Tongue tie Assessment Form

Kigo Dental - Self Assessment form for tongue tie/ankyloglossia.

The following is a self-assessment to help you identify factors that may indicate you / your child have a tongue tie/ankyloglossia. The assessment is meant to be informative but does not substitute for a comprehensive orthodontic evaluation by your dentist or orthodontist to determine your actual risk and condition.

Airway problems Assessment

Be sure to answer all the questions honestly to obtain an accurate score. Hereafter "you" can be related to you, your child, or any person in need of taking this test.

1. Do you have trouble sticking your tongue out or moving it from side to side?
Yes No

2. Do you have difficulty lifting your tongue to the roof of your mouth? Do you feel like your tongue is "stuck" or restricted in your mouth?
Yes No

3. Do you have pain or discomfort while swallowing or chewing?
Yes No

4. Have you ever been told that you had difficulty breastfeeding or bottle feeding?
Yes No

5. Do you experience speech difficulties, such as lisping or pronouncing certain sounds?
Yes No

6. Have you ever experienced pain or discomfort in your tongue, especially while eating or speaking?
Yes No

7. Do you experience chronic bad breath?
Yes No

8. Do you have a small gap between your two front teeth?
Yes No

9. Do you have a family history of tongue ties?
Yes No

10. Do you experience headaches, jaw pain or clicking when opening your mouth?
Yes No

11. Do you have a history of snoring or sleep apnea?
Yes No

12. Have you noticed any visible signs of ankyloglossia, such as a heart-shaped or notched tongue?
Yes No

Have Doubts? Ask us! Online Consultation

Note: Please note that this self-assessment form does not intend to provide a definitive diagnosis if you / your child have a tongue tie or other health conditions; it is developed to give you approximate knowledge about tongue ties so that you / your child can get appropriate consultation. Consulting with a qualified healthcare professional is mandatory to get a definitive diagnosis.

Tongue tie Assessment Form

Kigo Dental - Self Assessment form for tongue tie/ankyloglossia.

LET'S TALK

Book your Appointment

Appointment Timings: Mon-sat: 10:00 am- 8:00 pm | Sun: 10:00 am - 1:00 pm

Appointment Timings:
Mon-sat: 10:00 am- 8:00 pm | Sun: 10:00 am - 1:00 pm

Contact

We would love to be a part of your Smile Reimagining Journey...