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It's time to know the difference between a lip tie and a normal frenulum

Have ever used Dr Google for a medical diagnosis or heard about a condition which a friend-of-a-friend has and decided you have it too? Maybe you’ve diagnosed your children with these conditions. Perhaps something which you have read in these blogs has you concerned about your child’s health. It is quite common for dentists to be approached because they think their child has a lip or tongue-tie because they have heard about it from someone. So our hope here is to debunk some of these possible concerns by clarifying what a ‘normal’ lip tie is, and what is a less-normal, possibly concerning one.

Upper labial frenulum, commonly known as an upper lip tie (“ULT”) is classified into four categories, much like a cyclone, with one being almost non-existent and four being of more concern. Cat 4 ties extend from the uppermost part of the inner lip through to the hard pallet of the mouth. Realistically no one category is worse than another because a person can still have a Cat 4 ULT without it being a hindrance to their lip movement. These categories are simply used as a gauge or measurement for determining treatment if the need arises. It is also important to note that the location and length of the frenulum is not a deciding factor of whether a ‘tie’ exists.

LTT-before after

The way in which ULT is diagnosed, as being in need of treatment, is in the feel and movement of the lip. Ordinarily, a lactation consultant or midwife will be the first to raise concerns as they will be examining an infant for attachment issues to either the breast or bottle. If the midwife or lactation consultant is concerned, they may then have a closer examination of the lip to see that the ULT can be shifted (pushed higher) or whether it is restricting the upper lip movement – which if it is unable to move, may hinder attachment. This examination will involve the midwife placing their hands inside the upper lip and stretching it. If it is determined that the tie is the cause of the attachment problems, then they will refer you on to a dentist to have the tie severed or lessened. For more information on this procedure, click here*.

If your child has a Cat 3 or Cat 4 ULT which hasn’t restricted feeding, they may still need intervention to lessen the degree of the ULT. This is because a Cat 4 ULT may cause dental concern by creating a gap in the teeth, which could harbour bacteria if not correctly cleaned. However, having a Cat 4 ULT is not an immediate cause for concern. It simply means that the patient may need intervention later on if a noticeable build-up of decay is detected. In some cases, a large Cat 4 ULT can be abolished naturally once the permanent teeth emerge, thus eliminating the need for dental intervention.

An important distinction to make, if your child has a ‘large’ frenulum is if it is interfering or causing discomfort. Some children may continually knock a Cat 4 frenulum with a toothbrush, for example, which may cause it to bleed often. Other times it may become sensitive. If this is the case, we recommend coming to see us for a closer examination. We are happy to treat a Cat 3 or 4 ULT for cosmetic or quality of life purposes, despite it being of no orthodontic concern.

For more information on upper lip labial frenulum or to make an appointment for an examination of a problem tie, please contact our KIDS practice or book online.

* Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.


Ghaheri, R. (2014). The difference between a lip tie and a normal labial frenulum. 

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