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The tongue is secured to the front of the mouth partly by a band of tissue called the lingual frenulum. If the frenulum is short, it can restrict the movement of the tongue. This is commonly called a tongue-tie.

Children with a tongue-tie can’t stick their tongue out past their lower lip, or touch their tongue to the top of their upper teeth when their mouth is open. When they stick out their tongue, it looks notched or heart-shaped. Since babies don’t routinely stick out their tongues, a baby’s tongue may be tied if you can’t get a finger underneath the tongue.

How common are tongue-ties?

Tongue-ties are common. It’s hard to say exactly how common, as people define this condition differently. About 8% of babies under age one may have at least a mild tongue-tie.

Is it a problem if the tongue is tied?

This is really important: tongue-ties are not necessarily a problem. Many babies, children, and adults have tongue-ties that cause them no difficulties whatsoever.

There are two main ways that tongue-ties can cause problems:

• They can cause problems with breastfeeding by making it hard for some babies to latch on well to the mother’s nipple. This causes difficulty with feeding for the baby and sore nipples for the mother. It doesn’t happen to all babies with a tongue-tie; many of them can breastfeed successfully. Tongue-ties are not to blame for gassiness or fussiness in a breastfed baby who is gaining weight well. Babies with tongue-ties do not have problems with bottle-feeding.
• They can cause problems with speech. Some children with tongue-ties may have difficulty pronouncing certain sounds, such as t, d, z, s, th, n, and l. Tongue-ties do not cause speech delay.

What should you do if think your baby or child has a tongue-tie?

If you think that your newborn is not latching well because of a tongue-tie, talk to your doctor. There are many, many reasons why a baby might not latch onto the breast well. Your doctor should take a careful history of what has been going on, and do a careful examination of your baby to better understand the situation.

You should also have a visit with a lactation specialist to get help with breastfeeding — both because there are lots of reasons why babies have trouble with latching on, and also because many babies with a tongue-tie can nurse successfully with the right techniques and support.

Talk to your doctor if you think that a tongue-tie could be causing problems with how your child pronounces words. Many children just take some time to learn to pronounce certain sounds. It is also a good idea to have an evaluation by a speech therapist before concluding that a tongue-tie is the problem.

What can be done about a tongue-tie?

When necessary, a doctor can release a tongue-tie using a procedure called a frenotomy. A frenotomy can be done by simply snipping the frenulum, or it can be done with a laser.

However, nothing should be done about a tongue-tie that isn’t causing problems. While a frenotomy is a relatively minor procedure, complications such as bleeding, infection, or feeding difficulty sometimes occur. So it’s never a good idea to do it just to prevent problems in the future. The procedure should only be considered if the tongue-tie is clearly causing trouble.

It’s also important to know that clipping a tongue-tie doesn’t always solve the problem, especially with breastfeeding. Studies do not show a clear benefit for all babies or mothers. That’s why it’s important to work with a lactation expert before even considering a frenotomy.

If a newborn with a tongue-tie isn’t latching well despite strong support from a lactation expert, then a frenotomy should be considered, especially if the baby is not gaining weight. If it is done, it should be done early on and by someone with training and experience in the procedure.

What else should parents know about tongue-tie procedures?

Despite the fact that the evidence for the benefits of frenotomy is murky, many providers are quick to recommend them. If one is being recommended for your child, ask questions:

• Make sure you know exactly why it is being recommended.
• Ask whether there are any other options, including waiting.
• Talk to other health care providers on your child’s care team, or get a second opinion.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

At a dental appointment last month, I spotted a lead vest hanging unassumingly on the wall of the exam room as soon as I walked in. “Still there, but now obsolete,” I thought.

I’d just learned about new guidelines from the American Dental Association (ADA) saying lead vests and thyroid collars that cover the neck are no longer needed during dental x-rays. But they’d been a fixture of my dental experiences — including many cavities, four root canals, a tooth extraction, and two crowns — for my entire life. What changed, and could I feel safe without the vest?

Why were lead vests used in past years?

Lead vests and thyroid collars have been worn by countless Americans during dental x-rays over the years. They’ve been in use for far longer than my lifetime — about 100 years. The heavy apron-like shields are placed over sensitive areas, including the chest and neck, before the x-rays are taken.

“I haven’t worn a lead apron in the last 10 or 15 years — unless a dentist insists I put it on — because I know it isn’t needed,” says Dr. Bernard Friedland, an associate professor of oral medicine, infection, and immunity at Harvard School of Dental Medicine.

What has changed about dental x-rays?

When lead vests and thyroid collars were first recommended, x-ray technology was much less precise. But the technology has evolved significantly over the last few decades in ways that dramatically improve patient safety:

• Digital x-rays enable far smaller radiation doses, reducing radiation exposure and the risks associated with higher doses, such as cancer. “The doses used in dental radiology are negligibly small now. If you go to the dentist today for a full series of mouth x-rays that are taken with a digital sensor, the total exposure time is just over five seconds,” explains Dr. Friedland, an expert in oral radiology. “A hundred or so years ago, that exposure time would have been many minutes.”
• The small size of today’s x-ray beam significantly reduces radiation “scatter” and restricts the beam size to only the area needing to be imaged. This protects patients from radiation exposure to other parts of the body.

A less-recognized strike against using lead vests and thyroid collars is their ability to get in the way. They may block the primary x-ray beam, preventing dentists from capturing needed images. This quirk can lead to repeat imaging and unnecessary exposure to additional radiation. This is more likely to occur with panoramic x-rays.

The gear may also spread germs, Dr. Friedland notes. Although disinfected, it’s not sterilized between uses. “There’s a risk of spreading bacteria and viruses,” he says. “To me, that’s also an issue and another reason I don’t want to use one on myself.”

Who no longer needs the shields?

No one does — even children, who presumably have a long life of dental x-rays in front of them. The new recommendations apply to all patients regardless of age, health status, or pregnancy, the ADA says.

The recommendation to discontinue lead vests has been a long time in the making. In fact, the ADA isn’t the first professional organization to propose it. The American Association of Physicists in Medicine did so in 2019, followed by the American College of Radiology in 2021 and the American Academy of Oral and Maxillofacial Radiology in 2023.

Are some people confused or concerned about the no-lead-vest policy?

Yes. The new guidelines are bound to draw confusion and fear, Dr. Friedland says. Some people may even insist on continuing to wear a lead vest during x-rays.

“A big problem is that people’s perception of risk is very skewed,” he says. “Some people, you’ll never convince.”

People are likely to feel more comfortable if the practice is uniformly adopted by dentists. However, the ability to implement this change may hinge partly on public response. And it could take a while to fully adopt.

“I think the public is going to have more say on this than dentists,” Dr. Friedland says. “It might take a generation to make this change, maybe longer.”

Still concerned about the new recommendations?

If you have lingering concerns about the new recommendations, talk to your dentist.

And ask if dental x-rays are necessary to proceed with your diagnosis or treatment plan. Sometimes it’s possible to take fewer x-rays — such as bitewing x-rays of the upper and lower back teeth only — or to use certain types of imaging less frequently. Even with far safer x-ray conditions, dentists should be able to justify that the information from images is integral to diagnose problems or improve care, Dr. Friedland says.

It’s worth noting that the dose of radiation, while far lower than in the past, varies with the type of imaging and which parts of the jaw are being imaged. For example, the digital dental x-rays mentioned above involve less radiation than conventional dental x-rays. Either panoramic dental x-rays, or 3-D dental x-rays taken with a CBCT system that rotates around the head, typically involve more radiation than conventional dental x-rays.

Whenever possible, dentists should use images taken during previous dental exams, according to the ADA. “If I don’t need an x-ray, I don’t get one,” says Dr. Friedland. “I’m not cavalier about it. I also use technical parameters that keep the x-ray dose as low as reasonably possible.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Chocolates and flowers are great gifts for Valentine’s Day. But what if the gifts we give then or throughout the year could be truly life-changing? A gift that could save a life or free someone from dialysis?

You can do this. For people in need of an organ, tissue, or blood donation, a donor can give them a gift that exceeds the value of anything that you can buy. Fittingly, Valentine’s Day is also known as National Donor Day, a time for blood drives and sign-ups for organ and tissue donation. Have you ever wondered what can be donated? Had reservations about donating after death or concerns about risks for live donors? Read on.

The enormous impact of organ, tissue, or cell donation

Imagine you have kidney failure requiring dialysis 12 or more hours each week just to stay alive. Even with this, you know you’re still likely to die a premature death. Or, if your liver is failing, you may experience severe nausea, itching, and confusion; death may only be a matter of weeks or months away. For those with cancer in need of a bone marrow transplant, or someone who’s lost their vision due to corneal disease, finding a donor may be their only good option.

Organ or tissue donation can turn these problems around, giving recipients a chance at a long life, a better quality of life, or both. And yet, the number of people who need organ donation far exceeds compatible donors. While national surveys have found about 90% of Americans support organ donation, only 40% have signed up. More than 103,000 women, men, and children are awaiting an organ transplant in the US. About 6,200 die each year, still waiting.

What can you donate?

The list of ways to help has grown dramatically. Some organs, tissues, or cells can be donated while you’re alive; other donations are only possible after death. A single donor can help more than 80 people!

After death, people can donate:

• bone, cartilage, and tendons
• corneas
• face and hands (though uncommon, they are among the newest additions to this list)
• kidneys
• liver
• lungs
• heart and heart valves
• stomach and intestine
• nerves
• pancreas
• skin
• arteries and veins.

Live donations may include:

• birth tissue, such as the placenta, umbilical cord, and amniotic fluid, which can be used to help heal skin wounds or ulcers and prevent infection
• blood cells, serum, or bone marrow
• a kidney
• part of a lung
• part of the intestine, liver, or pancreas.

To learn more about different types of organ donations, visit Donate Life America.

Becoming a donor after death: Questions and misconceptions

Common misconceptions about becoming an organ donor limit the number of people who are willing to sign up. For example, many people mistakenly believe that

• doctors won’t work as hard to save your life if you’re known to be an organ donor — or worse, doctors will harvest organs before death
• their religion forbids organ donation
• you cannot have an open-casket funeral if you donate your organs.

None of these is true, and none should discourage you from becoming an organ donor. Legitimate medical professionals always keep the patient’s interests front and center. Care would never be jeopardized due to a person’s choices around organ donation. Most major religions allow and support organ donation. If organ donation occurs after death, the clothed body will show no outward signs of organ donation, so an open-casket funeral is an option for organ donors.

Live donors: Blood, bone marrow, and organs

Have you ever donated blood? Congratulations, you’re a live donor! The risk for live donors varies depending on the intended donation, such as:

• Blood, platelets, or plasma: If you’re donating blood or blood products, there is little or no risk involved.
• Bone marrow: Donating bone marrow requires a minor surgical procedure. If general anesthesia is used, there is a chance of a reaction to the anesthesia. Bone marrow is removed through needles inserted into the back of the pelvis bones on each side. Back or hip pain is common, but can be controlled with pain relievers. The body quickly replaces the bone marrow removed, so no long-term problems are expected.
• Stem cells: Stem cells are found in bone marrow or umbilical cord blood. They also appear in small numbers in our blood and can be donated through a process similar to blood donation. This takes about seven or eight hours. Filgrastim, a medication that increases stem cell production, is given for a number of days beforehand. It can cause side effects such as flulike symptoms, bone pain, and fatigue, but these tend to resolve soon after the procedure.
• Kidney, lung, or liver: Surgery to donate a kidney or a portion of a lung or liver comes with a risk of complications, reactions to anesthesia, and significant recovery time. It’s no small matter to give a kidney, or part of a lung or liver.

The vast number of live organ donations occur without complications, and donors typically feel quite positive about the experience.

Who can donate?

Almost anyone can donate blood cells –– including stem cells –– or be a bone marrow, tissue, or organ donor. Exceptions include anyone with active cancer, widespread infection, or organs that aren’t healthy.

What about age? By itself, your age does not disqualify you from organ donation. In 2023, two out of five people donating organs were over 50. People in their 90s have donated organs upon their deaths and saved the lives of others.

However, bone marrow transplants may fail more often when the donor is older, so bone marrow donations by people over age 55 or 60 are usually avoided.

Finding a good match: Immune compatibility

For many transplants, the best results occur when there is immune compatibility between the donor and recipient. Compatibility is based largely on HLA typing, which analyzes genetically-determined proteins on the surface of most cells. These proteins help the immune system identify which cells qualify as foreign or self. Foreign cells trigger an immune attack; cells identified as self should not.

HLA typing can be done by a blood test or cheek swab. Close relatives tend to have the best HLA matches, but complete strangers may be a good match as well.

Fewer donors among people with certain HLA types make finding a match more challenging. Already existing health disparities, such as higher rates of kidney disease among Black Americans and communities of color, are worsened by lower numbers of donors from these communities, an inequity partly driven by a lack of trust in the medical system.

The bottom line

You can make an enormous impact by becoming a donor during your life or after death. In the US, you must opt in to be a donor after death. (Research suggests the opt-out approach many other countries use could significantly increase rates of organ donation in this country.)

I’m hopeful that organ donation in the US and throughout the world will increase over time. While you can still go with chocolates for Valentine’s Day, maybe this year you can also go bigger and become a donor.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD