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.

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.