What Are Tethered Oral Tissues (TOTs)?
Tethered oral tissues (TOTs) can include lip-ties and tongue-ties in infants and children. This is when the frenulums, which are the connective pieces of tissues between the tongue and floor of the mouth, or the lip and gum, are short or thick and limit the movement of the lips, cheek, and tongue.
What Are Symptoms of Tongue-Tie for Baby?
Often TOTs create symptoms that lead to a misdiagnosis of acid reflux, colic, or failure to thrive, all of which come with treatments that will not help with the true condition. Infants who have tongue-tie or lip-tie will show difficulty latching, gasping for air when nursing, drooling excessively and gumming or chewing when nursing. This can lead to excessive air ingestion during feedings, leading to hiccups and gassiness, which can cause colic and acid reflux.
TOTs are not only uncomfortable for the infant. Mothers of children with TOTs also suffer from discomfort while nursing, mastitis, thrush, and plugged ducts.
How are TOTs Diagnosed and Treated?
The main way to alleviate the frustration associated with TOTs is early diagnosis.
The process begins with informing expectant mothers about the signs and symptoms to watch for that are associated with TOTs. We can ask questions to determine if the baby is showing any of these symptoms. The best way to assess an infant for TOTs is to look for how high they can lift their tongue or how callous their upper lip is. We can also determine a potential tongue-tie by asking the mother to describe the sucking pattern the infant shows when nursing. Often, tongue-tie stops the baby’s tongue muscles from properly working, leading to choking or gagging.
Treatment options are most often based on the severity of the condition, but if the tie is enough to cause symptoms, then the benefit of treatment always outweighs the risk. The most common choice for treatment of TOTs is laser frenectomy. This is a short and simple procedure in which a laser is used to cut the connective tissue and release the lip or tongue from restriction. However, this treatment also involves weeks of post-treatment therapy, which must be done consistently every six hours each day for the best results.