Tongue Restriction Questionnaire: A New Screening Tool to Identify Tongue-Tied Patients

This study was intended to determine the prevalence of tongue restrictions in a pediatric population and develop a screening tool for tongue-tie symptoms.

Patients were screened for tongue elevation and common symptoms using a novel Tongue Restriction Questionnaire (TRQ) that assesses symptoms throughout the lifespan.

In total, 314 children (47.5% male) with a mean age of 5.8 years were screened; 25.5% of children were grade 1 (could elevate the tongue >80% to the incisive papilla), 51.3% were grade 2 (50%-80%), 20.4% were grade 3 (25%-50%), and 2.9% were grade 4 (less than 25% elevation) or most restricted. Inter-rater reliability between the dentist and the hygienist's independent grades was highly significant (ᴋ = .915, P less than .001). With regard to consideration of the child's symptoms in addition to the functional grade (tongue elevation), 26.1% of parents were interested in a referral for possible treatment; 24.5% chose to wait and consider treatment in the future if symptoms worsened; 49.4% of children had excellent mobility and/or were unaffected. Childhood symptoms that correlated with more restricted tongue grades were spitting out food (P = .004) and slow eating (P = .021), and a history of prolonged feeding (P = .052) and milk dribbling out of the mouth (P = .027) as infants. A higher symptom score in infancy correlated with a higher score in childhood (r = .386, P less than .001) and a greater likelihood of referral in childhood (P less than .001).

Tongue restrictions are common in pediatric patients presenting to dental practices, and symptom presentations vary between patients. Tongue elevation is an easy and reliable test of tongue mobility. Shared decision-making and proper assessments help prevent undertreatment and overtreatment.