Understanding Tethered Oral Tissues (TOTs):
Lip Tie and Tongue Tie in Infants

What are Lip Tie and Tongue Tie?

There are small folds of tissue that connect our lips and tongue to our gums and the floor of our mouth. These folds are called frenulums. In TOTs, these frenulums are unusually short, tight, or thick, restricting the movement of the lip or tongue.

• Lip Tie This occurs when the frenulum connecting the upper lip to the gum is too tight, limiting the upward movement of the lip. 
• Tongue Tie This is when the frenulum under the tongue (lingual frenulum) is too short or tight, restricting the tongue’s ability to move forward, upward, and side-to-side.

How Do TOTs Affect Infants?

Lip and tongue tie can significantly impact a newborn’s ability to latch and suck effectively during feeding. This can lead to several issues:

• Difficulty latching A tight lip tie can make it hard for the baby to flange, or create a wide seal, around the breast or bottle nipple.
• Shallow latch Restricted tongue movement can lead to a shallow latch, where the baby only gets the nipple in their mouth and not enough breast tissue. This can lead to ineffective milk transfer and frustration for both mother and baby.
• Poor weight gain Due to difficulties with latching and sucking, a newborn infant with TOTs may not receive enough milk, leading to poor weight gain.
• Nipple pain for mother A shallow latch can cause friction and pain for the mother during breastfeeding.

If you suspect your infant might have a lip or tongue tie, watch for these signs during feeding:

• Clicking sounds while feeding
• Fussy or gassy baby during or after feeding
• Short feeding sessions with frequent breaks
• Poor weight gain despite good feeding frequency
• Visible sores on the mother’s nipples

Diagnosis and Treatment of Lip and Tongue Tie

A pediatrician or lactation consultant can diagnose TOTs in a newborn through a visual examination of the mouth. In some cases, additional tests might be needed.

The most common treatment for TOTs is a frenectomy, a simple in-office procedure for lip and tongue tie release performed by a pediatrician or dentist. During this minor surgery, the tethered tissue is gently released using a laser or surgical scissors, allowing for improved movement of the lip or tongue.

Early treatment of TOTs can offer several benefits:

• Improved latch and sucking, leading to better milk transfer and weight gain
• Reduced feeding time and frustration for both newborn and mother
• Decreased risk of nipple pain for the mother
• Improved long-term development of speech and oral motor skills 

Lip and Tongue Tie and Adults?

While TOTs are typically diagnosed and addressed in infancy, they can go unnoticed and persist into adulthood. Some cases of TOTs are mild and may not cause significant issues in infancy, leading them to go undiagnosed. These mild cases might become more noticeable in adulthood as certain activities or demands on the oral system increase. 

TOTs can cause various issues in adults, including:

Speech difficulties Restricted tongue movement can affect articulation and make certain sounds challenging to pronounce.

Swallowing problems Difficulty maneuvering the tongue can lead to trouble swallowing food or liquids.

Breathing issues Tight lip or tongue frenulums can contribute to poor oral posture, potentially impacting breathing, especially during sleep (snoring or sleep apnea).

Dental problems TOTs may contribute to improper tongue positioning, potentially leading to crowded teeth or other dental issues.

Facial pain or tension Restricted movement in the oral area can lead to discomfort in the face, jaw, and neck. 

Frenectomy for adults Similar to the simple surgery performed on infants, a frenectomy is a minimally invasive surgery that releases the tethered tissue using a laser or surgical scissors. This lip and tongue tie release can significantly improve tongue and lip mobility in adults. 

Once a tongue or lip is released, the child or adult may need to retrain the muscles that were tethered and were functioning less than ideal. It’s not just speech that is affected. Folks’ swallow can be dysfunctional from the tethers; tongue and cheek musculature can be retrained. This is done with a credentialed Myofunctional Therapist and exercises.”

Benefits of Lip and Tongue Tie Release and Holistic Dental Services for Adults:

• Improved tongue mobility can enhance speech clarity and articulation.
• Increased lip mobility can benefit facial expressions and even aid in playing certain wind instruments.
• Better oral posture can improve breathing, especially during sleep, potentially reducing snoring or sleep apnea symptoms.
• Improved ability to chew and swallow food.
• A credentialed Myofunctional Therapist can help patients retrain muscles that were previously tethered to ensure they are functioning correctly.