Tongue-tie release, or frenotomy, is often suggested when breastfeeding is hard, but the evidence behind it is narrow. Trials suggest a short-term reduction in nipple pain for some mothers and no consistent improvement in how babies feed. For babies who are feeding well, there is no good evidence it helps, and skilled feeding support always comes first.
Written by Dr James Tran, dentist at Lumi Dental.
The trials show a narrow, short-term benefit
A Cochrane review by O'Shea and colleagues (2017) pooled five randomised trials involving 302 babies. Frenotomy reduced nipple pain for breastfeeding mothers in the short term. Its effect on how well babies breastfed was inconsistent across the trials, and the review noted serious weaknesses in how the trials were run, which limits how certain the findings are. No serious complications were reported in those trials, although the numbers were small.
In the same period, release procedures became far more common. Kapoor and colleagues, writing in the Medical Journal of Australia in 2018, described frenotomy for Australian children between 2006 and 2016 as an increasing problem. Since then, professional bodies have become more explicit. The Australian Dental Association's policy on ankyloglossia and oral frena, last reviewed in 2025, says non-surgical management should come first, and that surgery should be considered only for a clear functional problem after non-surgical management has failed. It does not support treating ties because of speculation about future problems.
When a tie may need further assessment
Putting the guidance together, a tie is more likely to matter when all of the following apply:
- There is a tongue-tie that restricts how the tongue lifts, extends or cups.
- There is a real feeding problem, such as ongoing nipple pain or damage, a latch that will not hold, or poor weight gain.
- That problem has continued despite good help with positioning and attachment from a lactation consultant, midwife or child and family health nurse.
If one of those is missing, waiting and continuing feeding support is usually the better path. If all of them apply, next steps are best discussed with your GP or a relevant specialist. Our guides on tongue-tie and feeding and on how ties are assessed cover those earlier steps.
Questions worth asking at an assessment
- Has a lactation consultant or feeding specialist watched a full feed, and what did they find?
- How is the tie affecting how my baby's tongue moves, not just how it looks?
- What else could be causing our feeding problems?
- Who will keep supporting our feeding?
A clinician who is comfortable with these questions and happy for you to take time to decide is a good sign. It is also reasonable to seek a second opinion, especially if treatment of a lip tie or a "posterior" tie has been suggested. An Australian tongue-tie and oral frena consensus statement published in 2020 found no evidence that lip ties cause feeding or speech problems, and advised that "posterior" tongue-tie should not be used as a diagnosis.
Caring for the mouth from the start
Whatever the outcome of an assessment, normal early oral care applies. Wipe the gums with a clean, damp cloth, then start brushing with a soft brush and water once the first tooth appears. Toothpaste is not needed until 18 months unless a dentist advises it. A first dental visit when the first teeth arrive lets questions about the tongue and teeth be checked, as our guide to a child's first dental visit explains. Our articles on teething symptoms and safe relief and breastfeeding and dental care cover what comes next.
Common questions
Does a tongue-tie cause speech problems?
Only a minority of children may develop speech problems linked to a tongue-tie, and evidence for a direct link is limited. If a speech pathologist finds that tongue movement is genuinely limiting particular sounds, next steps can be discussed then. Treating a tie in infancy to prevent possible speech problems is not recommended.
Talking it through
If you would like your baby's mouth examined, the dentists at Lumi Dental in Melrose Park screen for tongue-tie, can check the tongue and lip, and help connect you with feeding support. If a tie is found, we talk through next steps with you and your GP or a relevant specialist. See our general dental care or current offers on the deals page. This article is general information and not a substitute for personal medical or dental advice.
