When we think of oral ties or TOTs, we often associate them with tongue or lip ties. But did you know there’s another type of tie that can significantly affect oral function? It’s called a cheek tie or buccal tie, and although it’s lesser known, it can create real challenges, especially for adults.
In this article, we’ll break down what a cheek tie is, how it can impact you, and what options are available for treatment.
What Is a Cheek Tie?
A cheek tie occurs when the frenum, a thin band of tissue, connects the inside of the cheek to the gums in a way that restricts movement. While this tissue is a normal part of oral anatomy, an overly tight or restrictive frenum can cause issues with chewing, speaking, sinus drainage and even breathing.
Cheek ties can be upper, located to the side over the first molar or slightly in front of that spot. There may be one frenum or even a bundle of ties tightly located in a cluster.
Additionally, there are lower cheek ties, located by the lower teeth usually under the canine tooth. Again, there may be one frenum or a bundle in a cluster.
Not every cheek tie may be tight or restricted in the mouth. The most common ones to release are the upper cheek ties. You may find you have one restricted on the left side, but the right side is not. Or you may look and identify both left and right cheek frenulum are restricted.
This picture displays an upper frenum in an infant along with the identified level of attachment from class 1-3.
Find Dr. Richard Baxter’s full article here https://tonguetieal.com/what-is-a-buccal-tie-cheek-tie/
Now imagine how that tightens increases over the years and impacts facial growth as you become an adult.
In adults, cheek ties can contribute to a range of symptoms that may seem unrelated at first, such as:
- Difficulty opening the mouth fully
- Chewing challenges
- Speech difficulties
- TMJ (temporomandibular joint) pain
- Tension in the face or jaw
- Eye pain/focus
- Sinus issues
Many people with cheek ties adapt to these sensations and limitations over time, unaware that a simple issue, a tiny band, is at the root of their discomfort.
6 Ways a Cheek Tie Affects Adults?
Living with a cheek tie as an adult can affect your day-to-day life both subtly and harshly. Here are some common ways a cheek tie might be causing more trouble than you realize:
Limited Mouth Movement:
Struggling to open your mouth wide enough while eating, yawning, or during dental appointments?
That could be due to restricted cheek movement. With the cheek tie pulling the muscle and fascia closely into the gum ridge there is a counterbalance from the jaw. This counterbalance limits the opening space and creates tension in the jaw joint.
Speech Issues:
People with cheek ties may experience articulation problems, particularly when forming sounds that require lip rounding or forward cheek movement, like “SH” “J” or “CH.” The “S” and “Z” may also be impacted by a limited range in the cheek to retract or smile. Often, we hear a slushy quality to the speech.
This is due to too much air escaping into the cheeks while producing the sound. Adults with cheek ties will experience fatigue as they talk for a longer duration, such as a meeting presentation, and will begin to feel the precision in their speech slip.
They will notice an increase in the slushy quality emerging and also notice increased saliva build-up.
Oral Health Challenges:
Food might get trapped in tight spaces between the cheeks and gums, leading to plaque buildup, gum irritation, or even cavities.
Poor access for the toothbrush due to cheeks being tied too closely to the gum ridge also creates an unhealthy environment for the teeth and oral cavity.
Jaw Pain and TMJ Disorders:
Tension in the cheeks can lead to overcompensation in other parts of the face, causing jaw misalignment, headaches, or TMJ problems. The jaw is the base of support for all of the oral muscles.
When they are in disharmony the jaw provides corrective measures. Over time an adult with cheek ties will experience pain in other areas such as the jaw. They can spend years treating TMJ issues with no lasting solution until they release oral ties.
Eye pain and focus:
The impact of a cheek tie can be felt differently for each person. Many report a connection to their eyesight, general eye strain, and ability to focus.
When completing myofascial soft tissue releases around the cheek frenulum a patient will notice improvement in their eye strain and focus.
The sense of going from regular TV to HD TV. That pop of clarity into the vision when strain is lifted off the fascia and muscles below the eye is an indication that the tie is negatively affecting this area.
Sinus:
While having soft tissue releases performed on their cheek frenum patients will report their sinuses clearing. Feeling it dumps into the throat and relieves sinus pressure.
When the cheeks are stretched through protocols such as © Beckman, www.beckmanoralmotor.com there is a note of further release of facial and sinus pressure.
Cheek ties may be interfering with lymphatic drainage, the body’s natural plumbing system.
Patients will note that this relief lasts 1-2 days post-therapy session prior to the surgical release. Once the surgical release is completed these patients report longer stretches of relief and eventually feel symptoms are largely absent from daily life.
Cheek Tie Diagnosis and Treatment
If you suspect you might have a cheek tie, it’s important to consult with a healthcare professional who specializes in tethered oral tissues (TOTs). There is much disinformation in the world of oral ties and even more so surrounding cheek ties.
Who Identifies and Treats Cheek Ties?
Finding a knowledgeable professional will set you on a path to being connected to the correct interventions and a team of professionals that they recommend.
This could be a myofunctional therapist, dentist, oral maxillary surgeon, or ENT. They’ll perform a thorough evaluation and help determine if a cheek tie is present.
You can begin your search here: https://www.tonguetielife.com
But remember not all providers are created equal. Find the right fit for you and be confident in seeking second or even third opinions.
This next article discusses the buccal frenum and the trends in diagnosis amongst professionals:
https://onlinelibrary.wiley.com/doi/10.1111/joor.13609
The authors summarized their results as: “A multidisciplinary group of 466 providers responded. About 87% indicated that they assess buccal restrictions. Evaluation methods included finger sweep (89.1%), visual inspection (76.4%), tissue blanching (66.5%) and functional assessment (53.4%). Around 94% of providers reported that objective and subjective findings are both needed for diagnosis and that an estimated 5%–10% of infants may be affected. About 70% of providers release buccal-ties (if needed) simultaneously with tongue-ties, and 76.8% recommend post-operative stretches as necessary for optimal healing. Respondents indicated a need for further research, evidence-based assessments, a classification system and treatment protocols.”
Unfortunately, there are varying opinions among professionals. An ENT, Dentist, or Oral surgeon may well believe in the impact of tongue tie and regularly perform surgical releases for the tongue.
But these same well-respected professionals will not consider cheek ties necessary to release. There is a prevailing perspective that cheek ties do not impact speech and feeding functions.
Therefore, we have adults who may have revised a lip and or tongue tie as an infant or child, but the cheek tie remains.
Treatment Options for Cheek Ties
Myofunctional Therapy:
This therapy focuses on retraining the muscles of the mouth, face, and throat to function properly. For many adults, myofunctional therapy can improve the symptoms of cheek ties without surgical intervention.
But a tie is always going to be a tie. Once you stop an exercise routine the gradual process of tightness and poor movement will reemerge.
This is why the standard recommendation is to initiate myofunctional, or oral motor exercise, before the surgical release. Next, have a surgical release, and then continue with myofunctional therapy to restore full movement of oral muscles.
Frenectomy:
A frenectomy (a minor surgical procedure to release the tight tissue) may be recommended. This procedure is typically quick and minimally invasive, with a relatively easy recovery.
The dentist or surgeon will use either scissors or a laser. The skill is in the provider’s hands, not the instrument. Most choose the laser as it cauterizes as it cuts the tissue allowing for less chance of infection and faster healing times.
Some report an immediate sense of facial tension lessening, improved vision, and a reduction in jaw or neck pain. Others will note a few days of discomfort but overall, back to normal activities and work the next day.
It may seem scary to have a laser pointed in your mouth. But it will likely be the easiest and fastest dentist visit of your life!
Orthodontic Treatment:
In some cases, the tension from a cheek tie may contribute to misaligned teeth or bite issues, making orthodontics another avenue to explore. There is some degree of differing opinions on when to brace and when to surgically release a tie.
Some prefer to correct dental alignment first and then release a cheek tie. Others believe you should release the cheek tie and then brace the teeth.
At times this can seem overwhelming, especially financially. Braces should not deter you from releasing ties. If finance is an issue then release the tie first. Allow yourself to feel the benefits of the restriction being removed.
You may actually have a shorter time in braces if you release the cheek tie first. Also, you can plan and save for braces after the release is performed while already enjoying less facial and jaw tension.
Why Treating a Cheek Tie Is Important
Because a cheek tie is often left untreated in infants and children it can lead to a cascade of problems over time for an adult.
Not only can it affect your ability to chew and speak properly, but it can also impact your overall oral health and quality of life. Relieving constant sinus congestion and reducing jaw pain are just two small ways to greatly improve quality of life.
Seems incredible that so many professionals could have missed this right? But the truth is that oral ties have fallen out of regular diagnosis within several professions.
Complicating the matter further, those within professions who do not believe in the impact of oral ties will vehemently speak against those who do identify it and treat it.
Addressing a cheek tie early can prevent more serious issues from developing and give you greater control over your facial function and comfort. If you made it to adulthood with cheek ties intact it’s not too late. Knowledge is powerful!
Final Thoughts For Adults with Cheek Ties
People often overlook cheek ties, but they are far from insignificant.
If you’ve been dealing with unexplained jaw pain, facial tension, eye strain, misaligned teeth or difficulty with oral tasks, it’s time to investigate the possibility of a cheek tie.
With proper diagnosis and treatment, you can improve your oral health and feel more confident in your smile, speech, and overall well-being.
Not all providers have equal training in diagnosing and treating oral ties, especially cheek ties. So, don’t let a well-respected professional with little training in the benefits of cheek tie releases deter you.
Doctors have told patients very directly that there is no medical evidence for releasing any oral tie and that they would be putting themselves through an unnecessary procedure.
Only to go ahead and find help from other more knowledgeable professionals. Leading them to life-changing outcomes.
If you suspect you have a cheek tie, don’t hesitate to reach out to a professional who specializes in tethered oral tissues. Your quality of life, comfort, and health are worth it!
Feel free to explore more on Lynn’s Tied Together Hub for insights on oral ties and that can help you take control of your health!
Check out our other blogs on oral ties at https://lynnstiedtogetherhub.com/blog/