A patient's chief complaint is difficulty pronouncing certain words. Intraoral examination reveals a short lingual frenum. Which word is she most likely to have difficulty pronouncing?

Correct answer: C. Lilly

• A. 'Bunny' begins with /b/, a bilabial sound made with the lips, and the /n/ is the only linguoalveolar element. It is far less demanding of tongue-tip elevation than a word built around /l/.
• B. 'Puppy' is composed of bilabial sounds (/p/) produced entirely with the lips. Tongue mobility is essentially irrelevant to it.
• C. CORRECT. Ankyloglossia restricts elevation of the tongue tip, and the sounds that require the tongue tip to reach the alveolar ridge or palate are the ones that suffer. The classic affected group is the linguoalveolar consonants — t, d, n, l, s, z — plus r and the th sounds. 'Lilly' is loaded with the /l/ sound, which requires the tongue tip to press against the alveolar ridge, so it is the word this patient will struggle with.
• D. 'Mama' is bilabial and nasal, produced with the lips and soft palate, requiring no tongue-tip elevation at all.

Note: Sound groups worth knowing: bilabial (p, b, m) use the lips and are unaffected by ankyloglossia; labiodental (f, v) use lip and teeth; linguoalveolar (t, d, n, l, s, z) require tongue-tip elevation and are the ones impaired. Notice that this also means a patient with ankyloglossia usually speaks normally as an infant — the problem surfaces as speech becomes more complex.