From Mild to Severe: The Comprehensive Guide to Tongue-Tie

Ankyloglossia, better known as tongue-tie, is a condition that can restrict oral function in patients of all ages. The tongue’s movement is restricted due to a short, tight, or thin lingual frenulum, which is the connective tissue between the tongue and the floor of the mouth. As a result, it can impact speech, eating, and other day-to-day actions. Healthcare professionals use several classification systems to effectively diagnose and treat tongue-tie. Read on to explore these systems in detail!

Kotlow’s Assessment

A primary method for classifying tongue-tie is Kotlow’s assessment, which categorizes the condition based on the distance from the tip of the tongue to the frenulum:

• Class 1 (Mild): The tie is 12–16 millimeters from the tip of the tongue, causing minor issues in tongue movement.
• Class 2 (Moderate): The tie is 8–11 millimeters from the tip of the tongue, making the restriction more noticeable and leading to moderate difficulties with speech and eating.
• Class 3 (Severe): The tie is 3–7 millimeters from the tip of the tongue, severely impacting the ability to move the tongue.
• Class 4 (Complete): The tie is less than 3 millimeters from the tip of the tongue. At this severe level, the tongue is almost entirely immobilized.

Frenulum Type

Aside from Kotlow’s assessment, another important classification system focuses on the type of frenulum:

• Type II: The frenulum anchors the tongue 2–4 millimeters from the tip to the floor of the mouth, allowing some flexibility while still limiting the tongue’s range of motion.
• Type III: The frenulum is thick and stiff, anchoring the tongue from the middle of the underside to the floor of the mouth, creating a significant barrier to tongue movement.
• Type IV: The frenulum is posterior or not visible, but tight fibers can be felt when touching the area with the fingertips. This is often harder to diagnose because it’s less noticeable.

Anterior vs. Posterior Tongue-Tie

Lastly, this classification focuses on the location of the tie:

• Anterior Tongue-Tie: All four classes in Kotlow’s assessment fall under this category. These tongue-ties are much easier to diagnose because they’re visible and measurable.
• Posterior Tongue-Tie: These ties lie beneath the mucous membranes at the bottom of the mouth. They’re less visible and can be identified by touch. In many cases, they require a more nuanced approach for diagnosis and treatment.

Understanding how tongue-tie is evaluated and classified helps ensure accurate diagnosis and effective treatment for individuals of all ages. With early intervention, we can significantly improve the ability to speak, eat, and enjoy a better quality of life.

About the Author

Dr. Garcia-DeMartino is a lip and tongue tie specialist with decades of experience under her belt. She excels in educating patients of all ages about tongue-tie and offers painless laser frenectomies. Committed to staying current with the latest in the field, Dr. Garcia-DeMartino ensures the best care for her patients. To schedule an appointment, visit her website or call (909) 840-8399.