Tethered Oral Tissue and Manual Therapy

Being "tongue-tied" is not just a cliche from a Grouplove song. Leaving a child tongue-tied has the potential to impact feeding (from the breast, the bottle, and the plate), speech, sleep, and even potentially posture.

Tethered oral tissue (TOT) - also known as ankyloglossia or lip-ties, tongue-ties, and buccal-ties - are a relatively common physical restriction a child is born with that may impact the range of motion, control, and development of oral-motor structures.


If you are reading this, chances are you already know that. What you want to know is why your pediatric dentist (or another revision provider) is referring you to a Doctor of Chiropractic for post-op follow up care. There are three very important reasons to include specialized musculoskeletal therapy for optimal tethered oral tissue frenectomy success.

My job is to:

1 - Make sure you get the most out of this experience.

Although TOT frenectomy is a safe and usually very quick procedure, it is not usually pleasant (for parent or child). Most parents, given the option, would prefer not to go through it twice. Our first goal of treatment is to reduce the risk of reattachment. The stretches that you have been instructed to do at home are a crucial part of this. With the additional training, knowledge, and experience working in tiny little mouths, a skilled practitioner is going to provide exercises and stretches that are even more specific and effective than those performed at home. Most parents also really appreciate the reassurance that they are performing the stretches properly, or the additional instruction to make sure they are productive at home too.

2 - Relieve compensation patterns developed and promote retraining and ideal oral-motor developmental.

The tongue should be completely separate from the bottom of the mouth by 22 weeks gestation (in-utero). From this point on, while in mom's belly, babe begins to train tongue movement and suck/suckle pattern. Their tongue should also regularly be contacting the roof of the mouth, desensitizing the gag reflex and promoting the development of a broad palate (not too high and narrow, which can make nursing difficult and painful). This in-utero experience sets baby up for feeding success from day one. A restriction in the tongue, lip, or cheek may impede all or part of that development. But our bodies are smart! They do their best to get the job done using what they've got. This creates compensatory mechanisms, like using the chewing muscles in the cheeks rather than the tongue to suck. Although these compensations are well-intentioned, they come with a cost. Our second goal of treatment is to calm down compensations including over-active muscles and reflexes so that babe has the opportunity to retrain an ideal feeding pattern and continue along with normal oral-motor development with nothing holding them back.

Tethered oral tissues can pull on and impact directly the structures of the head, jaw, and neck. Because our fascial system is an interconnected web, any restriction in connective tissue at one part of the body also has the capacity to impact other body areas both near and far.  This is why we do a thorough, full-body checkup and not solely focus on the structures within the mouth.

3 - Address any confounding issues that may impact feeding success and ideal development.

Having a TOT does not exclude you from having other maladaptive patterns as well (and may in some cases actually increase their likelihood). Issues such as torticollis and cranial asymmetries (plagiocephaly) are also likely to impact feeding dynamics. Any time you have to feed differently on one breast or have to hold babe in a very specific position to feed, this is a flag for a musculoskeletal restriction. For a perfect feeding pattern (which is usually our primary decision maker for choosing to complete a frenectomy or not), a babe needs full and symmetrical neck rotation to both sides, adequate head extension, jaw symmetry and the capacity to open wide, and a slew of reflexes that should be active and automatic, as well as some that we need to be not too active. There is a lot going on with feeding! Fortunately, when there is nothing holding babe back, all this happens automatically. Our third goal of treatment is to remove any other barriers that may hold babe back from achieving thriving feeding success and optimal motor development.

That is what we do. We make sure you get the most of our your experience, remove compensations so baby can retrain easily, and check to see if there is any other neuromusculoskeletal aberrations that have the potential to get in the way of feeding and developmental success.

Dr Anna Marie Gierach and myself (Dr Amanda Stevens) at AltaVie Integrated Family Health, on top of countless hours of pediatric-specific course work, have both completed specialized training in tethered oral tissues and supporting a complete recovery after frenectomy. Our practice focuses entirely on pediatric and maternity care and we have experience supporting families through a plethora of feeding struggles, certainly not limited to tethered oral tissue.

Please note: We do not replace the technical assistance of a lactation consultant or specialized SLP/OT (although we do promote your retraining success). We strongly encourage you to also seek the support of a trained IBCLC. It takes a village to raise a child and it usually takes a team (and a little bit of time) to promote perfect recovery from restrictive TOTs.

Resources & References

About Amanda Stevens

Dr Amanda Stevens is a chiropractor and clinical nutritionist whose practice focuses entirely on paediatric and maternity care. She works with families through pregnancy and onward to infancy and childhood. She is passionate about thriving early development and a uses a multimodal approach for problem-solving and wellness care that is specific to each patient that walks through the door.

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