Tethered Oral Tissues (TOTS) in Infants
What is a Tongue Tie (ankyloglossia)?
The tissue under the tongue that connects the tongue to the floor of the mouth is called a frenulum. When this tissue is either too short, tight or thick, it can restrict the natural movement of the tongue.
What is a lip tie?
A lip tie is when the tissue (frenulum) that connects the lip to the gums is either too short, tight, or thick and restricts the movement of the lip.
What is the cause of TOTS?
Tongue tie is caused by the incomplete separation of the tongue from the floor of the mouth in utero. The exact cause of TOTS is unknown though researchers believe there is a genetic component.
TOTS can affect an infant's ability to fully evert their lip to maintain suction and a deep latch on the breast. As well as the ability to lift and grasp the nipple in their mouth and move their tongue appropriately to transfer milk from the breast. They can often be the main cause of nipple pain or discomfort, a shallow latch, decrease in milk supply and poor or slow weight gain. TOTS can affect both babies who are bottle fed or breastfed. Parents who breastfeed may run into difficulties that can be so severe it limits the duration of breastfeeding journey.
Troubles with feeding as an infant is only the first red flag one may experience in a lifetime. The position of our tongue and how it functions play an important role in the growth and development of our craniofacial structures including our airway.
Reaching out for help soon as possible is always advised to avoid and limit the following possible symptoms one may experience.
Inability to maintain latch
Slides off the breast or pops on and off
Long endless feeds or hungry soon after
Trouble with weight gain
Falls asleep easily while nursing or tires out quickly
Milk leaks out the sides while nursing
Frustrated or exhausted at the breast
Gumming or chomping
Frequent clicking sound
Colic Reflux
Gassy
Upper lip curls inward
Persistent lip blisters
Open mouth posture/heavy breathing/Snoring
Nipple pain or trauma
Misshapen nipples- flattened, creased, lipstick shape
Plugged ducts, Mastitis
Milk supply issues
Prolonged use of a nipple shield
Later in life:
Difficult transition to solids, swallow dysfunction
Difficulty with speech
Orthodontic concerns
Mouth breathing, Snoring, Sleep Disordered Breathing
Frequent ear infections
Clenching and grinding
Jaw pain and headaches
Neck and shoulder tension
How is a tongue or lip tie treated?
A frenectomy is the term used to correct a tongue or lip tie. A compounded topical anesthetic is applied to the frenulum using a Q-tip to temporarily numb the area. The infant will be placed in a swaddle and safety glasses will be worn as a standard precaution. The procedure is completed using a C02 laser. This type of laser is the gold standard for treatment in infants due to its benefits of quicker recovery times and healing. A frenectomy is a straightforward procedure that takes less than 30 seconds to gently free the tongue or lip of excess frenulum.
Timing and intervention may vary from one infant to the next. Our goal is to choose the best route to success for your infant. The tongue is a muscle and sometimes it requires help learning its new intended muscle pattern. Comprehensive collaborative care can be important. Dr. Slovack may recommend feeding support, oral motor therapy, or a form of body work to support your infant in this process.