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Functional Assessment and Collaboration for Tethered Oral Tissues (TOTs)

Reduced Tongue Mobility

Reduced Lip Mobility 

Smiling Baby

Our speech pathologists have extensive training in tethered oral tissues (TOTS) throughout the lifespan.  We provide a comprehensive approach to assessment looking at structure, function and symptoms.  From birth through adulthood we identify and educate families on the potential short and long term impact of tethered oral tissues on breast and bottle feeding, facial growth and development, sleep and speech.  Appointments will include:   

  • Functional screening of tongue, lip and buccal ties 

  • Pre and post release education, support and therapy

  • Neuromuscular retraining including suck training (infants) and orofacial myofunctional therapy for children and adults

Our therapists work collaboratively to educate, empower and support families with the knowledge they need to make informed decisions regarding interventions surrounding tongue and lip tie release.  This includes:

  • supporting families with knowledge regarding individualized optimal timing of release

  • understanding the important role of pre-release therapy

  • collaborating with community partners such as otolaryngologists, orthodontists, dentists, physical therapists, osteopaths and chiropractors to ensure we provide comprehensive and collaborative care.  

Tip of the Tongue therapists participate in regular professional development to ensure we provide the best possible care to our patients.  Some of the courses we love include:

  • The Breathe Course through The Breathe Institute (TBI) with     Dr. Soroush Zaghi *Karrie and Daniel are both TBI Ambassadors

  • The Breathe Baby Course with Dr. Chelsea Pinto

  • Tongue Tied Academy with Dr. Richard Baxter

  • Tethered Oral Tissues Specialty Training with Autumn Henning

  • Orofacial Rest Posture Program Canada (ORPP)

Member of the International Consortium of Ankylofrenula Professionals (ICAP).  ICAP is an international organization of tongue tie professionals.  The vision of ICAP is to promote best practices for the assessment, diagnosis and integrative treatment of restricted oral tissues. 

Tethered Oral Tissues

What is a tongue or lip tie?

Tongues and lips are only considered "tied" if their movement is restricted, impairing mobility for functional tasks such as eating, talking, sleeping or proper oral resting posture. A tongue tie occurs when the thin membrane under the baby's tongue called the lingual frenulum restricts the movement of the tongue. As therapists we refer to this as restricted lingual (tongue) mobility.  Many babies with a tongue tie also have an abnormally tight membrane attaching their upper lip to their upper gums (the labial or lip frenulum). 


It is important to note that most babies have a labial frenum that attach from their lip to their upper gum.  Functionally when this impacts a baby's ability to properly feed by creating difficulty with flanging their lips, and difficulty creating a proper seal at the breast this can be referred to as a lip tie. All babies are born with a labial and lingual frenulum... so it is normal to see one!  However, for some newborns, this tissue is so tight it restricts the ability for the tongue or lip to move optimally. It is important to understand that tongue and lip tie is a functional diagnosis.  What your baby's tongue looks like is much less important than how it is functioning.  It is important to note that not all oral ties cause problems and require correction. In newborns, reduced tongue mobility can lead to many different symptoms such as:

  • poor latch

  • poor milk transfer

  • fatigue with nursing/falling asleep at the breast

  • noisy suckling or clicking/popping on and off the breast

  • leaking on the sides of the mouth

  • poor weight gain

  • coughing or gagging when feeding

  • lip blisters

  • gas pain, reflux symptoms or "colic"

  • frequent hiccups

  • noisy breathing/snoring sounds when sleeping

Mothers often experience:

  • flattened nipples after breastfeeding (compressed or "lipstick shaped" nipples)

  • nipple pain and trauma

  • prolonged feedings

  • inefficient breast emptying

  • clogged ducts/mastitis 

  • decreased milk production

Please note: these symptoms can be linked with other breastfeeding problems and are not exclusive to tongue and lip tie.  A comprehensive lactation consultation of the breastfeeding dyad (mom and baby) by an International Board Certified Lactation Consultant (IBCLC) with training in tethered oral tissues, is required to properly evaluate the oral structure and function. ​


Do babies "grow out" of tongue or lip tie?

The impact of a tongue or lip tie can change with age as we attempt different functional tasks (ie., breast feeding, solid food eating, oral resting posture with our tongue lightly suctioned to our palate to assist with proper orofacial and dental growth, jaw development, nasal breathing, sleep, speech, licking and ice cream cone and of course kissing!). In our experience babies do not "grow out" of a tongue or lip tie but more likely grow into them with more symptoms presenting as infants develop.  Our bodies are amazing at compensations and therefore sometimes the functional impact of a tongue or lip tie is not always immediately apparent. When one muscle in our body is having a hard time our body will recruit other muscles to help.  Often when our tongue has reduced mobility the muscles of our neck and shoulders compensate which can result in symptoms such as headaches, muscle tension and dental grinding.  Functionally as therapists we are evaluating different functions for different ages.  The benefit to working with Tip of the Tongue is we are trained to assess lip and tongue mobility from infancy through adulthood. 



Team Collaboration

Full Body Connection

Our bodies are amazingly adaptive.  When one muscle area is having difficulty another muscle will come and help out.  Think about lifting weights.  If you try to do a bicep curl with a weight that is a bit too heavy, you might hold your breath, you might use your legs, shoulders and back muscles to help.  These are all compensations to help create the intended movement.  The orofacial muscles (tongue, lips and jaw) are not any different. If the tongue is trying to do a movement and is having difficulty because of restricted range of motion such as a tongue tie, other muscles will come to assist.  What we think of as a "mouth issue" then becomes a full body issue.  This is why it is important to have a full comprehensive assessment to look at how the muscles are functioning individually and then also as a connected group.  Tethered oral tissues can not be addressed by one discipline.  A collaborative team approach is the gold standard for care to ensure:

  • Proper functional diagnosis

  • Determining optimal timing of release

  • Providing proper education, support and intervention for all aspects related to the oral restriction to ensure optimal functional results post release

 Tip of the Tongue supports families in this process by collaborating with:

  • Physicians and Otolaryngologists 

  • Dentists and Orthodontists 

  • Body workers such as Physical Therapists, Chiropractors, Osteopaths, Massage Therapists and Craniosacral Therapists.  

All Hands In
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