Throughout my time as a speech therapist, I’ve found that conducting therapy for clients with tethered oral tissues (also called TOTs) is one of my favorite aspects of my job. However, I’ve also learned that there is a ton of misinformation surrounding tethered oral tissues as well as controversy regarding treatment, its effects on speech and feeding, and even its existence amongst providers. But before we dive into the myths and facts of TOTs, let’s talk about what tethered oral are.
What Are Tethered Oral Tissues?
There are several “strings” of tissue inside your mouth (some you can feel with your finger and/ or your tongue–try it!) There is typically one underneath your tongue (this is called the lingual frenulum), which connects the tongue to the lower jaw. There’s one just on the inside of your upper lip, one on the inside of your bottom lip, and even some in your cheeks! To be more specific, 2 on the top on either cheek and two on the bottom, both right and left. Typically, most people have 7 “strings,” or frena in their mouths total. So what qualifies as a tethered oral tissue?
A tethered oral tissue is when one or more of these frena are short or too tight, which can restrict movement of the tongue, lips, and/or cheeks (frena that are too tight or short are also known as “ties”). This can cause difficulty with certain speech sounds, feeding skills, sleeping habits, and even affect the alignment of your teeth! The tethered oral tissue I typically see the most is ankyloglossia, aka, a tongue-tie. However, as previously stated, ties can be labial (in the lips) or buccal (in the cheeks) as well.
Who Diagnoses Tethered oral Tissues?
Typically, ties are diagnosed by a dentist, ENT, or surgeon who specializes in TOTs.
Can Tethered Oral Tissues Be Treated?
Yes! Treatment can involve preoperative, or pre-release therapy from a trained provider or a Certified Orofacial Myologist, to retrain the oral musculature (like the tongue) to move in more typical and functional patterns. You can find the directory for Certified Orofacial Myologists (COM).
Additionally, a tie-release, also called a frenectomy, is typically performed by a specialist (the aforementioned dentist, oral surgeon, ENT, etc.) and involves “clipping” the tethered tissue with either a laser or manually with a scalpel. After a release or frenectomy, postoperative therapy with a trained provider or COM is crucial to facilitate proper healing and retrain the oral muscles to address feeding and speech concerns.
Some Myths and Facts
That’s a lot of information! Believe it or not, not every provider is trained to look for tethered oral tissues. If you suspect your child has TOTs, it’s crucial to find a provider that is up to date on the newest research regarding tethered oral tissues. With that in mind, let’s unravel through some of the most common myths I hear about tethered oral tissues and separate fact and fiction.
| Myth | Fact |
| Tethered oral tissues are not real | Evidence shows that tethered oral tissues are a structural issue that can affect breathing patterns, speech, sleep habits, feeding, dentition, and even more |
| The ties will stretch out on their own | Certain stretches and exercises in therapy can sometimes increase the range of motion of articulators like the tongue and lips, but the band of tissue itself does not increase in length or stretch out
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| The tie will snap if the child falls and hits their mouth, so a release is not necessary | Even if the tie breaks in a fall, ties can reattach/ scar improperly without therapeutic intervention before and after release, which can cause more damage in the long run. Furthermore, as a fellow colleague once told me, “Trauma is not adequate therapy” |
| There is a tie, but it doesn’t affect anything | Ties can affect speech, feeding skills, sleep, teeth alignment, and even the shape of the child’s face. There are also differing levels of severity (usually labeled as a Class I-IV) |
| If the child can stick their tongue out, there is no tie | Ties require the professional to look at a wide range of movements that are functional for everyday life, not just protrusion and retraction (in and out movement). These include, but are not limited to: tongue lateralization (side-to-side movement), tongue elevation (up and down movement), tongue suction, lip puckering and retracting, etc |
| SLPs can diagnose tongue-ties | Per the American Speech-Language-Hearing Association, speech therapists can screen for tongue-ties and make appropriate referrals to dentists, ENTs, and other professionals trained in tethered oral tissues. We can, however, provide pre and post release therapy! |
| Ties cannot grow back once they are released | Post-release therapy is crucial to adequate healing to avoid scarring as well as to avoid reattachment of the tissues. If the post-release exercise/ stretching regimen is not followed, the ties CAN re-attach! |
| There is a tie, but pre and post release therapy are not necessary | Pre-operative therapy is imperative to start training the oral structures to move and rest in more typical patterns. This will also make the postoperative therapy easier in the long run, as the child will have already started learning new movements to aid in speech and feeding. As previously stated, post-release therapy is crucial to avoid scarring and reattachment, as well as to train this new range of motion (in short: tell the tongue, lips, and cheeks where to go!)
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| A release of the tie will automatically correct all speech, feeding, and dental concerns | Retraining the muscles in the mouth can be a lengthy process. Just like learning a new musical instrument, it takes time and tons of practice. While a release will not immediately correct every concern, many patients make tons of progress with their speech and feeding skills post-release!
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Now that we know some common myths and facts about tethered oral tissues, if you suspect your child may have TOTs, speech, or language concerns (blog post about signs/ potential red flags to come!) come see us for a TOTs screening! (801) 996-7510.
-SLP Katie