Built from practice.
Driven by outcomes.
The Tongue Tie Toolbox is the education arm of the National Tongue Tie Centre Ireland's original dedicated tongue tie clinic. Everything here comes from two decades of clinical work with real patients, across every age group, from every discipline.
A personal experience.
A clinical mission.
The National Tongue Tie Centre was not built from research alone. It was built from lived experience. In 1999, Kate and Justin Roche encountered tongue tie within their own family and found that the care available at the time was fragmented, inconsistent, and incomplete.
That experience shaped everything that followed. They set out to develop a model of care that addressed not just the restriction, but the functional patterns that developed around it and the tension it created throughout the body.
The NTTC opened as a dedicated clinic in 2017, building on clinical work that had begun a decade earlier. It is now Ireland's only specialist tongue tie clinic, treating over 1,000 patients per year from more than 26 countries.
The Tongue Tie Toolbox grew from a recognition that the clinical education in this field was not keeping pace with the complexity of what practitioners were encountering in their work. Rather than wait for that to change, Kate and Justin built the resource they wished had existed at the start of their own journey.
Release. Retrain. Relieve.
The methodology behind the NTTC and the educational framework that runs through everything in the Toolbox is built on three principles that work together. Surgery alone is rarely sufficient. The Toolbox teaches the full picture.
Release Restrictions
CO2 laser frenectomy or frenuloplasty, performed by Dr. Justin Roche. The NTTC is the only clinic in Ireland offering frenuloplasty under conscious sedation for infants and children aged 12 weeks to 12 years, where clinically indicated. Appropriate surgical intervention is the foundation but it is never the whole answer.
Retrain Function
Feeding therapy and myofunctional rehabilitation to retrain oral movement patterns before and after the procedure. Led by Kate Roche, with a team of physiotherapists and lactation consultants. The goal is durable functional recovery not just a healed wound. This is the piece most often missing from care provided elsewhere.
Relieve Tension
Physiotherapy and bodywork to address fascial tension patterns in the jaw, neck, and throughout the body that develop around a restricted tongue. Tongue tie is a systemic restriction, not an isolated anatomical finding. Understanding fascial science is central to understanding why some patients do not recover well without it.
"A tongue tie affects far more than the tongue. The restriction shapes how a baby feeds, how a child breathes, how an adult holds tension in their jaw and neck. Addressing only the visible tether is addressing only part of the problem."
Kate Roche, Clinical Director, NTTC
Meet the founders
Kate Roche
Clinical Director & Co-Founder, NTTC
Kate is a Chartered Physiotherapist, feeding therapist, and International Board Certified Lactation Consultant. She co-founded the National Tongue Tie Centre in 2007 with Dr. Justin Roche, and has led the clinic's clinical and educational direction since its inception.
Her clinical background spans physiotherapy, lactation, myofunctional therapy, and fascial science. This breadth is not incidental it reflects a conviction that tongue tie cannot be adequately understood or treated through any single professional lens. The body does not work in silos, and neither does the NTTC's approach.
Kate leads all assessment, feeding therapy, bodywork, and myofunctional rehabilitation at the NTTC, alongside a team of physiotherapists and lactation consultants. She developed the educational curriculum that underpins the Tongue Tie Toolbox, including the Functional Feeding and Therapeutic Techniques course and the Surgical Insights series.
She has presented at Tongue Time 2026 in St. Gallen the world's leading tongue tie congress and is a confirmed speaker at ASTOT 2026 in Bali and Tongue Time 2027. She presented an ePoster at the ISCP 2026 conference and has delivered professional education across Ireland and internationally through the Tie Talk series.
Kate and Justin have six children and two grandchildren. Her understanding of what tongue tie means for families is not theoretical.
Dr. Justin Roche
Medical Director & Co-Founder, NTTC
Dr. Justin Roche is a Consultant Paediatrician and International Board Certified Lactation Consultant. He co-founded the National Tongue Tie Centre in 2007 and serves as Medical Director, providing paediatric medical oversight for every patient seen at the clinic.
Justin performs all frenectomy and frenuloplasty procedures at the NTTC. He leads Ireland's only frenuloplasty service for infants and children aged 12 weeks to 12 years under conscious sedation a pathway he and Kate developed in response to a clear gap in available care for older infants and young children who would not otherwise tolerate the procedure.
His paediatric medical background underpins the NTTC's approach to clinical governance, patient safety, and diagnostic rigour. The requirement for a full written assessment report before any treatment decision is made reflects a standard of care grounded in his medical training and professional values.
Justin's credentials as an IBCLC alongside his medical qualifications place him in a small global group of physicians who hold both. It shapes how the NTTC integrates lactation science with paediatric medicine as complementary rather than separate disciplines.
National Tongue Tie Centre,
Clonmel & Naas
The Tongue Tie Toolbox is the education arm of the National Tongue Tie Centre and the Toolbox draws its credibility directly from what happens in that clinic every week.
The NTTC was founded in 2007 and has operated as a dedicated specialist clinic since 2017. It is Ireland's original dedicated tongue tie clinic, and remains the only clinic in Ireland offering frenuloplasty under conscious sedation for infants and children aged 12 weeks to 12 years.
The clinic operates from Clonmel, Co. Tipperary, with a Saturday outreach clinic in Naas, Co. Kildare. Patients travel from across Ireland and from more than 26 countries internationally for assessment and treatment.
Every patient receives a full clinical evaluation and a written report before any treatment decision is made. There is no same-day surgery. The NTTC's model is built on the principle that appropriate preparation and rehabilitation determine the long-term outcome not the procedure alone.
The team includes seven IBCLCs across medicine, physiotherapy, and nursing an integrated lactation team without parallel in Ireland.
Visit tonguet.ie โtongue tie practice
per year
physio & nursing
by our patients
- Ireland's only frenuloplasty service under conscious sedation for children aged 12 weeks to 12 years
- Assessment first, always written report before any treatment decision
- Consultant Paediatrician and Chartered Physiotherapist both IBCLCs co-directing every aspect of care
- Pre-operative preparation and structured post-operative rehabilitation as standard not optional extras
International Speakers & Award Winners
The clinical work at the NTTC and the education delivered through the Toolbox are recognised at the highest levels of the international tongue tie and airway community.
The education we wished existed.
When we started this work, the clinical education in tongue tie was fragmented, inconsistent, and often siloed by discipline. Surgeons were not learning alongside therapists. Therapists were not learning the surgical context. And the parent-facing information available was frequently either alarmist or dismissive.
The Tongue Tie Toolbox was built to address that. Not as an overview of the topic, but as a substantive clinical resource one that draws directly from the cases we see weekly, the outcomes we track, and the questions practitioners ask us in Tie Talk sessions and at conferences.
The multidisciplinary model is not aspirational. It is how the NTTC operates. The Toolbox is where we make it available to practitioners who want to work at that standard, wherever they are.
Looking for clinical assessment or treatment?
The NTTC sees patients of all ages from newborns through to adults at clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
