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  • Alicia McGowan

TOTs Remediation

Pre-Operative Treatment

When the recommendation for surgical release of tethered oral tissues is made, really that intervention should be one of the last steps. Since what we are trying to improve upon is the function of the oral muscles and not just the look of the structure, there are a number of steps that are recommended to be part of healing and restoring normal function! For this reason we recommend pre-operative bodywork for patients of all ages. This sets the stage for teaching new range of motion and can be very helpful in reducing tension and inflammation at either end of the frenum. Less tension generally means happier patients (especially those babies) and faster healing. Think of it this way, if your neck is (remember the tie is connected to a muscle on at least one end. Your bodyworker will discuss what exactly their prescribed therapy will entail, and how many visits. We'd love you to see them for at least one visit before your release. For infants we always recommend working with a lactation consultant first!


Surgical Treatment

So now we have started on the path to healing, but that tie is still preventing full function and will influence the return of tension (that's why bodywork works but symptoms can return...the symptoms have been treated but not the cause). Enter our fabulous dentists! Our network providers release TOTs using a soft tissue laser. This is a relatively painless procedure that heals very quickly and can improve function immediately. Sometimes type 1 tongue ties will be “snipped” or "clipped" at birth to improve breastfeeding; this may not release the total restriction. Additionally, the current standard for screening TOTs suggests that many have been missed or under evaluated. A total release with a laser can be done at any age, of course the sooner the better to improve muscle function. What does the surgery feel like? I had the release of my anterior tongue tie without freezing so I could be a voice for the babies. It is definitely annoying, kind of like a guitar string being plucked inside my head...but not terribly painful. Lasers by nature are analgesic and we can offer the older patients additional freezing if preferred. The wound after felt like the worst pizza burn ever (I've had my fair share...thanks Stobies!) but certainly tolerable. I didn't want to talk or move my tongue too much that first day but within 24 hours I was back at work and talking. A lot. Probably too much.


Post-Operative Treatment

As with the pre-operative benefits of bodywork, we see continued improvement when patients continue their therapy. Often the remediation occurs much more quickly as muscles learn their proper function and tension is removed. Again your bodyworker will advise how they would recommend to keep treating you.

For babies we recommend a number of devices that facilitate correcting oral motor function. This can include the Liper Device, MyoMunchee, MyoChew and/or Chewy Tubes. I always provide my families with my own Baby Myofunctional Home Program.

For older patients, years of dysfunction may need to be corrected. A full course of myofunctional appliance therapy may be indicated after a frenectomy. The tongue may be more mobile, but it has NO CLUE what to do. The incorrect speech patterns, incorrect tongue placement at rest and swallowing functions will likely not correct themselves. Over the years, individuals with tethered oral tissues develop strong abnormal habits to compensate for the tongue being attached on the floor of the mouth. A habit is not something easy to change, and most people do not know what the correct position should be. As a myofunctional therapist with experience in proper tongue resting posture, I can help with learning correct placement for articulation, at rest, and while eating, drinking and swallowing.

Teaching the tongue its new, correct position is pivotal in helping to avoid future TMJ issues, bite dysfunctions, tension headaches, and mouth breathing. A low tongue rest is often accompanied with increased occlusal vertical dimension and changes in the craniofacial dentoskeletal structures.


Hope I answered a number of your questions! If you have any further questions or would like to book your functional assessment, connect with me today!

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