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Conclusion This study was conducted in response to the substantial increase of tongue-tie release, despite lack of a similar increase in consistent evidence to support it. Given the importance of evidence-based practice in clinical decision- making, we were interested in the patient perspective in regard to factors that influence people to have a tongue-tie released. Results of this study support suppositions in the literature regarding the impact of tongue-tie on feeding. Responses also indicated issues related to dentition as a primary motivator for adults who chose to have their tongue-tie released. Both factors lack equivocal evidence supporting a link with tongue-tie, and/or associated benefits after having the tongue-tie released. It is important that current evidence pertaining to expected outcomes following tongue-tie release be part of the decision-making process. Further research is needed to determine the degree to which this information is currently being shared or accessed by adults and parents when making the decision to have a tongue-tie released. In the meantime, speech pathologists can play an important role in educating both the community and various health professionals who perform this procedure about the (lack of) evidence in regard to swallowing and speech outcomes. Ideally, a referral for consultation with a speech pathologist should be made when patients approach health professionals about having their tongue-tie released, particularly if they cite concerns regarding swallowing or speech production as their reason for inquiry. Speech pathologists should continue to advocate for this. Acknowledgements This research did not receive any specific funding. We would like to thank respondents of the survey for their time and contribution to this research. References Berry, J., Griffiths, M., & Westcott, C. (2012). A double- blind, randomized, controlled trial of tongue division and its immediate effect on breastfeeding. Breastfeeding Medicine , 7 (3), 189–193. https://doi.org/10.1089/bfm.2011.0030 Brookes, A., & Bowley, D. M. (2014). Tongue tie: The evidence for frenotomy. Early Human Development , 90 (11), 765–768. https://doi.org/10.1016/j. earlhumdev.2014.08.021 Douglas, P., & Geddes, D. (2018). Practice-based interpretation of ultrasound studies leads the way to more effective clinical support and less pharmaceutical and surgical intervention for breastfeeding infants. Midwifery , 48 , 145–155. https://doi.org/10.1016/j.midw.2017.12.007 Emond. A., Ingram, J., Johsnon, D., Blair, P., Whitelaw, A., Copeland, M., & Sutcliffe, A. (2014). Randomised controlled trail of early frenotomy in breastfed infants with mild-moderate tongue-tie. Child Fetal Neonatal Education , 99 , F189–F195. https://doi.org/10.1136/ archdischild-2013-305031. Francis, D.O., Krishnaswami, S., & McPheeters, M. (2015). Treatment of ankyloglossia and breastfeeding outcomes: A systematic review. Pediatrics , 135 (6), e1467– e1474. https://doi.org/10.1542/peds.2015-0658 Glynn, R., Colreavy, M., Rowley, H., & Gendy, S. (2012). Division of tongue tie: Review of practice through a tertiary paediatric otorhinolaryngology service. International Journal of Pediatric Otorhinolaryngology, 76 (10), 1434–1436. https://doi.org/10.1016/j.ijporl.2012.06.017 Hall, D., & Renfrew, M. (2005). Tongue tie. Archives of Disease in Childhood , 90 (12), 1211–1215. https://doi. org/10.1136/adc.2005.077065

Anna Bennett is a speech pathologist. She completed this work as part of her honours degree. Dr Grace Vincent is a lecturer in psychology at CQUniversity. A/Prof Barbra Zupan is a speech pathologist and head of course of the program at CQUniversity Webb, A.N., Hao, W., & Hong, P. (2013). The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. International Journal of Pediatric Otorhinolaryngology , 77 , 635–646. doi: http:// dx.doi.org/10.1016/j.ijporl.2013.03.008 doi.org/10.1002/14651858.CD011065.pub2 Power, R.F., & Murphy, J.F. (2014). Tongue- tie and frenectomy in infants with breastfeeding difficulties: Achieving a balance. Archives of Disease in Childhood , 100 , 489–494. https://doi.org/10.1136/ archdischild-2014-306211 Ricke, L.A., Baker, N.J., Madlon-Kay, D.J., & DeFor, T.A. (2005). Newborn tongue-tie: Prevalence and effect on breast-feeding. Journal of the American Board of Family Medicine , 18 (1), 1–7. https://doi.org/10.3122/jabfm.18.1.1 Salt, H., Claessen, M., Johnston, T., & Smart, S. (2020). Speech production in young children with tongue-tie. International Journal of Pediatric Otorhinolaryngology , 134 , 110035. https://doi.org/10.1016/j.ijporl.2020.110035 Torii, K. (2015). Causes and contributing factors of temporomandibular disorders. In Evidence-based occlusal management for temporomandibular disorders (Vol. 1, pp. 20–34). Bentham Science. https://doi.org/10.2174/978160 8057832115010004 Varadan, M., Chopra, A., Sanghav, A.D., Sivaraman, K., & Gupta, K. (2019). Etiology and clinical recommendations to manage the complications following lingual frenectomy: A critical review. Journal of Stomatology, Oral and Maxillofacial Surgery , 120 (6), 549–553. https://doi. org/10.1016/j.jormas.2019.06.003 Walsh, J., Links, A., Boss, E., & Tunkel, D. (2017). Ankyloglossia and lingual frenotomy: National trends in inpatient diagnosis and management in the United States, 1997–2012. Otolargyngology: Head and Neck Surgery , 156 (4), 735–740. https://doi. org/10.1177/0194599817690135 Jang, S., Cha, B., Ngan, P., Choi, D., Lee, S., & Jang, I. (2011). Relationship between the lingual frenulum and craniofacial morphology in adults. American Journal of Orthodontics & Dentofacial Orthopedics , 139 (4), E361– E367. https://doi.org/10.1016/j.ajodo.2009.07.017 Kappoor, V., Douglas, P.S., Hill, P.S., Walsh, L.L, & Tennant, M. (2018). Frenotomy for tongue-tie in Australian children, 2006–2016: An increasing problem. Medical Journal of Australia , 208 (2), 88–89. https://doi.org/10.5694/ mja17.00438 Lalakea, L.M., & Messner, A.H. (2003). Ankylogossia: The adolescent and adult perspective. Otolaryngology: Head and Neck Surgery , 128 (5), 746–752. https:// doi:org/10.1016/S0194-59980300258-4 O‘Shea, J.E., Foster, J.P., O’Donnell, C.P.F., Breathnach, D., Jacobs, S.E., Tood, D.A., Davis, P.G. (2017). Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews , 3 , Art.No.: CD011065. doi: https://

Correspondence to: Barbra Zupan Central Queensland University phone: 07 4930 9265 email: b.zupan@cqu.edu.au

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