Understanding Tethered Oral Tissues and Their Impact on Health
Oral ties, also known as tethered oral tissues (TOTs), are a condition where the connective tissues, frenulum, in the mouth, such as the tongue, lips, or cheeks, are too restricted. These oral ties impact everything from chewing and swallowing to sleep and posture.
For adults who experience symptoms of oral ties, life can be a daily challenge. In this post, we’ll delve into the different types of tethered oral tissues, including tongue ties, lip ties, and cheek ties, and explore how these can affect your oral and overall health.
What Are Oral Ties?
Oral ties, or tethered oral tissues, occur when the connective tissue, a frenulum, in the mouth restricts normal movement.
For example, if a tongue is tied, the tissue underneath, called the lingual frenulum, is too tight or thick, limiting its range of motion. This restriction affects the tongue’s function which plays a role in everything from digestion and breathing to clear speech.
Adults who experience TOTs often feel the effects in ways they may not realize are connected to their oral ties, including headaches, jaw pain, and even fatigue.
Types of Oral Ties and Their Health Impacts
There are three main types of oral ties: tongue (lingual) ties, lip (labial) ties, and cheek (buccal) ties. Each type affects the body differently, but all can create ongoing health challenges if left untreated.
Essentially, the cheeks have two placements, upper and lower cheek. Then the lips have two placements, upper and lower lip. Finally, the tongue has one frenulum under the tongue. This totals 7 possible oral ties within the mouth.
Let’s take these one by one.
Tongue Tie
A tongue tie occurs when the tissue under the tongue (lingual frenulum) is too tight, thick, or short, limiting tongue movement.
This restriction affects the tongue’s ability to make precise movements in harmony with other facial structures and coordinated with breathing.
Speech:
Tongue ties are most associated with speech deficits. Oral ties located in the tongue can make it challenging to pronounce certain sounds.
The K and G sounds could be weak due to poor elevation of the posterior tongue.
The R sound is often affected due to the posterior side-spread and mid-blade elevation movements required to fully create the sound. The S, SH, CH and J sounds may be produced in error as there can be excess air creating a lisp quality.
For airflow sounds such as the S the tongue needs to retract and side spread where it holds onto the inner molars, creating a runway for the air to travel down. The tension in the tongue will create the force for the air to produce the S crisply.
If the tongue is tied, it struggles to create this runway and crispness. Hence a lisp exists, as too much air is escaping into the cheeks or out through the front teeth.
This oral tie can also make it difficult to speak for extended periods, meeting presentations as an example. The rapidly alternating patterns of speech can be fatiguing to a tied tongue that lacks full range of motion and strength.
Eating and Swallowing:
Adults with tongue ties may find chewing and swallowing food uncomfortable, sometimes leading to reflux or even nutrient deficiencies from not fully breaking down food.
The tongue needs to create a tongue bowl shape to accept and move food. It lateralizes food side-side for efficient chewing. When the tongue is tied it lacks the range of motion and strength to move food easily. This often leads to picky eating or limited diets.
The final oral stage of chewing food requires the tongue to squeeze up into the palate and then forcefully push the food down into the throat/pharynx. Poor propulsion of the food can lead to reflux, gas and burping.
Yes, that’s right, your tongue tie may be why you burp so much!
Breathing and Sleep:
Restricted tongue mobility can affect proper breathing patterns. The tongue should rest up in the palate. Lips would be sealed closed, and the tongue would be suctioned up into the palate (roof of the mouth).
When this is not achieved, mouth breathing is prevalent. Mouth breathing is generally considered unhealthy. The best air for your lungs and body comes through the nose where it has been filtered and warmed.
Mouth breathing when one sleeps can lead to increased occurrence of snoring and eventually develop into sleep apnea.
Having spent the night snoring or experiencing periods of sleep apnea an adult will suffer daytime drowsiness, reduced attention and a general feeling of moodiness.
For more information of tongue ties please check out our full blog article dedicated to tongue ties here:
Lip Tie
A lip tie happens when the connective tissue attaching the upper or lower lip to the gums (labial frenulum) is overly restrictive. While often associated with infants and breastfeeding, lip ties in adults can also cause various issues.
This oral tie is often noticed by parents, but doctors and therapists have adopted a don’t touch it will break on its own philosophy.
When one stops to consider this medical advice, it does seem a bit bizarre. First, they assume it is not impacting function at the current time or that it can be a factor in dentition and mouth breathing.
Second, this is actual medical advice to wait until you fall and have a facial injury. Breaking on its own means the child will fall and smash the lip, causing the tie to break.
Congratulations, you made it to adulthood with this oral tie well in place because you avoided damaging your face as a child!
What could this lip tie be affecting today in adulthood? Here are some possible impacts of a lip tie.
Appearance and Comfort:
A lip tie can affect lip mobility and appearance, sometimes creating a thinner upper lip or a flatter philtrum (the area between your upper lip and nose).
In a world where fuller lips and Botox injections are popular, a thin lip can make one self-conscious about their appearance. Men with thin upper lips often grow beards to hide it entirely. Women turn to expensive make up tricks to create a fuller appearance.
Adults may also notice that their lips chap frequently or feel tight, which can be both uncomfortable and cosmetically concerning. Frequent purchases of ChapStick, or lip balm become a financial issue as one tries to keep the lips hydrated.
When lips are tied, they may tend to be parted and not sealed. This facilitates open mouth breathing. This constant airstream over the lips will keep drying them out. It is a cycle without end due to the oral tie never being addressed.
Chewing and Oral Hygiene:
Restricted upper lip movement can impact eating, making it challenging to chew food with the mouth fully closed.
A lip seal is so important to manage the food bolus within your mouth. When lips keep parting during the chew cycle they are letting bursts of air into the mouth. This air is being swallowed with the food. Leading to increased burping, gas and indigestion.
Also, these parted lips may look like sloppy eating. Some patients with lip ties report that they eat holding a napkin in front of their mouth. This is done to hide the open mouth and to wipe excess food quickly that is resting on the lips and chin.
Lip ties may also contribute to gum recession if they create tension on the gums, potentially impacting oral health long-term.
This tight oral tie makes the lip muscle itself weak. While the tongue should be resting up in the palate, the lip rests pressing into the upper teeth. Naturally forming a mold for the teeth to grow and align into. A weak upper lip allows the teeth to gravitate out of this mold.
For more information on lip ties please check out our full blog article dedicated to lip ties at:
Cheek Tie
Cheek ties, although less commonly discussed, occur when the connective tissue (buccal frenulum) between the cheeks and gums is overly restrictive. This type of oral tie can contribute to:
Jaw and Facial Tension:
Adults with cheek ties may experience tension or pain in their jaw or cheeks due to limited movement.
This cheek tension has been noted to reduce vison, increase headaches and impact sinus issues.
The jaw is the base of support for all oral facial muscles. When we have a tie restricting movement on a muscle the jaw will compensate for that reduced movement. Excess gliding or jutting in the jaw will lead to TMJ difficulties over time.
Oral Hygiene Challenges:
The restricted movement can make it difficult to properly clean all areas of the mouth, leading to plaque buildup, especially around the molars.
Patients report significant improvement in being able to clean their teeth once they have this oral tie released.
Speech and Articulation:
Cheek ties can subtly affect speech by limiting cheek flexibility, making it harder to pronounce certain sounds clearly.
Certain speech sounds require airflow and for that airflow to be directed through the front teeth with some tension. Shaping of the sound may come from the rounding of the lips, or the retracting (smiling) of the lips.
For example, we change an S into an SH by changing from smiling to lip purse. The cheeks play an integral role in allowing the lips to round and retract. They have a subtle squeeze inward to direct the airflow.
An oral tie in the region of the cheek will reduce the ability to round, retract and squeeze inward. This will lead to a slushy or lisp quality in one’s speech.
For more information on cheek ties please see our full blog article dedicated to cheek ties here:
The Broader Impact of Oral Ties on Health
Living with oral ties impacts more than just the mouth. Here are some ways tethered oral tissues can affect overall health and well-being:
Digestive Health:
If chewing and swallowing are challenging, food may not be adequately broken down, which can cause digestive discomfort or even nutrient absorption issues. We noted that one or all of the seven possible oral ties can directly impact digestive health.
If spending money endlessly on antacid medications and over the counter remedies has you wondering why they don’t work. Then it may be time to consider that the source is an oral tie.
Addressing oral ties may indeed solve your digestive issues allowing you to enjoy that next meal out with friends in a way you never have before!
Posture and Musculoskeletal Health:
Restricted tissues in the mouth can subtly affect posture, leading to issues with neck and back alignment. The tightness from oral ties often causes compensations that extend into the jaw and down to the shoulders and spine.
Fascia is known to travel the length of the body like a web inter-connecting our muscles, organs and skin.
These restrictions can cause the diaphragm to be held up higher than normal, creating breathing issues. It can similarly pull tension into the pelvic floor. This may make it difficult to have a vaginal delivery as a woman, or to recover easily after birth.
Resolving oral ties may bring you ease in your neck, back, pelvic floor and breathing allowing you to be as active as you were as a teen!
Sleep Quality:
For many, oral ties can lead to airway restriction, which impacts sleep. When the airway is compromised, it can lead to breathing issues like snoring or sleep apnea, affecting both sleep quality and overall energy levels.
There are many snoring aides on the market today, and you may have bought them all. Without addressing the root cause of oral ties, these aides will only provide temporary relief.
Poor sleep leads to an entire cascade of issues for your waking self. From drowsiness to moodiness and poor focus. All of which can impact your work, social and personal life immensely.
Speech and Social Interactions:
Adults with oral ties may struggle with speech clarity, leading to social anxieties or self-consciousness. Simple actions like smiling or pronouncing certain words can become uncomfortable or awkward, affecting confidence and daily interactions.
No one told you about oral ties, not your dentist or doctor or even ENT. But you’re here learning about them because you want a change and know something can be done. You’re right, these oral ties may indeed be at the heart of your speech issues and releasing them may return you to a social life that you desire and enjoy.
Emotional:
Not knowing about oral ties and their impact often means you have been to multiple doctors and therapist for a particular issue. This can be emotionally and mentally draining. Seeking answers on your own is likely what led you here.
Anxiety is noted to be higher in patients with oral ties. There can be a general sense of heightened stress and tension in the body. This is directly connected to the fight or flight neurology we are all born with.
The fascia system, which is tied together with the frenulum or oral ties, runs through our body. When there is a hiccup in this system, we can feel it emotionally. Neurologically speaking its holding us in a constant fight or flight mode.
Patients who have had their oral ties released report a feeling of lowered stress and anxiety and general sense of relaxation in their bodies. One patient described it as a dimmer switch which has been all the way up on high and is now sliding down to a lower setting.
Treatment Options for Adults with Oral Ties
Fortunately, treatment options for adults with oral ties are available and can offer significant relief.
Myofunctional Therapy
Myofunctional therapy is an approach that uses exercises to retrain the muscles of the face, mouth, and throat to improve mobility and function. This can also be called oral motor therapy.
Myofascial release is a technique to go deeper into the soft tissues surrounding the frenulum and release the tension held there.
Myofascial is a tool used within the scope of myofunctional therapy.
Working with a specialist can help address the specific limitations caused by your oral ties, restoring comfort and functionality.
Surgical Release
In some cases, a simple procedure called a frenectomy may be recommended. This involves releasing the tight frenulum under the tongue, lip, or cheeks, allowing for greater range of motion and alleviating the strain TOTs can place on the body.
This surgical release may be performed by a dentist, oral-maxillary surgeon or ENT. But know that this is a sped\fic area of practice for these professionals.
It is best to seek an evaluation from a preferred provider who specializes in oral ties.
You can start your search here for both a Myofunctional therapist and a release provider:
But all providers are not created equal, and you should feel comfortable setting up 2-3 opinions to find the right fit for you.
Is It Time to Address Your Oral Ties?
If you’re struggling with any of the issues mentioned above, addressing your tethered oral tissues could be life changing.
Identifying oral ties and understanding their impact on your health is the first step toward improving your overall well-being. At Lynn’s Tied Together Hub, we’re here to help you understand your options and find relief from the daily challenges caused by TOTs.
Oral ties may seem like a small issue, but their effects can ripple through many areas of your life. Reach out to our team to learn more about how myofunctional therapy and TOTs treatment can transform your health and restore your comfort and confidence.
visit us at https://lynnstiedtogetherhub.com/