Three Different Ties, One Confusing Conversation
If you've been told your baby might have a tongue-tie, you've probably also heard the words 'lip-tie' and 'buccal-tie' thrown into the same conversation. They sound similar. They show up in the same babies. And almost no one explains the difference clearly.
At Latched Beginnings in Austin, we evaluate babies for all three every single day. The short version: a tongue-tie is under the tongue, a lip-tie is under the upper lip, and a buccal-tie is inside the cheek. They can each affect feeding, and many babies have more than one. Here's how to actually tell them apart, what each one does, and how a thorough evaluation handles them.
What These Ties Have in Common
Inside your baby's mouth are little strips of tissue called frenula (singular: frenulum). They connect the tongue, lip, and cheeks to the surrounding tissue. In most babies, these frenula are flexible enough that they don't cause problems. In some babies, one or more of them is too tight, too thick, or attached in the wrong place. That restriction is what we call a 'tie.'
All three types of ties can affect feeding. They can co-exist. And they share many of the same symptoms in babies: poor latch, gas, fussiness, weight gain concerns, or maternal pain. The key to telling them apart is location, function, and what a hands-on evaluation reveals.
Tongue-Tie (Ankyloglossia)
A tongue-tie is a restriction of the lingual frenulum, the thin band of tissue under the tongue. When this band is too short or attached too far forward, the tongue can't lift, extend, or cup as freely as it should. This is the most well-known of the three ties, and the one most often diagnosed.
Tongue-ties come in two main forms. Anterior tongue-ties are visible right at the front of the tongue and often create a heart-shaped or notched tip when the baby cries. Posterior tongue-ties sit further back, beneath the floor of the mouth, and are easier to miss without a hands-on evaluation. Up to 30% of the second-opinion consults we see at Latched Beginnings turn out to involve a posterior tie that was missed elsewhere.
Common Signs of Tongue-Tie
Painful breastfeeding past the first two weeks. Shallow latch with cheek dimpling and clicking. Slow weight gain or long, inefficient feeds. A heart-shaped tongue tip when crying. Difficulty lifting the tongue to the roof of the mouth.
Lip-Tie
A lip-tie is a restriction of the labial frenulum, the band of tissue between the upper lip and the gum line. When this tissue is too tight or attached too low, the upper lip can't flange out properly during feeding. The lip stays tucked in, which creates a tight, shallow seal.
Many parents can see a lip-tie themselves. Pull your baby's upper lip up gently. If a thick band of tissue is attached close to or between the front teeth (or where the front teeth will be), that's a lip-tie. Severity varies. Some lip-ties cause significant feeding issues. Others are more cosmetic and only become relevant as a child grows and dental health enters the picture.
Common Signs of Lip-Tie
Upper lip that stays curled in during feeds rather than flanging out. A 'lipstick'-shaped nipple after nursing. Tucked-in upper lip with milk leaking around the bottle. White or blistered upper lip. In older children, a visible gap between the front teeth or recurrent food sensitivity behind the upper lip.
Buccal-Tie
Buccal-ties are the least talked-about of the three. The buccal frenula are the bands of tissue inside the cheeks, between the cheek and the gum. When these bands are tight, they can pull on the upper jaw and restrict cheek movement during feeding. Babies with buccal-ties may struggle to maintain suction or seal effectively.
Buccal-ties often appear alongside tongue- or lip-ties. They're rarely the primary issue on their own, but missing them during a release can lead to incomplete improvement. That's one of the main reasons families come to Latched Beginnings for second opinions after a previous release didn't fully resolve feeding problems.
Common Signs of Buccal-Tie
Cheek dimpling during feeds, indicating loss of seal. Persistent feeding issues even after a tongue- or lip-tie has been released. Asymmetric jaw movement. Sometimes a visible thick band when the upper lip is lifted to the side.
Why Babies Often Have More Than One
The frenula that form tongue-ties, lip-ties, and buccal-ties develop in the same prenatal window. When one is restrictive, the others often are too. About 60 to 70% of babies we treat for a tongue-tie also have a meaningful lip-tie. A smaller percentage also have buccal-ties contributing to incomplete feeds.
This is why a single-site evaluation isn't enough. Dr. Kacie Culotta examines all three areas at every consultation, and she watches a feed before drawing conclusions. Releasing one tie while leaving another in place can mean families don't get the full improvement they were hoping for.
How an Evaluation Tells the Difference
A proper in-person evaluation includes a feeding observation, a visual inspection of all three frenula, and a hands-on functional check of tongue, lip, and cheek mobility. We test whether the tongue can lift to the roof of the mouth, whether the upper lip can flange comfortably, and whether the cheeks move freely.
We also rule out other causes of feeding difficulty: positioning issues, body tension, flow imbalances, oral aversions. The goal isn't to find a tie. The goal is to understand why feeding isn't working and offer the most appropriate path forward, which sometimes means a release and sometimes means lactation support, bodywork, or simple reassurance.
How Latched Beginnings Approaches Tongue-Tie, Lip-Tie, and Buccal-Tie in Austin
When you've spent weeks worrying about feeding, the last thing you need is a provider who looks at one piece of the puzzle and misses the rest. That's what makes a thorough evaluation worth driving across Austin for.
Dr. Kacie Culotta, DDS holds both a laser certification for tongue-tie releases and a lactation counselor certification. She uses the LightScalpel CO2 laser, the gold standard in infant releases, and she evaluates all three potential restriction sites at every consultation. Our all-mom team makes the experience feel like family helping family, because that's what we are. We're moms helping moms.
If your baby needs only one release, we'll do that. If your baby needs all three addressed, we'll talk you through it carefully. If your baby doesn't need any release at all, we'll tell you that too. Whatever the answer, you'll leave with clarity.
Frequently Asked Questions
What's the difference between tongue-tie, lip-tie, and buccal-tie?
A tongue-tie restricts the tongue's movement, a lip-tie restricts the upper lip from flanging out, and a buccal-tie restricts cheek movement. All three are caused by tight bands of tissue (frenula) in the mouth. They can occur alone or together. Around 60 to 70% of babies with a tongue-tie also have a meaningful lip-tie.
Can a baby have all three types of ties at once?
Yes. Many babies have a tongue-tie, lip-tie, and buccal-tie at the same time, often because the tissues form during the same prenatal window. About 1 in 4 of the babies we evaluate at Latched Beginnings has at least two ties contributing to feeding issues.
Which is worse, a tongue-tie or a lip-tie?
Neither is automatically worse. A significant tongue-tie usually has a bigger impact on feeding because the tongue does most of the work during nursing. But a moderate tongue-tie combined with a lip-tie can cause more issues than either alone. Severity matters more than location.
How do I check my baby for a lip-tie at home?
Gently lift your baby's upper lip toward their nose. Look at the band of tissue between the lip and the gum. If it's thick, attached close to or between where the front teeth will erupt, and your baby has feeding issues or a tucked-in upper lip during nursing, a lip-tie evaluation is worth scheduling.
Do all three types of ties need to be released?
No. Not every tie needs a release. The decision depends on whether the tie is meaningfully affecting feeding, weight gain, or comfort, and whether other interventions have helped. At Latched Beginnings, we recommend release only when the clinical picture supports it, in line with American Academy of Pediatrics guidance on conservative evaluation.
Are buccal-ties commonly missed during evaluation?
Yes. Buccal-ties are the least frequently checked of the three, and missing them is a common reason families return for second opinions after a previous release. Around 10 to 15% of the post-release consults we see involve unaddressed buccal-ties contributing to incomplete improvement.
Do lip-ties affect breastfeeding more than bottle feeding?
Both can be affected, but breastfeeding is usually more sensitive to a lip-tie because a flanged-out upper lip is essential for a deep latch. Bottle-fed babies with lip-ties often show milk leakage, gas, or chewing motions instead of smooth sucking.
Where can I get an evaluation for oral ties in Austin?
Latched Beginnings at 1701 Simond Ave, Suite 107A in Austin evaluates all three types of ties. Dr. Kacie Culotta, DDS holds both a laser certification and a lactation counselor certification. We serve families across Austin, Mueller, East Austin, Round Rock, Cedar Park, Pflugerville, Leander, and Georgetown.
Call to Action
If you've been wondering whether your baby might have a tongue-tie, you don't have to figure it out alone. Dr. Kacie Culotta and the all-mom team at Latched Beginnings are here to listen, evaluate, and walk you through what's actually going on with your baby. Schedule a 1-on-1 consultation in Austin and let's talk through it together. Trust your instincts. We'll take it from there.
