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class="p1">class="s1">Providers use a classification system to describe the tongue tie. This system only indicates where the tie is attached between the floor of the mouth and tongue. Providers usually use four classifications of Coryllosclass="Apple-converted-space">  or Kotlow, (see pictures below).

class="p1">>class="s1">Type 1:

class="p1">class="s1">The anterior tie is easy to see when the baby cries or tries to lift up the tongue. It can also be felt with your finger under the tongue. It is attached all the way to the tip of the tongue. Very often it makes a heart-shaped tongue when the baby cries or tries to move it.

class="p1">>class="s1">Type 2:

class="p1">class="s1">The anterior tie is a little further from the tip of the tongue. It is also felt like a guitar string or easily seen when the baby cries or tries to lift the tongue. The tongue stays low in the mouth when the baby cries or tries to move the tongue, very often you see a bowl- shaped tongue when crying (only the edges move up).

class="p1">>class="s1">Type 3:

class="p1">class="s1">The posterior tie is further away from the tip and can be made visible by using a special tool, the groove director, or by using your two index fingers that push back the mucous in the direction of the throat and lift up the tongue simultaneously. The tongue stays low in the mouth when the baby cries, tries to move the tongue, or shows indentation or creases, very often you see a bowl shaped tongue when crying (only the edges move up). With your finger you can feel a “speedbump” or guitar string further back.

class="p1">>class="s1">Type 4:

class="p1">class="s1">The posterior tie is not visible, but “hidden” behind the mucous. It can only be shown with the groove director or with two index fingers that back push the mucous in the direction of the throat and lift up the tongue simultaneously. The tongue stays low in the mouth when the baby cries or tries to move the tongue, or shows indentation or creases, very often you see a bowl shaped tongue when crying (only the edges move up). With your finger you can feel a “speedbump” or guitar string further back.

class="p1">class="s1">Depending on the size and spread over the jaws, there are two options:

class="p1">>class="s1">Pearl of Epstein:

class="p1">class="s1">These are small thickened inclusion cysts on the palate, but can also occur on the gums or palate. Usually seen as multiple, white, rice grain large elevations in the vestibular (lying against the cheek) mucous membrane of the upper jaw (alveolaris processus). They are small cavities filled with fluid, (cystic nodule) covered by a thin epithelium (layer of skin) and filled with keratin (a type of protein).

class="p1">class="s1">The Epstein pearls are completely harmless, do not hurt, do not need to be treated and disappear spontaneously. Treatment is therefore not necessary.

class="p1">>class="s1">“Bohn’s” nodules (hard bumps):

class="p1">class="s1">These are white-like bumps spread over the entire upper and / or lower jaw (see photos). The exact aetiology is unknown, but it is suspected that they arise as a remnant of the dental lamina or of heterotrophic salivary glands. They can be present over the entire lower or upper jaw or on the palate (palate). These hard bumps are benign and disappear over time. Treatment is therefore not necessary.

class="p1">>class="s1">Tongue tie:

• class="p1">class="s1">Heart-shaped tongue;
• class="p1">class="s1">Indetation in the middle
• class="p1">class="s1">During crying a low tongue position with sometimes a dent or a bowl shape;
• class="p1">class="s1">White debris from halfway the tongue to the back

class="p1">>class="s1">Liptie:

• class="p1">class="s1">Suction blister upper lip in babies;
• class="p1">class="s1">Bloodless and red/ white line under nose when drinking babies; (see photo)
• class="p1">class="s1">Blanching attachment of tie on the edge of the upper jaw (see photo);
• class="p1">class="s1">A diastema when teeth come through

class="p1">class="s1">Providers use a classification system to describe the attachment or the lip tie. This system only indicates where the frenulum (tie) is attached between the lip and the upper jaw. Providers usually refer to four types or lip tie due to the Kotlow classification. (pictures below).
class="s1">This system does not indicate the severity.
class="s1">A >class 1 lip tie is quite rare (no restriction in attachment).

class="p1">class="s1">A >class 2 lip tie adheres to the gums somewhere in the middle above the gum line.

class="p1">class="s1">>Type 3 can be a very flexible frenulum with no symptoms while a very tight frenulum (type 2) can give a whole range of symptoms.

class="p1">class="s1">>Type 4 is therefore not any “worse” than type 2.

class="p1">class="s1">Although a tight type 4 obviously gives even less movement of the lip and can affect the ability of the lip to flange and hold on to the breast or bottle.
class="s1">Babies and children manage to compensate really well with their jaw muscles and people can grow old with a lip tie often with hardly any symptoms.
class="s1">Sometimes the upper lip tie creates a gap between the front teeth, but that is not always easy to predict exactly.
class="s1">Brushing the front teeth can be difficult and painful with a tie “in the way”.
class="s1">With debris stuck under a lip tie, caries may occur earlier in the upper front teeth. To determine if there is an impairment of the flange of the lip onto the breast a Lactation Consultant (IBCLC) can observe the breastfeeding. The Lactation Consultant lifts up the upper lip to see if it flanges out.
class="s1">If there is blanching on the gum, there is tension. The tension may result in too little movement of the lips and ability to flange out and to open the mouth wide.