When a provider tells you your child has a class 3 tongue tie, that is not a severity rating (mild, moderate or severe). That class tells you where the frenulum (the tissue under the tongue) enters the tongue. The frenulum can attach anywhere along the floor of the mouth, either right by the gum line or all the way back under the tongue. The frenulum then enters of “inserts” into the tongue anywhere from the tip of the tongue (class 1), to the belly of the tongue (class 3), or the back of the tongue (class 4 or posterior). Just because you have a visible class 3 frenulum does not mean it is tied or a “min/mod/max” restriction. There currently is no severity rating for tongue ties. A frenulum either still allows the tongue it’s range of motion to all areas/planes in the mouth, or motion is restricted. Now while the frenulum does not have a severity rating, we can classify the restriction of movement of the tongue: is the tongue movement from side to side normal or mild/moderate/severely reduced? Is tongue protrusion normal or mild/moderate/severely reduced? Is tongue elevation normal or mild/moderate/severely reduced? Regardless of class (where the frenulum is located), a frenulum that is too short or too tight that restricts movement of the tongue and causes breastfeeding problems (that cannot be fixed through improved position and deeper latch or bodywork to reduce stress in other areas of the body) should be further assessed by a pediatric dentist or qualified ENT for management. Some day there may be a different classification system that includes severity, but in current research it does not exist.
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