What Is a Lip Tie?
Every person has a labial frenulum, a small fold of tissue that connects the inside of the upper lip to the gum above the upper front teeth. In most people, this tissue is thin, flexible, and does not restrict lip movement. A lip tie occurs when this frenulum is thicker, tighter, or attached lower on the gum ridge than normal, limiting how far the upper lip can move.
Lip ties are classified by severity using the Kotlow classification system. Class I is a mild attachment that rarely causes problems. Class II attaches into the gum tissue between the teeth. Class III extends to the area where the front teeth will erupt. Class IV is the most severe, with the tissue extending into the hard palate behind the gum ridge. Class III and IV lip ties are more likely to cause functional issues.
Lip ties frequently occur alongside tongue ties (ankyloglossia), where the tissue under the tongue is also restricted. When both conditions are present, feeding difficulties are more likely and more pronounced.
What Causes a Lip Tie?
The labial frenulum forms during fetal development. A lip tie occurs when the normal thinning and recession of this tissue during development does not happen as expected. The result is a frenulum that remains thicker or more prominent at birth than it would otherwise be.
Developmental and Genetic Factors
The exact cause of lip ties is not well understood, but there appears to be a genetic component. Lip ties tend to run in families, and some studies suggest a connection to variations in the MTHFR gene, though this link is not definitively established. Lip ties are present at birth and are not caused by anything the mother did or did not do during pregnancy.
How Common Are Lip Ties?
Mild lip ties are very common, as the labial frenulum varies widely in thickness and attachment among healthy infants. Clinically significant lip ties (those that cause functional problems) are less common but still not rare. Estimates vary because there is no universal diagnostic standard, but studies in the International Journal of Pediatric Otorhinolaryngology suggest that functionally significant upper lip ties occur in approximately 4% to 12% of infants. The condition affects boys and girls at roughly equal rates.
Signs and Diagnosis of Lip Tie
A lip tie may be identified by a lactation consultant, pediatrician, or pediatric dentist. The signs depend on the child's age.
Signs in Newborns and Infants
In breastfeeding babies, a significant lip tie can cause difficulty latching or maintaining a latch during feeding. The baby's upper lip may appear tucked inward rather than flanged outward (turned out like a fish lip) during nursing. Feeding sessions may be unusually long, and the baby may seem frustrated or fatigued during feeding. The mother may experience nipple pain, cracking, or damage despite correct positioning.
Other signs include poor weight gain in the baby, excessive gas or reflux from swallowing air during feeding, a clicking sound during breastfeeding, and the baby falling asleep quickly at the breast due to fatigue from an inefficient latch.
Signs in Toddlers and Older Children
As children grow, a lip tie may become less noticeable or may contribute to other issues. In toddlers, a tight frenulum can make it difficult to clean the upper front teeth properly, increasing the risk of early childhood cavities on the front teeth. In older children, a persistent lip tie may contribute to a gap (diastema) between the two upper front teeth that does not close on its own.
How Lip Tie Is Diagnosed
Diagnosis is based on a physical examination. The provider lifts the upper lip and evaluates the thickness, tightness, and attachment point of the frenulum. They also assess the functional impact by observing how the lip moves and, in infants, how the baby latches during feeding. There is no blood test or imaging study for lip tie. A thorough evaluation considers both the anatomy and the symptoms before recommending treatment.
Treatment and Recovery for Lip Tie
Not every lip tie needs treatment. If the tie is mild and not causing feeding problems, dental issues, or other functional concerns, monitoring is appropriate. When treatment is recommended, the procedure is a frenectomy (also called a frenotomy).
The Frenectomy Procedure
A frenectomy involves releasing the tight frenulum tissue to allow the lip to move freely. The procedure can be performed using a soft-tissue laser (most common in pediatric dental offices), surgical scissors, or a scalpel. Laser frenectomy is popular because it causes minimal bleeding, requires no stitches in most cases, and has a shorter recovery time.
For infants, the procedure typically takes less than 5 minutes. Topical numbing gel is applied to the area. If a laser is used, the tissue is released with a focused beam of light that simultaneously seals blood vessels, minimizing bleeding. The baby can usually breastfeed immediately after the procedure, which also helps soothe them.
Recovery After Frenectomy
Most babies and young children recover quickly from a frenectomy. The treatment site forms a white or yellowish patch (this is normal healing tissue, not an infection) that typically resolves within 1 to 2 weeks. The provider will likely recommend stretching exercises to perform several times daily for 2 to 4 weeks after the procedure. These stretches involve gently lifting the upper lip to prevent the released tissue from reattaching during healing.
Mild fussiness for the first 24 to 48 hours is normal. Infant acetaminophen (as directed by your pediatrician) can be given if the baby seems uncomfortable. Breastfeeding or bottle-feeding can resume immediately. Some babies show an immediate improvement in latch, while others take several days to weeks to adjust to the new range of motion.
Working with a Lactation Consultant
A frenectomy releases the physical restriction, but the baby and mother may need to relearn effective feeding technique. Working with a board-certified lactation consultant (IBCLC) before and after the procedure is strongly recommended. The lactation consultant can help with latch assessment, positioning, and exercises to help the baby adapt to the improved lip mobility.
Cost of Lip Tie Treatment
The cost of lip tie evaluation and treatment varies by provider, method, and location. Below are typical cost ranges as of 2024. Actual costs may differ.
An initial evaluation and feeding assessment typically costs $100 to $300. A laser frenectomy ranges from $250 to $800, depending on the provider and geographic area. A frenectomy performed with scissors or a scalpel may cost $150 to $500. Lactation consultant visits typically cost $100 to $250 per session, and multiple sessions may be recommended.
Insurance and Coverage
Coverage for lip tie treatment varies widely. Some medical and dental insurance plans cover frenectomy when it is documented as medically necessary (for example, when it is causing weight gain problems in an infant). Other plans classify it as elective. Medicaid coverage varies by state. If the procedure is performed by a dentist, it may be billed under dental insurance. If performed by an ENT or pediatrician, it may be billed under medical insurance. Contact your insurance provider and the treating office before the procedure to understand your coverage.
When to Seek Evaluation for a Lip Tie
Consider seeking evaluation if your newborn or infant is having persistent difficulty latching during breastfeeding despite working with a lactation consultant. Seek help if your baby is not gaining weight as expected, if breastfeeding is consistently painful for the mother, or if you notice the baby's upper lip remains tucked in rather than flanging outward during feeding.
For older children, consult a pediatric dentist if you notice a persistent gap between the two upper front teeth that does not close as more teeth come in, if your child has frequent cavities on the upper front teeth despite good oral hygiene, or if the tight tissue causes pain or makes it difficult to brush the upper front teeth.
Early evaluation is especially important for feeding issues. If breastfeeding problems are caught and treated in the first few weeks of life, outcomes are generally better than if treatment is delayed.
Finding a Provider for Lip Tie Treatment
Lip tie evaluation and treatment may be performed by a pediatric dentist, an ear-nose-throat (ENT) specialist, or in some cases, a pediatrician with training in frenectomy. For laser frenectomy, a pediatric dentist with specific training and experience in soft-tissue laser procedures is a good choice.
When choosing a provider, ask about their experience with infant lip and tongue ties, the method they use for the frenectomy (laser vs. scissors), their recommendations for post-procedure stretching exercises, and whether they work with or can refer you to a lactation consultant. A collaborative approach involving the treating provider and a lactation consultant typically produces the best results for breastfeeding infants.
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