Evidence-based clinical practice guideline for assessment and management of ankyloglossia in infants with breastfeeding difficulties

Authors

• Vineet Dhar, Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore.
• Abdullah A. Marghalani, Preventive Dentistry Department, College of Dental Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
• Homa Amini, Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Department of Dentistry, Nationwide Children's Hospital, Columbus, Ohio, USA.
• Tegwyn Brickhouse, Department of Pediatric Dentistry, School of Dentistry, Virginia Commonwealth University.
• Erica Caffrey, Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, both in Baltimore.
• Jayakumar Jayaraman, Richmond Pediatric Dentistry and Orthodontics, both in Richmond, VA, USA.
• Martha Ann Keels, Department of Pediatrics, Duke University, Durham, and an adjunct professor, Department of Pediatric Dentistry and Dental Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill.
• Anna Messner, Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children???s Hospital, Houston, Texas, USA.
• Kimberly K. Patterson, Department of Orthodontics and Pediatric Dentistry, Stony Brook School of Dental Medicine, Stony Brook, New York, NY, USA.
• Nikhila Raol, Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
• Poojan Shrestha, Department of Pediatric Dentistry and Dental Public Health, Adams School of Dentistry, and adjunct associate professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, all in NC, USA.
• Christopher Stark
• Harlyn K. Susarla, Department of Dentistry, Seattle Children's Hospital, and an affiliate assistant professor, University of Washington School of Dentistry, Seattle, WA, USA.
• Jennifer Thomas, Advocate Health - MidwestFollow

Recommended Citation

Dhar V, Marghalani AA, Amini H, et al. Evidence-Based Clinical Practice Guideline for Assessment and Management of Ankyloglossia in Infants With Breastfeeding Difficulties. Pediatr Dent. 2026;48(4):250-263.

Abstract

Purpose: To provide evidence-based recommendations for managing infants with restrictive lingual frenum and breastfeeding difficulties. Methods: Recommendations were informed by 2 recent systematic reviews regarding outcomes such as the diagnostic criteria for ankyloglossia, association of ankyloglossia with feeding difficulties, and evidence for surgical release of the lingual frenum. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach guided consensus on problem prioritization, certainty of evidence, benefit-risk balance, patient values, acceptability, and feasibility. Results: Twelve conditional recommendations were developed addressing the diagnosis and management of symptomatic ankyloglossia. Both anatomical and functional assessments were advised for a comprehensive assessment of the tongue. Evidence suggested an association between restrictive lingual frenum and feeding difficulties and potential benefits of frenotomy on feeding in carefully selected cases. This document provides guidance on preferred surgical techniques, postoperative care, and counseling regarding possible adverse events, aiming to support clinical decision making for dental professionals. Conclusions: All recommendations were conditional and grounded in very low-certainty evidence, underscoring the need for high-quality research. Clinicians should engage in multidisciplinary, shared decision making with parents to determine the most appropriate intervention from available options, incorporating the family's values and preferences.

Document Type

Article

PubMed ID

42649580