breastfeeding difficulties is poor," and the 2021 Rochester study of 100 newborns found "no correlation between maxillary frenulum grade and comfort with breastfeeding, pain scores, or latch." That is not proof that no infant benefits — it means the decision cannot be made from appearance, and other causes deserve attention first.
Do a lip tie and a tongue tie usually occur together?
They are usually diagnosed together, which is a different claim. The 2021 Rochester study measured both in the same 100 newborns and found "a modest inverse correlation in the degree of tethering for the tongue and lip," concluding that "tongue tie and lip tie may not cluster together in infants."
Will a lip tie release prevent a gap between my child's front teeth?
The AAO-HNS panel reached consensus that "upper lip frenotomy in infants or children with primary dentition will not prevent the occurrence of an upper interincisor diastema." The AAPD adds that most gaps in the baby and mixed dentition close with maturity, that surgery is "not recommended before the permanent canines erupt," and that scarring from an early release may make a gap more likely later.
What about cheek ties or buccal ties?
The AAO-HNS panel reached consensus that "surgery to release a 'buccal tie' should not be performed," noting that no criteria exist for deciding whether a buccal frenulum is restrictive.
Does Bloom diagnose or release ties?
No. Laura Friedman is a speech-language pathologist and Qualified Orofacial Myologist, not a surgeon or a dentist. Bloom assesses function — tongue mobility, lip seal and flange, resting posture, the swallow — which is useful whether or not a procedure is ever on the table.
Told Your Child Has Both? Start With Function.
Before anyone cuts anything, it is worth knowing what the tongue and lips can actually do. Schedule a free consultation with Laura Friedman, MS, CCC-SLP, QOM — in person in Dallas or online nationwide — for a functional assessment and an honest read on whether a procedure is even the question.