What is a Tongue or Lip Tie?

Tongue ties. Lip ties. Oh my!


If you are (or have been) a breastfeeding mom, you probably have heard these terms. But what do they mean? What exactly is a lip and tongue tie?

What is Tongue Tie?


Ankyloglossia, more commonly known as tongue-tie, is a condition that restricts the range and motion of the tongue. If you run your finger carefully under your tongue you will feel a piece of tissue that goes from the bottom of your tongue to the floor of your lower jaw. This piece of tissue is called a frenulum and connects your tongue to the soft area on the bottom of your mouth. The frenulum is normal – everybody has one – but if that frenulum is too far forward or too tight, a tongue tie may be present. 

There are four classes of tongue ties


Each class is dependent on where the frenulum is connected to the tongue and not on the severity of the tie itself. 


Class 1 – When the frenulum is attached to the very tip of the tongue, which often makes the tongue look like a heart. This tongue-tie is anterior, which means near the front. 

Class 2 – A tie that is slightly further back/behind the tip of the tongue but still anterior. Though not as far forward as a Class 1, this tie is usually quite obvious. 

Class 3 – This classification starts the posterior ties. The tie is closer to the base of the tongue, and a  tight, thin, or short membrane may still be visible. 

Class 4 – Also posterior, submucosal (under mucous membrane). This is the most commonly missed tongue tie, since the frenulum may not be present because it is under the mucous membrane of the lower jaw. Babies with this type of tie often can not reach the roof of the mouth with the middle of the tongue. To be diagnosed, a provider must be able to feel this tie, as it is very hard to see. 

What is a Lip Tie?


Everyone has an upper lip frenulum. Run your tongue across your top teeth and you will feel a thin membrane between your gum line and the inside of your upper lip. However, this upper frenulum is sometimes restricted and is defined as an upper lip tie or simply a lip tie. Babies with a lip tie almost always have a tongue tie. Much like tongue ties, lip ties are also defined by a class-based off placement, not severity. 


Class 1 – No frenulum attachment. 

Class 2 – There is a frenulum, however, it causes no restrictions. 

Class 3 – The frenulum is attached near the point of upper front teeth. There is a noticeable restriction in range of motion.

Class 4 – There is a small notch in the middle of the upper gum line. Often accompanies a thick frenulum. Notable restrictions. 

Tongue and lip ties can be complicated, but the good news is they are treatable. If you notice any of the above in your baby, or latching is painful or difficult, please seek the counsel of an International Board Certified Lactation Consultant (IBCLC) and a medical professional who specializes in oral ties.