Why it Matters

The identification and diagnosis of frenum restriction has come a long way since many practitioners were trained. There are a few ways to diagnose a tongue- tie. It is multifaceted and the reasons for diagnosis have moved beyond articulation concerns or difficulty licking an ice cream cone.  

Failure to accurately diagnose a tongue-tie and recognize the importance of treating it can lead to a lifetime of problems. Pre- and post-operation myofunctional therapy are important in addition to an oral surgical operation called a frenectomy. An experienced Myofunctional therapist will help evaluate you as a whole person. The big picture of myofunctional impairment is more important than just the tongue- tie itself. 

Look at the research ||“The tongue is an important oral structure which intervenes in speech, the position of the teeth, swallowing and certain social activities.” || MFT and Tongue ties (ankyloglossia)

What is our Evaluation Process?


“I use an adaption from the lingual frenulum protocol (Marchesan 2014) for my screening of the lingual frenum.

I look at 3 general tests. The difference in mouth opening with and without tongue tip to the incisive papilla (not suctioned), alterations to the shape of the tongue during elevation, and the frenulum fixation. 

I then look at several functional tests (Tongue mobility, tongue protrusion, and tongue lateralization) and evaluate how you feel when you're moving your tongue through those motions.” 

- Cindy Feagler, OMT, RDH (link to bio)

 How to Grade a Tongue-Tie

Calculate the TRMR (Tongue Range of Motion Ratio), this is calculated with two measurements.

Grade 1: TRMR > 80%                                                   Grade 2: TRMR 50-80%                                              

Grade 3: TRMR 50-25%                                            Grade 4: TRMR < 25% 

 Some ties are obvious, and others are identified as “mild” but still require a frenectomy due to all the myofunctional impairment present. A general rule of thumb is that anyone who has a TRMR of less than 50% needs a frenectomy. However, there are many clients with a better ratio that still require a frenectomy based upon the rest of their myofunctional impairment snapshot. 

If you think you may have tongue-tie, please contact us here.