A lip tie is a condition where the small band of tissue connecting the upper lip to the upper gum is unusually short, thick, or tight, restricting how freely the lip can move. Every person has this tissue, called the labial frenulum, but when it’s especially restrictive, it can potentially interfere with breastfeeding in infants and, less commonly, affect dental health later in life. Lip ties have become a hot topic in parenting circles, but there’s significant debate among medical professionals about when (or whether) they actually cause problems.
The Anatomy Behind a Lip Tie
The upper labial frenulum is a fold of soft tissue made up of connective tissue, a thin outer layer of cells, and some muscle fibers from the muscles around the nose and lip. It runs from the inner surface of the upper lip down to the ridge of gum where the upper front teeth sit. In young children, this band of tissue is naturally wide and thick. As a child grows, the eruption of baby teeth, development of the upper jaw, and vertical bone growth cause the frenulum to thin out, shrink, and migrate upward. What looks like a significant tie in a newborn often resolves on its own.
A frenulum becomes potentially problematic when it stays thick and extends deep into the gum tissue between the front teeth, reaching or penetrating the small bump of gum (the papilla) between the upper incisors. This tighter attachment can limit how much the upper lip flanges outward, which matters most during the early months of breastfeeding.
How a Lip Tie Affects Breastfeeding
The concern around lip ties centers almost entirely on infant feeding. For a baby to latch effectively at the breast, the upper lip needs to flange outward and form a seal. A restrictive frenulum can prevent this, leading to a shallow latch. Babies with a shallow latch may:
- Struggle to stay on the breast, sometimes making a clicking sound as they lose suction
- Leak milk from the corners of their mouth during feeds
- Feed for very long stretches without getting enough milk
- Choke or sputter when milk flows quickly
- Show poor weight gain or need supplemental feeding
For the nursing parent, a poor latch typically causes significant nipple pain and damage. These symptoms overlap heavily with those caused by tongue tie, and in practice, it can be difficult to pin the problem on the lip alone. It’s also worth noting that many babies with visible lip ties breastfeed without any issues at all. The appearance of the tissue matters less than how well a baby is actually feeding.
What the Research Says About Dental and Speech Effects
Outside of breastfeeding, lip ties are sometimes blamed for a gap between the upper front teeth (midline diastema), tooth decay from trapped food, gum recession, and speech problems. The evidence for most of these claims is thin. One observational study comparing children with restrictive frenulums to those without found no statistical difference in pronunciation difficulties, speech development issues, or dental conditions between the two groups. The rate of noticeable gaps between front teeth was similar as well: about 28% in children with lip ties versus 21% in children without.
In adults, an untreated restrictive frenulum can make it harder to lift the upper lip for brushing along the gumline, potentially contributing to gum recession and plaque buildup in that area. Some adults report difficulty fully exposing their upper teeth when smiling. These effects tend to be mild and manageable with careful oral hygiene habits.
The Medical Debate Around Lip Ties
This is where things get contentious. The American Academy of Pediatrics published a clinical report in 2024 stating plainly that the upper labial frenulum is a normal structure present in all infants and is “unrelated to breastfeeding mechanics.” The AAP’s position is that lip ties do not require surgical intervention to improve breastfeeding. No randomized controlled trials have been performed to evaluate whether releasing a lip tie improves any functional breastfeeding measure.
Despite this, many lactation consultants, pediatric dentists, and some ENTs do diagnose and recommend treatment for lip ties, particularly when a baby is struggling to feed. The disconnect comes partly from the fact that breastfeeding difficulties are real and urgent for families experiencing them, and releasing a tie is a quick procedure that some parents report helps. Without controlled studies, though, it’s hard to separate genuine improvement from placebo effect, natural adaptation, or the concurrent lactation support that often accompanies a diagnosis.
One common assumption is that lip ties and tongue ties tend to occur together, but research published in the Laryngoscope found no meaningful relationship between the two. The degree of tethering in the lip did not predict the degree of tethering in the tongue, suggesting they don’t cluster together the way many practitioners assume.
How Lip Ties Are Graded
There is no universally accepted grading system specifically for lip ties. Practitioners who diagnose them generally assess how far the frenulum extends toward (or past) the ridge of gum between the front teeth and how much it restricts lip movement. The evaluation is largely visual and functional: can the lip flange outward easily, or does the tissue pull it tight against the gum?
Some providers adapt classification systems originally designed for tongue ties, but these don’t translate directly to the lip. The lack of a standardized diagnostic framework is one reason the AAP and other medical bodies have been cautious about endorsing lip tie as a clinical diagnosis requiring treatment.
What Treatment Looks Like
When a provider does recommend releasing a lip tie, the procedure is called a frenectomy. It involves cutting or removing the restrictive band of tissue. In infants, this is typically done in an office setting and takes only a few minutes. Two main approaches exist.
A scissors-based release (sometimes called cold steel) involves snipping the tissue with surgical scissors. A laser release uses a concentrated beam of light to vaporize the tissue. Laser procedures generally involve less bleeding because the heat seals small blood vessels as it cuts, and some evidence from similar oral procedures suggests patients experience less pain in the days following a laser approach. Both methods carry low complication rates.
After the procedure, parents are usually instructed to perform gentle stretching exercises on the release site several times a day for a few weeks. This helps prevent the tissue from reattaching as it heals. Most babies can breastfeed immediately after the procedure, though it may take days to weeks for feeding to noticeably improve as the baby learns to use their newly mobile lip.
Getting an Accurate Assessment
If you’re concerned about a possible lip tie in your baby, the most practical first step is working with a board-certified lactation consultant who can evaluate the full picture of how your baby feeds. Poor latch has many causes, including tongue tie, positioning issues, low milk supply, and oral anatomy variations that aren’t ties at all. A lactation consultant can help identify whether the frenulum is genuinely restricting function or whether the feeding difficulty has a different root cause.
For older children or adults noticing gum recession, difficulty with oral hygiene around the upper front teeth, or a persistent gap between the incisors, a pediatric dentist or periodontist can evaluate whether the frenulum is contributing and whether a release would help. In many cases, the frenulum naturally thins with age and no intervention is needed.