Oceans Tongue Tie Center

Tethered Oral Tissues (TOTs)

TOTs is a term used to describe tight, restrictive connective tissue between the oral structures. This connective tissue is called the frenum. Typically, we see tethered oral tissues in the form of a lip, tongue, or buccal tie. These tethered tissues can cause call kinds of issues ranging from airway, to speech, to sleep to feeding.

Below is a list of common issues that patients may experience with tethered oral tissues.


  • Open mouth breathing
  • Teeth grinding
  • Poor posture
  • Snoring
  • Dry, chapped lips


  • Frustration with communication
  • Difficulty to understand by others
  • Difficulty speaking/getting words out
  • Trouble with specific sounds
  • Stuttering, mumbling, speech delay

Feeding in Infants:

  • Milk dribbling out of mouth
  • Poor supply
  • Painful/shallow latch, falling off nipple
  • Gagging/choking
  • Falling asleep in the middle of a feed
  • Hiccups often
  • Lip curls under when feeding
  • Lip blisters
  • Colic symptoms
  • Gassy
  • Noisy breathing
  • Restless, short sleep or not sleeping well
  • Baby always seems hungry/not full
  • Reflux/spitting up
  • Unable to hold a pacifier
  • Clicking/smacking noise
  • Required use of nipple shield
  • Baby is frustrated at breast/bottle
  • Significant weight loss

Feeding in Children/Adults:

  • Slow eater
  • Grazes on food
  • Packs food in cheeks
  • Picky with textures
  • Choking/gagging on food
  • Spits out food


  • Sleeps in strange positions
  • Moves around a lot at night
  • Wakes easily/often
  • Gasps for air/sleep apnea
  • Wakes feeling tired
  • Grinds teeth while sleeping
  • Snoring

Other related issues:

  • Neck/shoulder pain or tension
  • TMJ/clicking/popping
  • Headaches/migraines
  • Constipation
  • Hyperactivity/inattention
  • Ear tubes/tonsils/adenoid treatment

Treatment: The tissue is released using a minimally invasive procedure with a CO2 laser. By using the laser, the procedure is quick and results in minimal bleeding. Stitches are not needed, and the patient can resume eating and drinking immediately after. For the little ones, a topical anesthesia is placed in the area prior to treatment. On older children, treatment can be completed under N2O (laughing gas) to ease any nerves and is typically done with a small amount of local anesthesia.

Post-Op: After the procedure, there is homework which involves doing stretches and exercises about 5x/day to the treated areas to ensure it does not reattach. It is important to understand the commitment of the aftercare when moving forward with the procedure to obtain the most optimal result. We discuss the rule of 5s -performing the stretches 5x/day for 5 rounds of 5 seconds each. Typically, the site is completely healed in about 3-4 weeks.

We find that families who follow up with various specialists have optimal results. Below is a list of offices we recommend to our families.


  • Taherrah McGriff, RN, IBCLC, CBS, NCS, Love, Latch & Little Ones [Middlesex, NJ] (732)-351-2392


  • Flourishing Families Chiropractic [Clark, NJ] (908) 653-0000


  • Ivy Rehab, Danielle Valente OT / Shauna Lawlor PT [Cranford, NJ] (908)-315-3616
  • Riki Newman, OTR/L, CLC – little tpOTs [Westfield, NJ] (917) 647-8185
  • Milk Matters, PT [Ramsey, Manalapan & Martinsville, NJ] (201)-401-0702


  • Jenna Friedman, MS CCC-SLP [Westfield, NJ] (908)-588-7250

Myofunctional Therapy

  • Communikids [Summit, NJ] (908)-273-5537
  • Speak, Eat, Smile [NJ] (917)-601-6488
  • Melissa Arrigo, MyoTherapy & Me LLC [Westfield, NJ] (908)-514-0376

We at Oceans Orthodontics and Pediatric Dentistry aim to be exceptionally caring while providing exceptional care. The Oceans Team  always provides the best dental care with a genuine smile. We elevate the lives and smiles of each and every person with whom we come in contact.


522 E Broad St.
Westfield, NJ 07090
[email protected]

Mon: 8:30am - 6pm
Tues: 9am - 6pm
Wed: 8am - 6pm
Thur: 8:30am - 6pm
Fri: 8:30am - 4:30pm

Oceans Orthodontics and Pediatric DentistryOceans Orthodontics & Pediatric Dentistry
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