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

Whole Body Anatomy
Of course any tethered oral tissues will affect oral motor capabilities and health - this makes sense the area of tightness is in the mouth, so the mouth would be directly affected. 

A common misconception is that the affects of a tethered oral tissue only remains in the mouth. Here we're really going to focus on tongue ties and how they impact the rest of the body. 
Fascial tissue is a type of connective tissue made primarily from collagen that surrounds and binds body parts together. If you've ever peeled that weird white layer off a chicken breast - that is fascial tissue. It can be thought of as an elastic band- with a certain threshold of stretchability before it starts to pull on other structures, or in some instability cases, breaks. 

One of the ways the whole body is impacted is through the deep front fascial plane, seen in the picture, that goes from the head and tongue all the way down to the toes. 
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A tight, immobile, frenulum under the tongue can create a fulcrum of tension, immobility, and dysfunction down this entire front line.

Infants
A few key movements are needed for an infant to properly nurse at the breast/chest. 

• Relax whole body into a slight flexion curl against nursing person's body
• Look/tilt head slightly upwards - (a bit why you'll hear baby's nose to nipple!)
• Drop jaw wide enough to take in large portion of areola not just nipple tip
• Create proper seal from cupping of tongue against breast/chest - Babies must be able to form a proper seal so that a pressure change can be created that brings the milk out of the breast. Think drinking through a straw! You can't bring as much, if any, liquid up through your straw if there is a hole in the straw or your lips aren't closed correctly. 
• Coordinate Suck, Swallow, Breathe

Let's put ourselves in our baby's experience:

• Imagine you are having to get to that point of stretching where your body says AH! Stop! We can't go any further! - only to have another person come and without asking  pushes you farther into the stretch. It'd probably make you feel anywhere from unsafe, to pain, sadness, to guarded and wary they're going to do it again. This is part of the dysregulated dynamic that occurs when a baby goes to be with their nursing parent and they already start screaming, won't relax in your arms, won't take your breast/chest, won't settle down.. etc. We've created a dynamic that breaks their trust! They're wary and not at ease, and creating extra guarding patterns to prevent further pain and discomfort. 
• Hold the area under you chin firmly and try to tilt your head even just a little upwards, then try opening your mouth nice and wide. GAH! 
• Ever become frustrated and just give up when you have to suck through a really windy bendy straw or a straw with a hole. It's just not getting the job done! Or then "luckily" your nursing person has a really active letdown and now it's like trying to drink through the straw while someone is tipping the cup at you! 
• And you have to do all of this while you're experiencing all these new sensations all the time like lights, gravity, noise a max volume, peeing, pooping, gas, PARENTS! 

I don't know about you, but even just reading all that gets my heart space a little tighter and activated. And I, as an adult, have logic to try and contend with it all. 
Tethered oral tissues can be such a systemic (affecting the whole body) problem because it sets an uneasy stage for one of the core functions of a baby's life - to eat. 

Adolescents and Adults
Now we add in the functions of having to sit, crawl, walk, run, express oneself, learn, regulate stress - all from a dysregulated foundation. 

The adage " I have a TOT and I turned out FINE" is an easy one to peel away, when we start to realize just how integral and interrelated the body, mind, and spirit are. One of my favorite moments from an interaction at an expo. A dad says just that adage - whilst continually bouncing his leg, rubbing his temples from a headache, shares he has ADHD and Anxiety and Depression. Fine it is <3 We'll all come to a more holistic balance when we're ready. 

Not all TOT are created equal. There are many cases where the presence of a tethered oral tissue does not equal dysfunction and something further throughout the central nervous system is the root fulcrum of dysregulation. 
Continued in PART 3.... 

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. 

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