10/21/2022
TOTs: Tethered Oral Tissue
As clinicians we have skills to screen things, diagnose things and provide treatment that is within a paricular scope of practice, but if you don’t know what you’re looking for, said skill is useless. In addition, I commonly hear clients express that if they do know they have TOTs or their children do that it’s “just a little bit.” Folks,TOTs (tongue ties, lip ties, buccal ties) are black and white: you have them or you don’t. It’s either there, or it’s not. The DEGREE of TOTs can vary, however.
A normal lingual frenulum is about one half of the tongue. You should not see any blanching or restriction of movement, particularly when taking the tongue to the top of the palate.
Today I had a follow up visit with a client who on her evaluation with myself was informed she had TOTs. You cannot appreciate the degree of her tie in the picture, but you can see that it is greater than the length of her tongue, blanching is visible and she cannot open the mouth more than what is seen because her tongue is so restricted in it’s mobility secondary to that tight piece of tissue. She talked with her dentist about this who then sent her to an ENT; as I understand it, both concluded that she has “no tie.” So where does that leave her? With two providers telling her she doesn’t have something and one who does, which is a really unfortunate place to be. I don’t know if she’ll pursue a release or myofunctional therapy to help her symptoms, but I do believe by not making that choice that she will likely continue to suffer.
As providers, we need to do better. If we don’t know the answer or have the education to answer, we should be resourceful enough to help get our clients to places or individuals who can help.
TOTs are not a “trend.” They are HIGHLY genetic and if you have them, your children will likely have them as well and often to a more severe degree.
Some other signs of TOTs:
✅Dentition issues / crowding / over or underbite / inversion / gapping
✅Mouth breathing
✅Long face syndrome
✅High palpate / bone on top of the palate (palentine tori) / narrow palate
✅Headaches / migraines