Tethered oral tissues (TOTS) are bands of tissue that can restrict movement of parts of the mouth and thereby decrease the extent of functional movement of a person’s lips and tongue. This is termed a “tie” (lip tie or tongue tie) or in medical terms, “ankyloglossia.” Current understanding is about 5-10% of the population can be affected by tethered oral tissues, but that number is increasing as knowledge and diagnosis is expanding. Here are some things to know about tethered oral tissues.
Everyone has a frenum! (Not everyone has tethered oral tissues).
The culprit for tethered oral tissues is a band of connective tissue called a frenulum, which serves a purpose – it is supposed to help prevent TOO much movement of flaps of tissue that would otherwise move, especially during embryonic development. In some people, this band of tissue is not fully removed by the body during development and results in tissues that are tightly attached (tethered) that are not supposed to be attached. (Similar to webbed fingers or toes). In certain people this can pose functional issues related to the movement of the lips and tongue.
Does my baby’s Frenum need A revision or Release?
Not all frenulum’s need to be released! A frenum can be compared to shoelaces tied together. Some people have long laces that do not hinder movement or stretchy laces that do not hinder function. Other people have short, non-stretchy laces that would make it difficult for someone to walk, let alone run a mile. To tell if our patients need a frenum release, we do a functional assessment of their anatomy to explore the limits of motion of the tongue and lips and integrate that information with a symptomatic assessment of any reported issues related to the function of the tongue and lips.
What benefits are there to releasing a tethered tongue/lip?
The functional benefits to releasing tethered oral tissues are to allow a larger range of motion for these structures. This has as many effects as there are functions of the tongue and lips! For example:
- Breastfeeding: More efficient, less painful, less difficult, less tiring, less gas.
- Diastema: A midline gap between the teeth (especially those that are the only ones) are in many cases due to a severe lip tie, which if released can allow the front teeth to touch and help keep them touching.
- Speech: easier articulation of tongue sounds —such as “t,” “d,” “l,” “th,” and “s”
- Feeding: Increased bolus (food ball) control, less gas, better swallow pattern.
- Posture: Proper tongue posture is easier to achieve (tongue should rest behind the front teeth and along the palate, with teeth slightly separated).
- Development: Upper jaw and palate development is dependent on tongue pressure (i.e. tongue range of motion) to create adequate circumference and size of the bones holding the teeth.
- Airway: Proper tongue posture and development of the maxilla lead to better breathing (silent breathing through the nose) and less resistance (better airflow) through the airway.