Tethered Oral Tissues

TOTs: Tethered Oral Tissue Initial Exam


 At your initial visit 
  • a detailed symptoms and concerns discussion with the dentist
  • a full examination of your muscles, joints, bite, gums and tissues
  • airway screening and functional exam of the tongue, lips and other structures contributing 

Comprehensive exams are typically conducted for new patients, or every three  to five years for existing patients, depending on their past and current treatment. 

For the pre clinical exam your doctor and assistant will begin with an interview where you will discuss your medical history and your presenting concerns.  As part of the pre clinical exam your doctor will take may take a series of dental x-rays to examine your teeth and root structure in  more detail, as well, as evaluate the bone supporting and surrounding the teeth.
For the extra oral exam your doctor will massage the muscles on your temples, jaw, neck and shoulders, to see if there is any sensitivity or pain that could be related to a larger issue.  We will examine the TMJ (jaw Joint) the primary joint involved with chewing and jaw movement by feeling the area while having you perform a series of movements.   The joint is checked for any sensitivity, pain, clicking or popping sounds.   
The intra oral exam includes checking the soft tissues inside your mouth, as well as the muscles, throat, tongue and any indications of oral cancer.   In addition to checking for pain or sensitivity any abnormalities are noted that could require additional attention, including tongue movement and functional restriction that may require Myofunctional Therapy and Tongue or Lip Tie Correction
We will examine your teeth and gums conducting a visual and hands on probing to check the structural health of your teeth and vitality of your gum tissues noting any areas of concern. 
We will also conduct an occlusal exam, brining the entire chewing system together by looking at the way the teeth touch, and come together.   This helps evaluate the overall health and alignment of your bite.
We will gather additional records that will help the fact finding process. 
  • Diagnostic models of your mouth are created taking a digital scan or impression
  • Photographs of your mouth may be taken to allow us to create a visual record of 
           the appearance and   condition of your teeth at the time of examination
  • Digital CBCT 3D scan of your jaws may taken to evaluate for pathology as well as           
           growth/development/airway concerns

Once all aspects of the exam have been completed, we will review the findings with you and discuss any areas of concern at a follow up Second Consultation Visit.  The doctor will review all findings from your Comprehensive Exam, Diagnostic Models, Photographs and Digital CBCT 3D scan, at which point you will have the opportunity to discuss your won concerns and ideas for your treatment plan.  The doctor and you will decide together on the steps to begin your journey toward oral and overall health. 

By completing a comprehensive airway exam, both you and your doctor will be equipped with all the information you need to ensure your achieve your oral health goals. 

Please review the following Screening Questionnaire to help you decide if a consult is needed:

FLIP chart,  Breastfeeding Disfunction Screening Questionnaire

FLIP Breastfeeding Concerns Screening Tool

FLIP Breastfeeding Concerns Screening Tool Practitioner evaluation


Tethered Oral Tissues

Ankyloglossia, more commonly referred to as tongue tie, is when the bottom of the tongue is attached to the floor of the mouth by an overly short and thick lingual frenulum.  The cause of the condition is not known, but genes may play a role since it tends to run in families.


Some symptoms include a tongue with limited range of motion, trouble sticking out the tongue past the lower front teeth or a tongue that appears notched or heart shaped when stuck out.  It can also cause esthetic issues by pulling the gums away from the teeth causing a gap between the lower front teeth. 


Ankyloglossia in children can lead to a range of problems, such as difficulties
breastfeeding, speech impediments, poor oral hygiene, and embarrassment
during childhood.

In cases the lingual frenulum attachment is severe enough to interfere with daily life, your doctor will work with you to develop a plan of care to correct the issue and prevent any additional complications for your infant, child or you.

A frenectomy is a simple surgical procedure that can be completed with the use of the CO2 Lightscalpel laser and sutures for adults and older children. The doctor uses sterile scissors or a laser to snip the
frenulum free. The procedure is quick with minimal bleeding or discomfort.

Pre and Post Operative care is extremely important for the success of any surgical procedure or release.

Please use these resources provided by Dr. Richard Baxter, Dr. Chelsea Pinto and The Breathe Institute to help with recovery.  It is very important to have therapy pre and post procedure with a qualified therapist in your area or virtually, to help with success of healing.


The Breathe Myo and The Breathe Institute Youtube Videos

Dr Richard Baxter and the Alabama Tongue Tie Center

Dr. Chelsea Pinto Youtube Channel and Instructional videos

Post Operative Stretches

Myofunctional Therapy 

Myofunctional therapy is a program used to correct the improper function of the tongue and facial muscles. Myofunctional therapy is a series of highly effective physical therapy exercises. 

It involves strengthening of the tongue and orofacial muscles by teaching individuals how to engage the muscles to the appropriate position. They also help keep the airway open, especially during sleep. 

Myofunctional therapy may also be an effective treatment for sleep-disordered breathing. Sleep-disordered breathing is a group of sleep conditions that cause a reduction in airflow through your upper airways. It includes heavy snoring and obstructive sleep apneaMyofunctional therapy treatment is safe and relatively inexpensive, which makes it an attractive alternative to other treatments

Proper diagnosis allows for targeted and effective therapy exercises for oral posture to promote better health with the goals to improve breathing, reduce pain and enhance quality of life.  Improper patterns can lead to a host of health problems and conditions including:


- Sleep-disordered breathing (including snoring and sleep apnea)

- Bruxism/Clenching

- Neck and shoulder tension

- Headaches

- Gastroesophageal reflux (GERD) or Heartburn

- Orthodontic relapse

Airway circle logo