Tethered Oral Tissues (TOT) Part One

Craniosacral therapy for lip, tongue, and buccal ties - pre, post, and in alternative to frenectomies. 

Part 1 - Basic Information about Tethered Oral Tissues
Part 2 - Whole Body Anatomy and TOT 
Part 3 - Craniosacral Therapy Impacts, Pre & Post Care Information 

Understanding the Common Language
Frenulum: A piece of skin or connective tissue that anchors a semi-mobile body part.  

• There are seven frenulums in the mouth: tongue, upper and lower lip, and four buccal ties in the cheeks

Ankyloglossia aka Tongue Tie: Dysfunction in the lingual frenulum (tissue under tongue) restricting and affecting oral motor function. Ankylo means stiff, fused, or fixed and glossia means tongue. 

Lip Tie: Dysfunction in the maxillary labial frenulum (tissue under upper lip) restricting and affecting flaring of the upper lip. This can often be misdiagnosed as the lip will flare but it will cause blanching (red based tissues turning white) in the frenulum, gumline, or lip itself. Blanching would still be indicative of a restricted tissue that needs further evaluation. 

Buccal Tie: Dysfunction in the buccal frenulums that attach the cheeks to the gum line. These are often what cause those cute dimples! These aren't often treated through a release unless they are severe. 

Class/ Severity Level of Tongue Tie : Primarily, I find most providers use the classification system  from Laurence Kotlow, a pediatric dentist out of New York who is considered an expert in the field and developed the following metrics to determining the severity of a tongue tie. 

• Class 1 - From the base of the tongue, halfway to the salivary duct
• Class 2 - From the back of the salivary duct, halfway to the base of the tongue
• Class 3 - From the salivary duct, halfway to the tip of the tongue
• Class 4 - Halfway from the salivary duct, up to the tip of the tongue 

Types of Tongue Ties :   You might hear providers referring to the type of tie vs the class of tie. Often the are referencing the overall location of the tie. It can be an anterior (front) presenting ties, and/or posterior (back) ties. It is possible to have both. Posterior Tongue  Ties are important to oral motor functioning and often missed or overlooked by release providers. 

Image Source: Research Gate 6 Examples of Tongue Ties in babies

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Symptoms of Tethered Oral Tissue Dysfunction
Both infants and adults may experience symptoms related to a TOT.
Infants

• Colic
• Feeding Difficulties - at breast and/or bottle. This includes clicking, popping off the breast, choking on milk flow, shallow latch, sore/blistered/cracked nipples, failure to thrive, gas, green bubbly stools, low milk supply. 
• Deep flexion preference - Flexion: curling in towards the feet. Baby experiences tension, unease, or pure inability to lay flat, extend backwards, or do any amount of quality tummy time. 
• Retained Torticollis (crooked neck), with head tilting in flexion. 
• Dysregulated feeding intervals - either too short or too long while feeding and needing more frequent feeds outside of a cluster feeding developmental leap. 
• Lip Blisters - this comes from an incorrect latch and can be from the baby is trying to stay on the breast by grasping with the lips vs maintaining connection with suction from mouth and upper palate. 
• Flat or misshaped head
• Delayed, missing, or dysfunctional developmental milestones 

Adolescents into Adulthood​

• Speech dysfunctions - particularly sounds T, TH, D, Z, R, L, and S
• Poor Oral health - cavities, bad breath, gum disease, even recession of the gums from the teeth
• TMJ Dysfunction 
• Frequent headaches, migraines, jaw, neck, and back pain
• Pelvic Floor dysfunction
• Unusually poor or dysfunctional flexibility
• Sleep Apnea
• Learning disabilities and disorders
• Over sympathetically activated nervous system that can lead to - anxiety, depression, anger, mood swings