©Alison K. Hazelbaker, PhD, IBCLC, FILCA S A F B a3 a1 Q C f6 f5 f4 f2 f1 S 3 2 1 f7 f3 a5 a4 a2 1
2
3 S Screening C F
f1
Assessment f2
f3
f4 Classification f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1
2
3 S C F f1 f2 f3 f4 f5 f6 f7
A a1
a2 a3
a4
a5
S B
Q In Action: Screening with the Assessment Tool for Lingual Frenulum Function S A F B a3 a1 Q C f6 f5 f4 f2 f1 S 3 2 1 f7 f3 a5 a4 a2 1
2
3 S C F f1 f2 f3 f4 f5 f6 f7
A a1
a2 a3
a4
a5
S B
Q 1
2 Function 7: Snap-back 3 S C F
f1
f2 1: Lateralization f3
f4
f5
f6
f7
6: Progressive Tongue A
Contraction a1
5: Cup a2
a3
a4
a5 2: Lift S B 3: Extension/Dimple Q 4: Spread 1
2 Lateralization 3 S C 2: Complete F 1: Body of tongue but not tongue tip f1 f2
0: None f3 f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1 Lift 2 3 2: Tip to mid-mouth S C 1: Only edges to mid-mouth F 0: Tip stays at alveolar ridge OR rises only to mid- f1 f2 mouth with jaw closure AND/OR mid-tongue dimples f3
f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1 Extension 2 3 S 2: Tip over lower lip C F
1: Tip over lower gum only f1 0: Neither of the above OR anterior or mid- f2 f3 tongue humps AND/OR dimples f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1 Spread of Anterior Tongue 2 3 2: Complete S C 1: Moderate OR partial F f1
0: Little OR None f2
f3
f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1
2 Cupping of Tongue 3 S C 2: Entire edge, firm cup F 1: Side edges only, moderate cup f1 f2
0: Poor OR no cup f3 f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1 Peristalsis (progressive contraction) 2 3 S 2: Complete anterior to posterior (originates at tip) C 1: Partial: originating posterior to tip F f1 0: None OR Anterior thrusting f2 f3
f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1
2
3 S Snap Back C F
2: None f1 1: Periodic f2 f3 0: Frequent OR with each suck f4 f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1
2
3 S C F f1 f2 f3 f4 f5 f6 f7
A a1
a2 a3
a4
a5
S B
Q 1
2
3 S C F
f1
f2
f3
f4
f5 Tongue shape during lift Length of f6
frenulum when f7 Attachment of tongue lifted frenulum to tongue A underside a1 a2
Elasticity of Attachment of a3 frenulum frenulum to inferior a4
alveolar ridge a5 S B
Q 1
2
Appearance of Tongue when Lifted 3 S 2: Round OR square C F 1: Slight cleft in tip apparent f1 f2
0: Heart shaped f3
f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1
2
Length of Lingual Frenulum When Tongue 3 S Lifted C F
2: More than 1 cm OR absent frenulum f1 1: 1 cm f2 f3 0: Less than 1 cm f4 f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1 Elasticity of Lingual Frenulum 2 3 S 2: Very elastic (excellent) C F
1: Moderately elastic f1 0: Little OR no elasticity f2 f3
f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1 Attachment of Lingual Frenulum to Tongue 2 3 Underside S C 2: Posterior to tip F f1
1: At tip f2
f3
0: Notched OR under the mucosa at the tongue base f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1 Attachment of Lingual Frenulum to Inferior 2 3 Alveolar Ridge S C 2: Attached to floor of mouth OR well below ridge F f1
1: Attached just below ridge f2 0: Attached to ridge f3 f4
f5
f6
f7
A
a1
a2
a3
a4
a5
S B
Q 1
2
3 S C F
11 Function f1
• Perfect 10 Appearance • Function f2 function impaired • Acceptable f3 • Regardless of function • Frenotomy f4 appearance • Look for recommended alternate cause f5 < 11 Function 14 Function f6 <8 Appearance f7
A
a1
a2
a3
a4
a5
S B
Q 1
2
3 S C F f1 f2 f3 f4 f5 f6 f7
A a1
a2 a3
a4
a5
S B
Q 1
2
3 S C F f1 f2 f3 f4 f5 f6 f7
A a1
a2 a3
a4
a5
S B
Q 1
2
3 S C F
f1
f2
f3
f4
f5
f6
f7
A
a1
a2
a3
a4 To clip a5
S B
Q