It explains some things... (Calling for tongue-tie experts)

So here's the situation. Earlier this week I took the children to the dentist. She informed me that Michael has a mild-moderate tongue-tie. My mental response: Umm what? Are you sure? How on earth could I have possibly missed that!!! Did you make that determination based upon physical examination or behaviors?

I wasn't present for his examination because they accidentally scheduled the children at the same time and I was busy with Ava keeping her very overloaded sensory system calmed down just enough to get a little cleaning in through holding her in my lap, trying to simultaneously cover her ears and hold her hands, and singing soothing songs. But that's another story and I digress.

I knew Michael can't raise his tongue on command and that he can't stick it out very well. When you ask him to stick his tongue out he can get it out, but it curls down and sticks to the outside of his lower lip. He cannot stick it out forward at all. He can't raise it at all. I had always assumed that that was part of the same motor-planning spectrum that I've become so familiar with in Ava - or possibly a weakness issue. Well, look at where assumptions get you.

When we got home, I grabbed a clean cloth and pried up his tongue. Sure enough, you can't get it up very far and his lingual frenulum extends pretty far towards the tip of his tongue. On top of that, the lingual frenulum doesn't stretch at all and therefore even with some gentle manual pulling you can't get a lot of distance between the tongue and the bottom of his mouth. On top of that, he cannot get any upward curl of the tip of his tongue at all.

Let's summarize. Michael does appear to have a mild-moderate physical tongue tie. He has speech problems with /f, v, s, z, and th/. He produces all of those sounds as an interdental /s/ that is produced auditorily as a nice sharp /s/ sound. So, his /s/ sounds sound fine but are produced "incorrectly" and his /th/ sounds are produced with proper placement but sound like an /s/. He can, however, produce /t, d, and l/ just fine and those involve alveolar placement.

So here's my question for anyone out there who wants to chime in with an opinion. Given that he can produce /t, d, and l/ is it likely that the tongue-tie is the issue with the other speech errors? If there is no functional consequence of the tongue-tie I'm reluctant to have it clipped. However, if it is likely that the tongue-tie is impacting his speech errors, even in part, getting it clipped seems like an option to consider.

I already have a pediatrician appointment set up for Friday to discuss Michael's chronic mouth-breathing and nasal congestion and I intend to get her opinion about the tongue-tie issue then. However, she's not a speech-path so her opinion on whether it is effecting his speech isn't going to be an expert one. She's more the person to offer information and pros and cons on the procedure itself.

Thoughts and opinions from SLPs with some experience with tongue-tie? Please. :-) I tried to get some pictures for reference, but it was tricky. I had to try to manipulate his tongue with my left hand while taking the picture one-handed with my right. I apologize for the picture quality.

The first picture is what he does if you just instruct him to stick his tongue out.

The second picture is what he can do if you model sticking the tongue straight out without letting it curl downward.

The third is his attempt to curl his tongue up. He tilts his entire head backward and tries to push it up with his bottom lip and bottom jaw.

The fourth picture is my attempt to get an actual picture of his lingual frenulum.