Access to Care and Practice Variation in the Assessment of Ankyloglossia

Importance Diagnosis and treatment of ankyloglossia has increased in recent years. A lack of universal evaluation and management guidelines may contribute to inconsistent practice patterns and variable access to care. Objective To evaluate access to care and practice pattern variation in the treatment of ankyloglossia as a source of breastfeeding difficulty across clinicians and sites of care in Ohio. Design, Setting, and Participants This cross-sectional study of pediatric dentists and pediatric and general otolaryngologists providing treatment to pediatric patients in Ohio was conducted using a secret shopper approach from October 6, 2025, to January 5, 2026. All pediatric dentists and otolaryngologists providing treatment to pediatric patients were eligible for inclusion. Health care professionals were identified using lists obtained from the Ohio State Dental Board and the American Academy of Otolaryngology. Exposure Clinics were contacted via phone by a simulated patient’s mother using a vignette describing a 2-week-old infant with breastfeeding difficulty characterized by painful latch and inquiring regarding ankyloglossia (ie, tongue tie) evaluation. Main Outcomes and Measures Primary outcomes were time to first available appointment and procedure cost to patient on the day of service. Secondary outcomes included referral requirement, potential for same-day procedures, procedure technique, additional procedures discussed during scheduling, insurance acceptance, and total cost of consultation and procedure. Results A total of 175 clinics representing 487 health care professionals (299 dentists and 188 otolaryngologists) were contacted. The median (IQR) appointment wait time was 14 (7-28) days. For practices providing cost information, time-of-service cash payment was required by 31 of 36 dental offices (86%), while all otolaryngology practices (38 of 38; [100%]) billed medical insurance. Dental clinics were more likely to empirically recommend other procedures (eg, maxillary frenulum release) at the time of appointment scheduling (29 of 45 [64%]) than otolaryngology offices (1 of 38 [3%]) ( P < .001). Across all practices, the median (IQR) cost of lingual frenotomy alone was $474 ($350-$545), while total cost (consultation and all recommended procedures) ranged from $200 to $1515. Conclusions and Relevance In this cross-sectional study of pediatric dental and otolaryngology clinics in Ohio, access to care for ankyloglossia was similar, but the anticipated cost of procedures varied widely, as did empiric recommendations for intervention beyond lingual frenotomy. Prospective patients should be aware of this heterogeneity and the potential for significant price differences for treatment.