Dental and oral development

Lip Tie: What It Is and What the Evidence Shows

Diagnosis rates rose far faster than the evidence did — what the labial frenum is, and what to ask before agreeing to anything.

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A dentist in gloves examining the inside of a young boy's mouth

Reviewed by Dr. Yana Pekarski, DDS Sources are listed at the foot of the page. · Last updated August 27, 2026

A "lip tie" refers to the band of tissue connecting the upper lip to the gum — the labial frenum — being described as unusually tight or attached low. This tissue is normal anatomy present in every infant, and its appearance changes as a child grows. In 2024 the American Academy of Pediatrics stated there is no evidence supporting release of the upper lip or buccal frena in infants to help with feeding, and the Australian Dental Association's policy statement, amended in October 2025, found insufficient evidence to support labial frenum release for breastfeeding difficulties, speech outcomes, or orthodontic issues. A 2020 clinical consensus statement concluded lip ties are over-diagnosed and over-treated in some communities. If feeding is difficult, a skilled feeding assessment should come first.

What the labial frenum is

The labial frenum is the small band of tissue connecting the inside of the upper lip to the gum above the front teeth. It is normal anatomy present in every infant. Its attachment naturally looks lower and tighter in a baby and changes as the jaw grows and the teeth erupt — which is why something that looks concerning at three months often looks unremarkable at three years.

What the evidence says

Across pediatrics, dentistry, and ENT, the position is consistent — and notably, one of the clearest statements comes from a dental association's own policy.

Why lip tie diagnosis rose

Three things drove it: greater awareness, the growth of a commercially significant procedure, and the habit of diagnosing lip tie alongside tongue tie during the same assessment. A lip tie is frequently identified in the same appointment as a tongue tie — which is one reason the two rose together.

If feeding is difficult

Skilled feeding support comes first: an IBCLC lactation consultant, a speech-language pathologist where indicated, and only then any surgical consideration — and that consideration is for a clearly restricting anterior tongue tie, not a lip tie. See the full tongue tie evidence page for how that decision should be approached.

The gap between the upper front teeth

A common reason parents are told about lip tie is a gap between the two upper front teeth. In young children this gap is normal and often closes on its own as the canine teeth erupt. The ADA statement found insufficient evidence that frenum release addresses orthodontic issues. If an orthodontic assessment is needed, it belongs later in development — not in infancy.

Questions to ask before agreeing to a procedure

  • What exactly is this expected to change, and what is the evidence for it?
  • What feeding assessment has been done, and by whom?
  • What happens if we try skilled feeding support first?
  • Is there any professional-body guidance supporting this for my child's situation?

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Frequently Asked Questions

What is a lip tie?

It's the band of tissue joining the upper lip to the gum — the labial frenum — described as tight or low-attached. This is normal anatomy in every baby, and its appearance changes as the jaw grows and teeth come in.

My baby is struggling to feed — what should we do?

Start with skilled feeding support: an IBCLC lactation consultant, and a speech-language pathologist where indicated. Surgery, if considered at all, is for a clearly restricting anterior tongue tie — not a lip tie.

Should a lip tie be released to help breastfeeding?

Major bodies say no. The AAP's 2024 report found no evidence supporting upper lip or buccal frenum release in infants for feeding, and the Australian Dental Association found insufficient evidence for labial frenum release for breastfeeding, speech, or orthodontic reasons.

Does a lip tie cause the gap between my child's front teeth?

A gap between the upper front teeth is normal in young children and often closes as the canine teeth come in. The ADA found insufficient evidence that frenum release addresses orthodontic issues, including this gap. Orthodontic assessment, if needed, comes later in development.

Sources

  1. Thomas J, Bunik M, Holmes A, Keels MA, Poindexter B, Meyer A, et al.; American Academy of Pediatrics. Identification and management of ankyloglossia and its effect on breastfeeding in infants: clinical report. Pediatrics. 2024;154(2):e2024067605. doi:10.1542/peds.2024-067605 (PMID 39069819)
  2. Knight M, Ramakrishnan R, Ratushnyak S, Rivero-Arias O, Bell J, Bowler U, et al. Frenotomy with breastfeeding support versus breastfeeding support alone for infants with tongue-tie and breastfeeding difficulties: the FROSTTIE RCT. Health Technology Assessment. 2023;27(11):1–73. doi:10.3310/WBBW2302 (PMID 37839892)
  3. Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, et al. Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Archives of Disease in Childhood: Fetal and Neonatal Edition. 2014;99(3):F189–F195. doi:10.1136/archdischild-2013-305031 (PMID 24249695)
  4. O’Shea JE, Foster JP, O’Donnell CPF, Breathnach D, Jacobs SE, Todd DA, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews. 2017;(3):CD011065. doi:10.1002/14651858.CD011065.pub2 (PMID 28284020)
  5. Australian Dental Association. Policy statement 2.13: ankyloglossia and oral frena. Board amendment October 2025. Checked August 19, 2026.
  6. Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, et al. Clinical consensus statement: ankyloglossia in children. Otolaryngology–Head and Neck Surgery. 2020;162(5):597–611. doi:10.1177/0194599820915457 (PMID 32283998)
  7. Thornton AR, Montgomery EA, Graham ME, Riley CA, Lawlor CM. Systematic review of tongue tie publications: exponential rise in publications without exponential rise in evidence. Otolaryngology–Head and Neck Surgery. 2025;173(2):324–331. doi:10.1002/ohn.1264 (PMID 40366002)
  8. Hill RR, Lee CS, Pados BF. The prevalence of ankyloglossia in children aged <1 year: a systematic review and meta-analysis. Pediatric Research. 2021;90(2):259–266. doi:10.1038/s41390-020-01239-y (PMID 33188284)
  9. Khalsa I, Pappas A, Cafferkey M, Banik G. Avoiding frenotomies and improving health equity: findings from a paradigm shift newborn feeding model. International Journal of Pediatric Otorhinolaryngology. 2025;194:112355. doi:10.1016/j.ijporl.2025.112355

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. If your baby is struggling to feed, a skilled feeding assessment by an IBCLC lactation consultant, and where indicated a speech-language pathologist, should come before any decision about surgery. Discuss your child's specific situation with their own clinicians.