Tongue-Tie and the Surge in U.S. Procedures
Ankyloglossia, the short band of tissue under an infant's tongue often blamed when breastfeeding does not go well, is being diagnosed more often than warranted in the United States, and the surgery used to treat it is increasing beyond what is actually needed.
According to the Associated Press, the American Academy of Pediatrics (AAP) said in a report released in July 2024 that the practice of cutting the tissue under an infant's tongue with scissors or a laser has grown to "almost an epidemic" level.
Ankyloglossia, or tongue-tie, refers to a congenital condition in which a thin membrane connecting the underside of the tongue to the floor of the mouth is too short, preventing the tongue from extending or lifting fully. It is cited as a cause of painful, difficult breastfeeding, since the infant cannot properly latch onto the nipple with the tongue.
Dr. Maya Bunik, a Colorado-based pediatrician who co-authored the report, said, "It's almost an epidemic." More than 100,000 infants in the United States are estimated to undergo this surgery each year, though there is no precise count. According to a study cited in the report, less than half of infants who show the characteristics of tongue-tie actually have difficulty breastfeeding.
No Unified Diagnostic Criteria and Where Each Society Stands
Diagnoses of tongue-tie are increasing worldwide, but there is no unified diagnostic standard or agreement on treatment. In 2020, the American Academy of Otolaryngology-Head and Neck Surgery issued a statement saying tongue-tie is being overdiagnosed in some areas and that there is insufficient evidence that laser procedures are superior to other methods. In 2021, the Academy of Breastfeeding Medicine likewise stated that treatment decisions require a high level of clinical judgment. In a 2022 policy statement, the American Academy of Pediatric Dentistry (AAPD) said not all infants with tongue-tie need surgery and that treatment plans should be made jointly by multiple specialists. The American Dental Association (ADA) told the AP it agrees with this policy statement.
The Spread of Dental Laser Procedures and Korea's Coverage Rules
Laser Procedures at U.S. Dental Offices
Pediatricians say more parents of infants struggling to breastfeed are going straight to a dentist rather than a pediatrician, where the tongue-tie is cut away with a laser. The cost ranges from $750 to $800, or roughly 1.05 million to 1.12 million South Korean won.
Haley Brown, 33, of Englewood, Colorado, turned to a Denver dentist she had heard about on social media after her son Shiloh, who was born prematurely, had trouble nursing. The dentist diagnosed Shiloh with both tongue-tie and lip-tie, a tightness in the tissue inside the upper lip, and performed a $750 laser procedure. Breastfeeding improved right away. But after having another child, another specialist told her a simple snip with scissors could have done the job just as well. Brown said, "I probably should have consulted with my pediatrician before I went straight to the dentist."
Health Insurance Coverage for Tongue-Tie Surgery in Korea
Tongue-tie surgery is not uncommon in Korea either. Dr. Kim Nam-gyun, a dentist at Yonsei Good Plant Dental Clinic, explains that Korea's national health insurance covers the surgery only when a functional problem is confirmed, such as a speech or swallowing issue in children or a pronunciation problem in adults. If the procedure is purely cosmetic or there are no symptoms, it is classified as not covered. The direction the American Academy of Pediatrics is calling for is similar: basing surgery on actual functional impairment rather than on the diagnosis itself. However, no debate over the diagnosis itself being excessive, as seen in the United States, has yet been formally raised in Korea.