Dr. Katie ToThe Wellness Dentist, CEO and Founder of Center for Wellness Dentistry and Wellness Dentist Institute.

What a Grade 4 Tongue Tie Actually Looks Like

28 Sept 2026 · 1 min

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In this brief clinical monologue Dr. Katie To explains the visual and functional features of a severe (grade 4) tongue‑tie, typically seen in a 4‑5‑year‑old child. She describes a heart‑shaped tongue with a thick, tight restriction that prevents the tongue from being lifted. The speaker emphasizes that this presentation signals the need for intervention: a course of myofunctional therapy consisting of multiple appointments and home exercises, followed by a laser tongue‑release procedure. She notes that patients who complete the therapy sequence often experience significant improvement.

Chapters

Here's what a restriction looks like on the tongue. This is a grade 4, so very severe. And one of the things I was going to share is that you have very heart-shaped tongue, and you can see that restriction where the arrow is really thick and very tight. So that patient cannot lift their tongue. This is something we look for. This patient is probably 4 or 5 years old and definitely needs to have that tongue release after myofunctional therapy. They find a lot of success going through myo. It's a series of appointments. Uh, with exercises to do at home, and then we do a laser tongue release, and that's really awesome. That helps the patient.