As a Denver chiropractor, I see a lot of newborns with tongue ties. Interestingly enough, I work with a lot of adults with tongue ties as well and although the tongue gets all the attention, the general verbiage for oral ties is Tethered Oral Tissues (TOTS). The terms oral ties and tethered oral tissues (TOTS) take into to account the other areas of the mouth that may be restricted and cause restriction as well. An oral tie is a band of restricted tissue that causes functional concerns. These “bands” connect the tongue to the floor of the mouth, the cheeks to the gums and the lips to the gums as. Any of these areas can be thickened, shortened or restricted and cause concerns.

What are the different types of oral ties?

Despite tongue tie being the most “popular” type of tie, there are multiple areas that can be “tied” and there’s more than one type of tongue tie. The other options include:

• Upper cheek ties (right / left) known as buccal ties - connects the cheek to the gums

• Lower cheek ties (right / left) also known as buccal ties - connects the cheek to the gums

• Upper lip tie - connects the lip to the gums

• Lower lip tie - connects the lip to the gums

• Anterior tongue tie (more in the front and typically what people see)

• Posterior tongue tie (deeper and more commonly missed)

What is the difference between an anterior and posterior tongue tie?

An anterior tongue tie is typically pretty obvious, which is what most people imagine when they think of a tongue tie. This is typically a thin band of tissue anchoring the tongue to the floor of the mouth, or even attaching up into the gum. However, a posterior tongue tie is typically a more hidden as it is a bit deeper under the tongue and is often missed. This is why many people are told their kiddo doesn’t have a tie, but then continue to have symptoms that resemble that of a tongue tie (such as difficulty feeding). If your concerns have been dismissed please know that not every provider has additional training and experience in this area and you are entitled to a second opinion!

Does the type of tongue tie determine the need for a release?

The location of the band of tissue (also known as a frenum) or how it looks does not determine the need for a release. Instead, symptoms and function of the structures of the mouth and surrounding areas are what determine the need for a release. Again, only a skilled provider can provide this assessment so if someone simply looks at the tongue and provides a diagnosis based off of that criteria alone, please seek out a provider that asks in-depth questions and provides a full assessment! Also, to note- please see a dentist with specific training in tongue ties (and ideally airway) for a formal diagnosis. “Bodyworkers” such as chiropractors, occupational therapists, physical therapists, etc. can identify functional and structural concerns, but cannot diagnose a tongue tie or any other oral ties. Collaborative care between a release provider and a “bodyworker” is incredibly important as bodywork is important prior to and after a tongue tie release.

If you have any questions about tongue tie, please feel free to reach out and contact Dr. Dani!