What is a Tethered Oral Tissues (TOTs)?
TOTs has become a common acronym used by speech, feeding and dental professionals, and those who practice orofacial myofunctional therapy. TOTs includes lingual restriction — also known as ankyloglossia (tongue tie)– but can also be a restriction of the frena of the lips and cheeks, by a band of tissue
What does the Speech Pathologist do?
- Assess : Structural Red Flags/Functional Red Flags
- Treat: PRE-OP/POST-OP Care
Functional Red Flags
- Tongue thrusting
- Teeth grinding
- Oral phase feeding issues
- Breast-feeding issues
- Mouth breathing
- GERD/reflux symptoms
- Sleep Disorder Breathing
- Articulation errors
- Torticollis
- Thumb sucking
Structural Red Flags
- High palate
- Diastema (space) between the top central incisors
- Open mouth posture
- Heart-shaped tongue tip
- Dental malocclusion (misaligned teeth)
- Enlarged tonsils and/or adenoids
- Parted lips at rest
- Facial asymmetry
- Long face syndrome
- Full cheeks/unresolved nursing pads
Key points for TOTs
- TOTs TEAM Professionals should be trained in TOTs
- Releases shouldn’t be performed due to appearance alone, but rather due to functional impact
- PRE-OP and POST-OP neuromuscular re-education will be needed for optimal release
- Everyone’s journey is unique!
By,
Mallory McBride M.A., CCC-SLP
Speech Language Pathologist
