Oral ties explained: Types, symptoms and why early release matters”

Written By Carly Hupfeld

As a GP specialising in oral tie releases, I often encounter questions about the various types of oral ties, what they are, what they look like, where they are and their impact. Understanding these can help parents seek timely treatment. Below you will find a very brief summary of the types of oral ties.

The Different Types of Oral Ties

1.Tongue Ties (Ankyloglossia)
Tongue tie occurs when the lingual frenulum - the tissue connecting the underside of the tongue to the floor of the mouth - is unusually short or tight, restricting tongue movement.

The classification varies depending on your source, but the commonly used Coryllos classification separates tongue ties into 4 types.

This classification helps in diagnosing and determining the severity of tongue-tie conditions, but it doesn’t reflect the severity of the symptoms. As such, a functional assessment is always necessary to complete the diagnosis.

Types 1 & 2 are considered the “classical” type of tongue ties but type 3 and 4 can cause just as significant symptoms but are commonly missed.

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Table 1.1 – The Coryllos Classification of tongue ties

2. Lip Ties (maxillary labial frenulum attachments)
The labial frenulum connects the upper lip to the gum. When tight or thick, it can restrict lip movement, potentially causing breastfeeding difficulties, poor latch, or dental hygiene challenges.

The Kotlow lip tie classification is a widely used system for describing the severity and location of upper lip ties in infants and children. It is based on where the frenulum attaches to the gingival (gum) tissue, helping clinicians assess the potential impact on function.

Class I is rarely restrictive, Class II and III may affect feeding or oral hygiene, depending on tightness, while class IV is most restrictive and most likely to cause functional problems. However, although the classification system helps guide treatment decisions, it does not always indicate symptom severity, as some children may compensate well despite a higher class tie.

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Table 2.1 The Kotlow lip tie classification

3. Cheek Ties (Buccal Ties)
Less common, buccal ties involve a mucosal attachment from the cheek to the gum, which may affect oral function and comfort. They are classified based on the membrane attachment site.

  • Class 1 – Mucosal Attachment

  • Class 2 – Gingival Attachment

  • Class 3 – Alveolar Ridge Attachment

Under normal circumstances, the buccal frenulum supports the structure of the cheeks and lips. The membrane extends to both sides of your mouth, but if it’s too tight, it has been said to restrict normal cheek movement, interfering with the feeding process.

Why Early Diagnosis and Treatment Matter
Oral ties can interfere with breastfeeding, speech development, dental health, and even posture or breathing. Early assessment by a trained professional ensures appropriate management - whether it is monitoring, feeding support, bodywork, frenotomy, or frenuloplasty - leading to better outcomes.

If you have concerns, I am happy to consult with you and your family to discuss the symptoms and help make a proper assessment and diagnosis. To arrange an appointment, please call Medical on Robina to discuss your concerns with me.

 

References

Carly Hupfeld
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