Tongue ties

The position of the tongue at rest is the most important factor that determines the shape of the upper jaw. For example, a narrow palatum, which we all know, is mainly determined by a low tongue position at rest. This also helps determine the direction of growth of the entire face. A low resting position of the tongue will therefore often result in a vertical growth direction (sie Vertical growth of the face). A low tongue position is very often caused by a too short or too stiff tongue tie. Sometimes the tongue tie can be slightly stretched, sometimes the bottom of the mouth is flexible, but very often a tongue tie will have to be removed or split. An English pediatrician, Lawrence Kotlow, has given a guideline for this: the lengths of the tongue tie where intervention is required, when this may be necessary and when not. This is called the Kotlow classification. 

Kotlow ruler

Based on this, has developed a Kotlow ruler, useful and actually indispensable to be able to quickly and properly determine when to refer for correction of a tongue tie. The Kotlow rulers can be used in two ways:

1. For determining the place of attachment (the original measuring method Kotlow):

Hereby the distance is measured from the tip of the tongue to the point of attachment of the tongue tie at the bottom of the tongue. A distance> 16 mm is normal (for babies this is> 10 mm). Everything that is less is considered slightly to seriously deviant:

12 -16 mm Kotlow class 1: Mild
8 – 12 mm Kotlow class2: Moderate
4 – 8 mm Kotlow class 3: Severe
0 – 4 mm Kotlow class 4: Complete

2. To determine the length of the tongue tie (by the insights and experiences of

To determine the Kotlow classification in this way, hold the client's tongue backwards with a slot probe (the grooved director) or with a Liper device and tighten the tongue tie. Then you take one of the Kotlow measuring rulers, which you then keep parallel to the tongue tie. You place the end of the ruler between the bump that is visible near the bottom of the mouth at the lower part of the tongue tie (the saliva caruncles) and where the top of the tongue tie is attached to the tongue. Find the measuring rod that fits exactly in between. The relevant scale indicates which Kotlow classification is involved.

Tongbandje opmetenLiper device
Measuring the tongue tie with a Kotlow ruler and grooved director or liper device

Correction of the tongue tie?

Experience shows that intervention with a Class 1 is usually not necessary. A Class 2 may require intervention, but sometimes OMFT exercises can provide greater flexibility in the mouth and force in the tongue, making it possible to learn a good tongue position at rest and during swallowing. Experience shows that with a Class 3 and 4 this is unsuccessful and intervention by a frenulectomy or frenulotomy is necessary. Kotlow says about this:

When determining the need to revise the frenum in infants and children, the following guidelines are suggested:

  • The lingual attachment should not create a diastema (gap) between the lower front teeth
  • The lingual attachment should not cause excessive force on the lower front teeth causing them to tip backward.
  • The lingual attachment should not cause severe blanching of the gum tissue behind the lower front teeth.
  • The lingual attachment should not prevent a normal swallowing pattern. The tongue should be able to lick the lips and allow the
  • tongue to clean the tooth surfaces after eating.
  • The lingual attachment should not prevent a normal swallowing pattern. The tongue should easily touch the roof of the mouth.
  • The lingual attachment should not cause abrasion to the underside of the tongue.
  • An abnormal lingual attachment can interfere with certain eating pleasures.
  • Certain Social Activities (Importance and concerns here are under reported and under expressed!)
  • Does it affect speech?

After the tongue tie has been corrected, the parents should regularly stretch and give massage  to the place where the tie has been to prevent the wound edges from sticking. With a Liper device that is very easy and super good. The parents, and later the children, will be grateful for it.

  • Kotlow ruler
    Kotlow ruler

    A set of rulers to measure the tongue tie according to Kotlow classification. See for more information the page Tongue ties on this website.

    To be able to measure the tong-tie in a good way, you need a grooved director or a liper…

    € 19,50
  • Grooved director
    Grooved director

    The grooved director is to be used to hold the tongue backwards and tighten the tongue tie, so you can assign the Kotlow classification with the Kotlow ruler.

    € 9,50
  • Liper device
    Liper device

    When the lingual frenum was too short and has been corrected by surgical treatment, it is very important that the parents give massage to the wound, to prevent adhesion of the wound edges.

    € 14,50

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Liset Maas and Berry Verlinden
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+31 (0)6 53 783 428


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