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  • Alicia McGowan

What Are Tethered Oral Tissues?

Updated: Apr 23, 2020

Tongue ties are are definitely at the tip of our tongues these days! (Pun intended!) The current classification, diagnosis and understanding of the whole body impact is a very new science and certainly one we'll be talking about for years to come.


So what exactly is a tongue tie? The structure is technically called a frenum, and there can be seven locations. If any of these frenums restrict the movement or function of the attached muscle, we term it as a tethered oral tissue (TOTs for short). They can be located under the tongue, on the upper lip and cheeks, and on the lower lip and cheeks.


Frenums are a normal structure during embryo development. They are a fold of tissue which guides and advances growth during the first months; however around 12 weeks in utero these tissues under go apoptosis (programmed cell death) and the folds are meant to separate from the attachment points. By the time of birth they should be completely detached allowing for full function of these important muscles.


The most often discussed is the tongue tie, as the limitation of function of the tongue can be a significant detriment. Traditionally only type 1 (involving the tip) tongue ties have been addressed but we now know there are 4 types of tongue ties and that all other restrictions can impair function, growth and health.

Type 1 and 2 tongue ties are seen towards the tip of the tongue whereas type 3 and 4 are at the back under tissues and not easily seen.


In infancy, tongue and lip function is the key to successful breastfeeding. Breastfeeding is one way to nourish a baby, but it is the best way to start to grow and develop the dental arches. A tongue tie discourages proper growth and function which can result in dental crowding, increased risk for cavities and gum disease and jaw joint issues.


From day one of life all the way to the last, the way we breathe is dictated by the tongue. If the tongue is in it’s ideal position against the roof of the mouth, we will breathe through our nose. This allows more oxygen to be absorbed into the body, as well as preventing respiratory issues such as allergies, asthma and sleep apnea.

Proper tongue function is also necessary to chew and swallow food, and for many aspects of speech.


Common TOT symptoms in children can include:

  • Inability to chew age appropriate solid foods

  • Gagging, choking or vomiting foods

  • Persisting food fads

  • Difficulties related to dental hygiene

  • Persistence of dribbling

  • Delayed development of speech

  • Deterioration in speech

  • Behaviour problems

  • Dental problems starting to appear

  • Loss of self confidence because they feel and sound ‘different’

  • Strong, incorrect habits of compensation being acquired


Common TOT symptoms in adults can include:

  • Inability to open the mouth widely affects speech and eating habits.

  • Always having to watch their speech

  • Inability to speak clearly when talking fast/loud/soft

  • Difficulty talking after even moderate amounts of alcohol

  • Clicking jaws

  • Pain in the jaws

  • Migraine Headaches

  • Protrusion of the lower jaws

  • Professional setbacks

  • Loss of self-confidence in social situations, eating out, kissing, relationships

  • Poor Dental health, higher risk for gum disease, tooth decay and extractions

  • Poor aesthetic appearance

  • Emotional factors resulting in rising levels of stress

I hope you have found this information informative! It is by no means a replacement for a functional assessment and proper diagnosis, so if you have any further questions please don't hesitate to ask for your complimentary Questionnaire, or schedule a Functional Assessment!


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