Dr Shereen Lim

30/03/2026

Facial changes at one week review post oral releases (x6) in an adult

Recently, I shared an adult case where I performed six oral releases - excluding the posterior tongue-tie, as her palate was too narrow and I felt this would be less worthwhile to address without palate expansion to restore more tongue space.

Following release of the upper and lower lip and cheek ties, this patient had an increase in mouth opening of 14 mm (measured inter-incisally). This remained stable at +14 mm at her one-week review.

She was also my first adult patient to report an immediate perception of her palate opening behind her upper front teeth following upper lip-tie release. On her drive home from our practice, she continued to notice further opening and changes.

At her one-week review, she reported that her lips were much easier to seal, she was mouth breathing less, and her sleep had become more restful and still. She had been sleeping through the night instead of having multiple awakenings.

Today is day 11, and she reports that her face continues to show less tension.

Here are her facial photos immediately before release and at her one-week post-release review.

This case, which did not include tongue-tie release, adds to my observations that facial tension related to these additional soft tissue restrictions may play a broader role in oral function than we currently recognise.

I am increasingly seeing consistent patterns of reduced facial tension following release of lip and cheek ties. I also perceive that earlier intervention may have the potential to support improved infant latching and promote better facial and jaw development.

Moving forward, I’ll be sharing more of these visual changes in a new Facebook album:
A Case Series: Facial Tension Changes in Infants Following Oral Releases

My intention is to contribute to ongoing discussion and encourage greater attention to the role of these tissues.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

30/03/2026

In this episode of The Healthy Mouth Movement Podcast, I sit down with Dr. Shereen Lim—dentist, dental sleep medicine expert, myofunctional therapist, and author of Breathe, Sleep, Thrive—to dive deep into what we’re learning about oral ties, airway development, and why early intervention matters so much for our kids. This conversation builds on our previous discussions, but we go even further into the often-overlooked areas of lip ties, cheek (buccal) ties, and how tension patterns in the mouth can shape facial growth, breathing, sleep, and overall health.

We talk honestly about what parents should be watching for, why “wait and see” can be risky, and how breathing, feeding, sleep, behavior, reflux, and even cavities are all connected. Dr. Lim also shares powerful clinical stories—from infants to adults—that highlight just how life-changing addressing oral dysfunction can be when we truly look at the whole body.

Podcast Episode · The Healthy Mouth Movement Podcast · 15 December 2025 · 37min

28/03/2026

8 month old baby with prominent cranial sutures - 4x oral releases

Here’s a throwback to a one-week review of a baby I treated last December.

She had a laser release of her upper lip and tongue-tie on day 4 of life, but the tongue-tie reattached. Feeding and latching difficulties persisted, along with significant gas intake, unsettledness, and poor sleep.

Mum kept searching for answers. She saw two highly skilled IBCLCs, as well as a chiropractor and osteopath. She put in a huge amount of effort. But concerns around her cranial shape and the prominent sutures became the overriding focus.

When I assessed her, the oral and facial tension stood out. Given all the support this family had already pursued, and the plateau in progress, it made sense to proceed with the release of upper cheek (x2), lower lip, and tongue tie to help alleviate that obvious tension.

Mum reported the shift was significant, with a reduction in facial, cranial, and body tension, and with that came improvements in feeding, mobility, and sleep.

Now three months on, she continues to make meaningful developmental gains.

There is ongoing professional debate around oral ties, especially those beyond the tongue and a perceived “lack of evidence" to support intervention.

But absence of evidence is not the same as evidence of no impact. These case studies are part of the best evidence we currently have, and I will continue to share patient stories to support ongoing discussions.

These families are living with very real struggles, including challenges with feeding, disturbed sleep, stress, and uncertainty.

We need to keep paying attention, keep asking questions, and stay open to what our families are telling us.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

26/03/2026

Evolving protocols.

These are images of two different children I consulted with yesterday - including images of the mouth during full smile.

Both show patterns of facial tension, soft tissue restriction related to cheek and lip ties, and early significant alterations in jaw development.

They are also both cases where I’m offering a variation from my usual treatment sequence:

1️⃣ Addressing upper lip, cheek, and lower lip ties first
2️⃣ Then proceeding with expansion
3️⃣ Reserving tongue-tie release until more tongue space has been achieved and the tongue has been better prepared with myofunctional therapy

I’ve traditionally started with palate expansion.

When you turn a key, it works. I know we’re likely to complete a first round of expansion in about two months, and it often provides a relatively rapid functional shift - especially in children with sleep and breathing concerns, or those who need more tongue space for speech sounds.

In contrast, preparing for tongue-tie release with myofunctional therapy is more compliance-based and can take longer.

But in children like these - with significant alterations in jaw development, no spacing of the baby teeth, and markedly tilted in teeth - I know we are looking at a longer treatment time in the range of six months with two rounds of palate expansion and one lower dental expander.

Our field has been heavily focused on the tongue as the primary muscular driver of palate development. But I’m increasingly recognising that the lips and cheeks can exert equally significant forces that influence growth, and that cheek tension from ties have been a very overlooked contributor to instability of results with expansion.

So the question I’m asking is:

Can we reduce some of that soft tissue restriction earlier, while they are still young - and allow the muscles to work with expansion, rather than against it?

Both of these children had a history of poor latch and breastfeeding difficulties.

When facial tension is present in infancy and goes unaddressed, it’s not just a latching issue. It can influence how oral function and jaw development unfold over time.

This is one of the reasons I’ve become more confident offering more comprehensive releases in infants, and been excited seeing the depth of latch that can be achieved.

And why I’m passionate about promoting awareness of optimal latch being the foundation for optimal oral function and development.

24/03/2026

When babies struggle to latch, could facial tension be part of the picture?

These photos are of a 3 month old baby pre- and 6 days post release of 5 oral ties - upper and lower lip, upper cheeks (x2), and tongue-tie.

When I first saw her, she had refused the breast for three weeks, and feeding was not going well on the bottle.

Mum had been advised early on that her baby’s mouth was too small for her ni**le.

These photos illustrate clear reductions in tension in the lips and cheeks. I’m increasingly recognising this as very important for deep latching and efficient tongue suction. When these tissues are tight, a baby will not be able to sustain a deep latch and can start slipping shallow.

6 weeks later, mum happily reports she is feeding more on the breast than ever before. Not 100%, but improving with time.

Unfortunately, tongue-ties are still given limited attention in most healthcare training and can remain a source of debate. Whilst research has focused primarily on tongue-ties, other ties may also be overlooked. It’s why I had not looked at them as closely until recently. Now that I recognise their potential contribution to facial tension and oral dysfunction across my patients of all ages, I can’t unsee it.

Today I happened to consult with four babies - all had been offered ni**le shields early on when latch was poor.

From memory, at least two of them weaned from the breast early, as it was not helping.

Not one of them was advised to seek assessment for oral ties, or given an alternative pathway if the shields did not work (all four had stopped using them).

So I want to highlight this:

If you’ve been told your baby’s mouth is too small to get a good latch, or you’ve been offered a ni**le shield due to latching difficulties, make sure you are also seeing someone who can assess for all ties inside the mouth - not just the tongue.

In the case illustrated, as with all cases - the aim is not to jump in and release every tie. This family had multiple visits with IBCLC Brenda from The Gentle Village and our chiropractic colleague Dr Jean-Luc Sulon at Oceanside Chiropractic - Alkimos to address other contributing factors first.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

21/03/2026

Reflections

The last couple of evenings I have enjoyed some stunning sunsets on evening walks around Lake Monger.

And with my earbuds out of action yesterday I had a lot of time to get lost in my thoughts!

Mainly they were reflections of work.

I have been learning so much through my patients since I have paid more attention to cheek and lower lip ties.

It’s been challenging at times to look back and see things that I have missed, and to have new discussions on changing perspectives and approaches.

But overall, it’s been mind opening to see what’s possible and how much more predictable care can be with a bigger picture.

I love the discoveries, and also the changes that we see through our full scope of work every day. The facial changes, the better breathing and sleep, release of chronic tension, continually making good progress with oral function, building trust along the journey, and having entire families seek care with us after the first members successful outcomes.

Every day has many highlights but my biggest one for the week was oral releases for a 7 month old baby with Down Syndrome. She couldn’t take more than 10-20ml milk at a time and had been resigned to a feeding tube.

Mum sought external advice. And she ended up with me. There were several positive factors that influenced me to proceed despite all the healthcare resistance to this being explored.

So I was happy to hear she fed 60 ml on the day of her release. Mum noted her whole face had changed. I check in and on day 3 she had taken 120ml over 2 bottle feeds, and mum felt this was promising.

I know that not everyone will agree with stepping outside conventional pathways.

But when traditional pathways aren’t leading to progress, I believe it’s important to keep asking questions and exploring what else may help.

It also raises the question of whether children with syndromes or those born prematurely should be approached differently when families have gone the extra mile to optimise their starting point to be more similar to that of a non-syndromic child.

In the end, my focus, and what’s most rewarding is making a difference in the lives of our patients and their families.

20/03/2026

6x oral releases for 41 year old - upper and lower cheek ties, and lip ties (tongue-tie not addressed)

You may have seen my post yesterday, sharing how I had viewed a webinar on some research by US colleagues who have been finding a trend - that upper cheek ties releases appear to be the most impactful in increasing mouth opening - as measured by the maximum interincisal opening. Their cohort did not include any lower lip or lower cheek tie releases.

This inspired me today to take some measurements on a patient who was having six oral releases, excluding the tongue.

When I first consulted her almost a year ago, my plan was to only do upper lip and lower lip ties, and lower right and left cheek ties. My concern at the time with proceeding with tongue tie release was her extremely small tongue space, without palate expansion.

But she was having botox to address lower chin tension - and I had discussed there was still value in doing the lower release to help reduce this chin tension. We were also planning to release the upper lip tie as the upper lip was very tight.

Fast forward to today, when she presented for her releases following regular osteopathic support prior to the procedure. She was most looking forward to the lower cheek releases as they were holding the most tension.

Since her initial consult, I have performed a good volume of upper cheek tie releases and seen fairly consistent improvements in facial tension, and other changes. So I offered that today too, which she was happy to proceed with.

For the first time I took maximum interincisal opening measurements before and after each release.

Here’s what I found:

✅ Pre:procedure before anaesthetic: 40mm
✅ Pre:procedure after anaesthetic: 40mm
✅ Post upper lip-tie release: 44mm
✅ Post upper cheek-tie releases: 47mm
✅ Post lower lip-tie release: 48mm
✅ Post lower cheek-tie releasees: 54mm

Overall she had a 14mm increase in mouth opening. The photos are immediately pre and post-releases.

Although a single case - this tends to support my perception that we must pay attention other ties beyond the tongue to achieving an open wide latch for infants.

Following upper lip-tie release this patient also reported an immediate "sensation into her (left) nostril - like a hair tickling her nose and it lifted it up and kind of opened” and "an opening sensation in the palate.”

Later, when the anaesthetic wore off - the patient reported it was quite sore - and “It feels worth it”

She described, “I noticed my palate behind my top teeth expanding as I was driving back home! I can’t believe how much my mouth is shifting and so quickly. Feels like relief…at 41 years old.”

Lately, I have been in discussions with two US dental colleagues who have been doing lip and cheek ties pre-expansion (and the tongue-tie later after myofunctional therapy) as they perceive expansion works better. I also see some value in that except for needing an extra appointment, and also I believe it’s a better experience for children to start their experience with us on orthodontic visits.

But his patient’s feedback - is very interesting, and why I am very open to adopting this approach (to fight less against the muscles) on a case by case basis when the ties and oral dysfunction are more severe.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

19/03/2026

A link to a webinar highlighting research on buccal ties.

This team collected maximum interincisal opening measurements on 62 patients aged 4-77 years. This was done pre-release, and following release of upper cheek ties, upper lip-tie, and tongue-tie.

They found the most significant increase in opening following upper cheek releases, no matter which order the releases were performed in.

They suggested that this increased jaw opening could be impactful for infant latching, speech, chewing, dental visits, and minimising symptoms of TMD. (jaw joint and muscle dysfunction).

It's an interesting finding. I have had an intuition that cheek ties are linked to TMD and that when symptoms are greater on one side, that it is linked to greater tension from the upper cheek tie on that side.

These measurements are a great way to help towards explaining and quantifying what we are perceiving.

Link to access free webinar recording:
https://www.americanlaserstudyclub.org/video/webinar-recording-buccal-up-clinical-insights-and-new-research-on-buccal-ties/?ica_src=Email&utm_campaign=ALSC%20-%20Courses&utm_medium=email&_hsenc=p2ANqtz-95qgAxa2Xou4G067lmb78NVzhp0y2fYn4AmL7uVRSH4UdZKVhLNOYwjkiwok3YwMKUYEPsByVsFBZoTXWCuXH6iTsZpg&_hsmi=25336573&utm_content=25336573&utm_source=hs_email

17/03/2026

Oral releases and release of facial tension

In my quest to document facial tension changes pre and post oral releases, I decided on a new photo this week.

I’ve instructed patients to do a big wide smile with the tongue on the n-spot and with their mouth closed. I believe it will demonstrate facial tension differences better than regular smile photos, which can also be challenging to get some children to do reproducibly!

This patient had six oral releases - upper and lower lip, upper cheeks, one lower right cheek, and tongue-tie. She originally had crowding of her top and bottom baby teeth. We have completed a round of palate expansion.

She has been one of two children who I have released one lower cheek tie this week. These children had a blocked out lower canine tooth on one side. In this situation, the baby canine is lost early to make room for all the lower adult incisors to come through. Then there is no room for the adult canine tooth to fit. In the last few months, I have consistently noticed this is related to greater tension on the affected side from a cheek tie.

My perception is that releasing these ties will promote better arch development, or if the problem is more severe - make future orthodontic corrections more stable. I will be proposing these additional releases in this situation moving forward.

These photos were immediately before and after release. The patient is regional so we may not have an opportunity to take new photos in the very near future.

In these photos she is numb which may have affected the appearance.

However overall I see a reduction in facial tension around her mouth. In her full smile photo her upper lip length is longer and there appears to be less gum display.

For me these cases keep reinforcing a key point - the greater the orthodontic complexity and needs of a child or adult, it’s worth more attention to facial tension that may be associated with other oral ties beyond the tongue.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

16/03/2026

The American Association of Orthodontists (AAO) recently released an updated white paper on sleep-disordered breathing and orthodontics.

It emphasises the role of orthodontists in screening for risk and referring patients for medical diagnosis before airway-related treatment is considered.

But in everyday practice, many children show mouth breathing, snoring, restless sleep, oral dysfunction, and altered jaw development long before a diagnosis is made.

That raises an important question:

What role should orthodontic care play in supporting airway health and development earlier in life?

Here's the link to the 2026 AAO White Paper Update:
https://www.sciencedirect.com/science/article/pii/S0889540626000351

12/03/2026

One week review post oral releases for 5 month old

In conjunction with lactation support and chiropractic care, this bub had 5 oral releases - right and left upper cheek, upper and lower lip, and tongue ties.

There was significant reduction of facial tension with some changes in head shape.

Feeding changes include:

✅ Deeper latch on one side - the other still has significant ni**le damage from pre-release
✅ Staying on better
✅ Feeding more efficiently - longer between feeds. Today went three hours without screaming
✅ Less air intake
✅ Less arching

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.