Journal of South Asian Association of Pediatric Dentistry

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VOLUME 4 , ISSUE 2 ( July-September, 2021 ) > List of Articles


Sequelae of Tethered Oral Tissues in Infants: A Challenging Expertise Conundrum

Jayalakshmi Pandranki, Narasimha Rao V Vanga, V Rajasekhar, Chandrabhatla S Kumar

Keywords : Infants, Lip tie, Tethered oral tissues, Tongue tie

Citation Information : Pandranki J, Vanga NR, Rajasekhar V, Kumar CS. Sequelae of Tethered Oral Tissues in Infants: A Challenging Expertise Conundrum. J South Asian Assoc Pediatr Dent 2021; 4 (2):73-78.

DOI: 10.5005/jp-journals-10077-3069

License: CC BY-NC 4.0

Published Online: 26-08-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Timely prediction of diversified effects of tethered oral tissues in infancy is utmost important for the proper development of the stomatognathic system. Objective: To assess current opinion/knowledge of infant oral care specialists about the repercussions of tethered oral tissues in infants influencing function, growth, and development. Study design: A cross-sectional survey was done among 192 dentists of which 46.35% were oral surgeons and 53.65% were pediatric dentists. The responses obtained were subjected to the statistical analysis using the Chi-square test. Results: Most commonly reported conjectures include speech defects (77.6%), breastfeeding dysfunction (71.8%), midline spacing between teeth (71.4%), atypical swallowing (67.7%), followed by sleep issues (31.8%) and dentoskeletal alterations (43.2%). Least possibly reported conjectures are postural alterations (10.4%), caries susceptibility (13.5%), unexpected and unexplained asphyxia (15.6%), and tearing of gingival tissues (19.3%). Conclusion: Both specialty dentists, i.e., pediatric dentists and oral surgeons, believe that tethered oral tissues cause breastfeeding dysfunction, speech impediments, midline diastema, and permanence of atypical swallowing but limited awareness exists about their consequences such as sleep and breathing disorders, caries initiation, gingival recession, malocclusions, and postural alterations.

  1. Priyanka M, Sruthi R, Ramakrishnan T, et al. An overview of frenal attachments. J Indian Soc Periodontol 2013;17(1):12–15. DOI: 10.4103/0972-124X.107467.
  2. Dezio M, Piras A, Gallottini L, et al. Tongue-tie, from embriology to treatment: a literature review. J Pediat Neonat Individual Med 2015;4(1):e040101. DOI: 10.7363/040101.
  3. Messner AH, Lalakea ML. Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryng 2000;54(2-3):123–131. DOI: 10.1016/S0165-5876(00)00359-1.
  4. American Academy of Pediatric Dentistry. Policy on the Dental Home. The Reference Manual of Pediatric Dentistry. 2018; 34-35. Available at: “ Accessed May 21, 2020.
  5. Kupietzky A, Botzer E. Ankyloglossia in the infant and young child: clinical suggestions for diagnosis and management. Pediatr Dent 2005;27:40–46.
  6. Lau C. Development of suck and swallow mechanisms in infants. Ann Nutr Metab 2015;66(Suppl 5(05):7–14. DOI: 10.1159/000381361.
  7. Lalakea ML, Messner AH. Ankyloglossia: does it matter? Pediatr Clin North Am 2003;50(2):381–397. DOI: 10.1016/S0031-3955(03)00029-4.
  8. Kotlow L. Infant reflux and aerophagia associated with the maxillary lip-tie and ankyloglossia (tongue-tie). Clin Lactat 2011;2(4):25–29. DOI: 10.1891/215805311807011467.
  9. Kotlow L. Tethered oral tissues as a differential diagnostic tool in infants and toddlers presenting with obstructive sleep apnoea and air induced reflux. AMJ 2019;12(5):131–137. Available at:
  10. Forlenza GP, Paradise Black NM, McNamara EG, et al. Ankyloglossia, exclusive breastfeeding, and failure to thrive. Pediatrics 2010;125(6):e1500–e1504. DOI: 10.1542/peds.2009-2101.
  11. Khoo AKK, Dabbas N, Sudhakaran N, et al. Nipple pain at presentation predicts success of tongue-tie division for breastfeeding problems. Eur J Pediatr Surg 2009;19(06):370–373. DOI: 10.1055/s-0029-1234041.
  12. Baxter R, Hughes L. Speech and feeding improvements in children after posterior tongue-tie release: a case series. Int J Clini Pediatr 2018;7(3):29–35. DOI: 10.14740/ijcp295w.
  13. Muldoon K, Gallagher L, McGuinness D, et al. Effect of frenotomy on breastfeeding variables in infants with ankyloglossia (tongue-tie): a prospective before and after cohort study. BMC Pregnancy Childbirth 2017;17(1):373. DOI: 10.1186/s12884-017-1561-8.
  14. Guilleminault C, Huseni S, Lo. L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Res 2016;2(3):00043–02016.
  15. American Academy of Pediatrics. Clinical practice guideline on the diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130(3):576–684. DOI: 10.1542/peds.2012-1671.
  16. Rambaud C, Guilleminault C. Death, nasomaxillary complex, and sleep in young children. Eur J Pediatr 2012;171(9):1349–1358. DOI: 10.1007/s00431-012-1727-3.
  17. Luzzi V, Ierardo G, Di Carlo G, et al. Obstructive sleep apnea syndrome in the pediatric age: the role of the dentist. Eur Rev Med Pharmacol Sci 2019;23(1 Suppl):9–14.
  18. Haller LA, Brown T. Upper-lip frenum as a predictive marker for unexpected and unexplained asphyxia in infants. J Rare Dis Diagn Ther 2016;2(2):2–5.
  19. Chinnadurai S, Francis DO, Epstein RA, et al. Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. Pediatrics 2015;135(6):e1467–e1474. DOI: 10.1542/peds.2015-0660.
  20. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngol Head Neck Surg 2002;127(6):539–545. DOI: 10.1067/mhn.2002.129731.
  21. Pompéia LE, Ilinsky RS, Ortolani CLF, et al. Ankyloglossia and its influence on growth and development of the stomatognathic system. Rev Paul Pediatr 2017;35(2):216–221. DOI: 10.1590/1984-0462/;2017;35;2;00016.
  22. Wright JE. Tongue-tie. J Paediatr Child Health 1995;31(4):276–278. DOI: 10.1111/j.1440-1754.1995.tb00810.x.
  23. Pransky SM, Lago D, Hong P. Breastfeeding difficulties and oral cavity anomalies: the influence of posterior ankyloglossia and upper-lip ties. Int J Pediatr Otorhinolaryngol 2015;79(10):1714–1717. DOI: 10.1016/j.ijporl.2015.07.033.
  24. Olivi G, Chaumanet G, Genovese MD, et al. Er,Cr:YSGG laser labial frenectomy: a clinical retrospective evaluation of 156 consecutive cases. Gen Dent 2010;58:e126–e133.
  25. Nathan JE. The indications, timing, and surgical techniques for performing elective lingual and labial frenulectomies for infants and children. Inter J Otorhinolaryngol 2017;4(1):3.
  26. Kotlow LA. The influence of the maxillary frenum on the development and pattern of dental caries on anterior teeth in breastfeeding infants: prevention, diagnosis, and treatment. J Hum Lact 2010;26(3):304–308. DOI: 10.1177/0890334410362520.
  27. Defabianis P. Ankyloglossia and its influence on maxillary and mandibular development. (a seven year follow-up case report). Funct Orthod 2000;17:25–33.
  28. Meenakshi S, Jagannathan N. Assessment of lingual frenulum lengths in skeletal malocclusion. J Clin Diagn Res 2014;8:202–204.
  29. García PMJ, González GM, García MJM, et al. A study of pathology associated with short lingual frenum. ASDC J Dent Child 2002;69(1): 59–62.
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