Tongue and lip tie, medically referred to as ankyloglossia (tongue tie) and maxillary labial frenulum tie, lip tie, can persist into adulthood if left untreated.
While these tethered oral tissues (TOTs) are often discussed in the context of infants and children, they can have significant implications for adults as well.
These conditions involve the lingual frenulum (the tissue connecting the tongue to the floor of the mouth) or the labial frenulum (the tissue connecting the upper lip to the gum), which may be unusually short, thick, or tight, restricting mobility.
In this article, we will explore how tongue and lip ties affect adults, from physical symptoms and oral health concerns to speech issues and overall quality of life. We’ll also dive into diagnostic methods and treatment options available to adults dealing with this condition.
Anatomy and Understanding Tongue and Lip Tie
In adults, the anatomy of a tongue or lip tie remains consistent with childhood cases. The primary issue lies in the structure and function of the frenulum.
Tongue Tie
A restrictive lingual frenulum can limit the tongue’s range of motion, while a tight labial frenulum can restrict upper lip movement.
Tongue ties are often classified based on TRMR (Tongue Range of Motion Ratio) grading system. Here’s a snapshot:
A. Grade 1: Tongue range of motion ratio (TRMR) is greater than 80%
B. Grade 2: TRMR is 50–80%
C. Grade 3: TRMR is less than 50%
D. Grade 4: TRMR is less than 25%
When viewing the tongue is it able to lift and point behind the upper teeth and maintain a wide open jaw. As it lifts and points does the tip look rounded or does it dip in the middle forming a heart shape?
Assessing the posterior, back, of the tongue is important. Too often the request is to simply stick out the tongue. This, however, is not a good measurement of function. Better to ask to click or pop the tongue, and to also hold the click up and suck the tongue into the palate.
Grab our home self-assessment of tongue tie HERE to help you determine the presence of tongue tie for yourself!
Lip Tie
Lip-ties are categorized and graded similarly, depending on the severity and location of the frenulum. The grade is determined by the thickness, point of attachment, and amount of restrictive lip movement.
Additionally, with the upper lip the space between the nose and lip, the philtrum, is assessed for flatness, length of space, and depth of groove.
Then the appearance of the lip, either thin or pressing against the gum ridge and M shape/bow dip, is considered in assessing lip tie.
Grab our home self-assessment lip tie HERE to help you determine the presence of a lip tie for yourself!
How Tongue and Lip Ties Affect Adults
Speech and Communication Challenges In Tongue and Lip Tied Adults
Adults with tongue and lip ties may experience lingering speech difficulties that were addressed in childhood.
A restricted tongue and lip can impair articulation, making it challenging to produce certain sounds, such as “L,” “R,” and “TH.” While also causing poor air direction on sounds S SH CH J creating lateral or frontal lisps.
Additionally, adults may experience fatigue or discomfort when speaking for extended periods. Describing tension in the facial muscles and tongue causing them to pause and rest.
For individuals who rely on clear speech for their profession—such as teachers, public speakers, or customer service workers—a tongue or lip tie can significantly impact their confidence and performance.
Oral Health Concerns
Restricted tongue and lip mobility can lead to poor oral hygiene habits. Adults with tongue-tie may struggle to clean all areas of their mouth effectively, increasing the risk of cavities, gum disease, and bad breath.
A tight upper lip frenulum can also contribute to dental problems, such as spacing issues between the front teeth (diastema) or difficulty in placing dental appliances like braces or retainers. Over time, these issues can lead to more significant oral health complications.
Ideally, there is harmony in the amount of pressure applied from the lip and tongue to the maxillary arch. In essence, forming a mold for the teeth to live in. This balance keeps the teeth straight and healthy.
Sleep and Breathing Issues
Tongue and lip ties have been linked to sleep-disordered breathing, including obstructive sleep apnea (OSA). A restricted tongue may fall back into the airway during sleep, causing partial or complete airway obstruction.
Adults with undiagnosed tongue-tie often report symptoms such as snoring, frequent waking, and excessive daytime fatigue.
Optimally, the tongue should rest up in the palate or roof of the mouth. In this position, it applies pressure to the nasal and sinus cavities to keep them open and flowing. The airway is open and moving without obstruction from the tongue falling into and blocking the airway.
For individuals with OSA, addressing a tongue-tie can sometimes improve breathing and sleep quality, particularly when combined with other therapies. Simply clipping a tongue tie or lip tie will not magically improve muscle function.
For that, one needs to complete oral motor or myofunctional exercises to teach the muscles where to go. This is best-done pre and post-surgery for the release of tethers.
Jaw Pain and TMJ Disorders
Adults with tongue or lip ties may experience jaw tension or temporomandibular joint (TMJ) disorders due to the compensatory movements required to perform basic oral functions. For example, limited tongue mobility can lead to improper swallowing patterns, placing undue stress on the jaw muscles and joints.
Symptoms such as jaw pain, clicking or popping sounds in the jaw, and headaches may indicate that a tongue or lip tie is contributing to the issue.
The jaw is the bigger structure supporting the oral muscles. It moves to compensate for the lack of tongue or lip movement. Over time this compensation will break down the joint causing pain and error patterns in movement.
When ties are present the oral system is out of balance. It is always trying to achieve balance, and in doing so will disrupt other areas.
Pelvic Floor Disorders
Which leads us to pelvic floor disorders. Just as the jaw is the base of support to the oral muscles, the body/core is the base of support to the jaw. In that body core, the support comes upward from the pelvic floor and diaphragm.
When tethered oral tissues are present, the fascia bands that run through the body have a hiccup in movement.
This hiccup leads to compensation and recruitment of other areas of the body. The jaw, neck, diaphragm, and pelvic floor become the line of defense. The mouth is recruiting help!
Considering the system as a whole in this way we can see the connections and potential breakdowns.
Difficulty with Eating and Drinking
A restricted tongue and lip can make eating and drinking uncomfortable or inefficient for adults.
Tasks such as licking an ice cream cone, clearing food particles from teeth, or swallowing certain textures may require extra effort. Over time, these challenges can lead to frustration or avoidance of specific foods.
Many children are picky eaters due to undiagnosed ties. As unaddressed tethered oral tissues persist into adulthood the limited diet can affect nutritional intake and overall wellness.
In some cases, adults may develop compensatory habits, such as using excessive force to chew or swallowing in small, inefficient gulps, which can lead to digestive discomfort. The mouth is the first stage of digestion. The poor breakdown here will lead to the issues below!
Digestive Disorders
Equally important to explore is the connection between tongue and lip tie to digestive disorders. Swallowing too much air can lead to gas, burping, and bloating.
The thrust of the tongue needed to propel the food into the throat and down the esophagus is weak and can lead to reflux or heartburn symptoms.
This results in the need to purchase anti-acid products and limit food choices. But all one is doing is treating a symptom and not a cause. Many adults report improvement with digestion and digestion disruptions after tongue and lip tie release.
Diagnosis of Tongue and Lip Tie in Adults
Diagnosing tongue and lip ties in adults requires a comprehensive evaluation by a qualified healthcare professional, such as a speech-language pathologist, dentist, or oral surgeon. The assessment typically includes:
Visual Examination: The provider will inspect the appearance of the frenulum and its attachment points.
Functional Assessment: The range of motion of the tongue and lip is tested, along with any associated symptoms such as speech difficulties, jaw pain, or swallowing issues.
Patient History: A detailed history of the patient’s symptoms, including any challenges with oral functions or quality of life, will help guide the diagnosis.
In some cases, imaging studies or diagnostic tools like videofluoroscopy may be used to assess swallowing patterns and tongue mobility in greater detail.
For some, there may be a sleep study involved if their primary area of concern is snoring and sleep disturbance.
Treatment Options for Adults with Tongue and Lip Tie
Speech Therapy and Myofunctional Therapy
Before and after surgical intervention, many adults benefit from working with a speech-language pathologist or myofunctional therapist. These specialists provide targeted exercises to improve tongue strength, coordination, and mobility.
Therapy sessions may also address any compensatory habits developed over the years, such as incorrect swallowing patterns or improper speech articulation.
Myofascial release is a specific technique utilized to release the tension under the tongue within the soft tissues. The fascia is the connective tissue within the muscle that becomes hindered when oral ties are present.
Directly addressing the fascia through soft tissue or deep tissue releases is beneficial to the overall function of the muscles.
Layering active myofunctional exercises with myofascial releases combines the concepts of passive and active exercises. For a more detailed dive into myofunctional and myofascial release exercise programs check out our article Myofunctional Therapy Exercises.
Orthodontic and Dental Support
In cases where tongue or lip ties have contributed to dental misalignment or bite issues, orthodontic treatment may be necessary. Braces, aligners, palate expanders or other dental appliances can help correct these problems and improve overall oral function.
This is often best combined with myofunctional therapy to address both the bone and muscle fascia systems together.
Addressing Sleep Disorders
For adults experiencing sleep-disordered breathing due to tongue-tie, addressing the tie may complement other treatments such as continuous positive airway pressure (CPAP) therapy, oral appliances, or positional therapy.
Surgical Release for Tongue and Lip Tie in Adults
Frenectomy
A frenectomy is a simple surgical procedure to release the restrictive frenulum. This is often performed using a scalpel, laser, or electrocautery device. Frenectomy procedures are relatively quick, with minimal discomfort and a short recovery period.
Finding a preferred provider is the key! Not all providers in the ENT and dentistry realms believe in the impact of tethered oral tissues. Adults at times are led away from treatment options by providers who do not specialize in these disorders.
For a state-by-state list of preferred providers please check out this website Tongue Tie Life.
Living with Tongue and Lip Tie
Living with an untreated tongue or lip tie can affect every aspect of daily life, from eating and speaking to sleeping and social interactions. Adults often report feeling frustrated or self-conscious about their condition, particularly if it has gone unrecognized for years.
The good news is that treatment options for tongue and lip ties are highly effective, with many adults experiencing immediate relief from their symptoms after intervention. Whether through surgical procedures, therapy, or a combination of approaches, adults can achieve significant improvements in their oral health, speech, and quality of life.
Conclusion Tongue and Lip Tie
Tongue and lip ties are not just pediatric conditions—they can persist into adulthood and cause a variety of functional challenges. By understanding the impact of these tethered oral tissues, adults can seek appropriate diagnosis and treatment to address their unique needs.
If you suspect that you may have a tongue or lip tie, consulting with a knowledgeable professional is the first step toward improved health and well-being. With advancements in surgical techniques and therapeutic interventions, living with a tongue or lip tie no longer has to be a lifelong struggle.
We’ve put together a step-by-step guide to better help you understand the whole process. Grab your free copy HERE!