Tethered Oral Tissues (TOTs)

TOTs relates to the frenum (aka: frenulum): a portion of soft tissues located under your tongue, lips, or in the cheek area.

Ankyloglossia (medical term for tongue tie) is a congenital condition, characterized by an unusually thickened, tightened, or shortened frenum, which can limit movement of the tongue in activities requiring tongue mobility. Ankyloglossia can have an adverse impact on both dentition eruption, general health, and speech production.

When the tongue or lips have reduced mobility, the child has to work much harder to feed (bottle or breast). Feedings may take an extended amount of time, the child may tire quickly (from the effort put forth), may gain weight slowly, etc. Also, the child may exhibit fussiness due to gas pains from extra air consumed during feeds.

The diagnosis of TOTs is based on the person’s function and symptoms. Many people have soft tissue under their tongues but they do not experience negative symptoms. Other people may experience various symptoms which point to a restricted frenum.

Some tongue ties are very easy to spot because you can easily see the soft tissue attached to an anterior part of the tongue. This can make the tongue heart shaped and you may notice the child cannot elevate to protrude their tongue.

Some tongue ties are much harder to spot; these are called posterior tongue ties because they can be hidden under other soft tissue. These ties are diagnosed based on symptoms.

TOTs, whether it is a lip, tongue, or cheek tie, can cause numerous problems relating to the development and function of the orofacial structure. Many orofacial myofunctional symptoms may be related to a restrictive frenum. It is important to be evaluated by a myofunctional therapist if you feel a tethered oral tissue is related to your symptoms.