What are TOTS?

What is a tongue and lip tie (TOTs)?

Generally, most people have two frenulums – one that anchors the tongue to the floor of the mouth and the other that connects the lip to the mouth.

  • Tongue Tie: An excessive amount of tissue or membranes where the tongue connects to the bottom of the mouth, prohibiting the tongue from moving freely. This condition is known as a tongue tie.
  • Lip Tie: Similar to a tongue tie, when excessive tissue is formed from the top of the lip to the upper gum tissue above the anterior teeth.

We call tongue or lip ties tethered oral tissues or TOTs for short.

Tethered oral tissues (TOTs) can include ties of the tongue, lip, and even buccal tissues. This is when the frenulums are short and/or thick and limit movement of tongue, lips, or cheeks.

Oftentimes, these anomalies produce symptoms that are misdiagnosed as acid reflux, colic, and even failure to thrive—all of which have treatments that will not help with the true condition itself.

Infants born with lip or tongue ties often have difficulty latching, leading many mothers to abandon breastfeeding efforts.  Aside from latch issues, mothers may notice infants gumming or trying to chew while nursing, gasping for air or clicking or wheezy sounds while nursing; and excessive drooling. This leads to excessive air swallowing during feedings, causing hiccups and gassiness, which can in turn cause colic and reflux issues.  Our aim is to properly diagnose ties so we can provide correct treatment as soon as possible, so mothers and babies can continue to successfully breast-feed. Breastfeeding not only helps moms and babies bond, but delivers nutritional and immunologic protection for the child.

Did you know? Breastfed infants work 60 times harder at the breast than feeding from a bottle. The very action of latching and suckling significantly increases the strength and size of the baby’s tongue. A good latch will help expand the size of the palate, open the airway, oxygenate the blood, support a baby’s brain growth, and help prevent Obstructive Sleep Apnea.



Dr. Ann did tongue/lip tie revisions for all 3 of my kids. My youngest was 1 week old and the team was so kind and helpful with dealing with a newborn! They were also very knowledgeable on how to work with my 2 and 4 year olds! We saw huge tongue mobility improvements for all 3 kiddos!

Heidi G.

What are the symptoms of a tongue or lip tie?

Symptoms in Infants:

  • Cobblestone nursing blister on lip
  • Clicking or gulping sounds while nursing
  • Gumming, chewing nipples, leaks milk
  • Chokes easily
  • Frequent release and relatch
  • Shallow latch
  • Long nursing sessions – falls asleep mid feed
  • Colic/gas/reflux
  • Poor weight gain or weight loss
  • Unable to hold a pacifier
  • Heart shaped tongue

Symptoms likely present in toddlers & older children:

  • Reflux
  • Fatigue during eating
  • Projectile spitting up after eating, weight loss
  • Lip blisters
  • Gassiness
  • Congestion
  • Liquids/foods dribbling from sides of mouth
  • Potential future speech and dental problems
  • Pocketing food/picky eater

Signs and symptoms of tongue or lip ties aren’t just isolated to the child. In fact, the mother may also exhibit signs that their child may have a tie. Here are some of the most common symptoms a mother could experience:

  • Decreased milk supply
  • Breasts don’t fully empty
  • Cracked, blistered, bleeding nipples
  • Plugged ducts
  • Discomfort or pain while nursing
  • Frequent mastitis
  • Long nursing sessions (or extremely short because baby gets tired)
  • Postpartum depression

Consequences of Untreated Lip and Tongue Ties

If left untreated, Lip and Tongue Ties (TOTs) may lead to social, orthodontic and gum-related problems in school aged children and adults.

Feeding issues – Many children can develop a high arch in the roof of their mouth (palate) as it does not get the benefit of proper shape and molding from the tongue if it is tied down. Many children struggle with not only breastfeeding, but also transitioning from milk to purees or table foods. Some become picky eaters and swallow their food in chunks or even experience choking episodes.

Speech issues – Many children may develop speech related issues where they have difficulty with articulating “t, d, z, s, th, and n” sounds. This speech impediment is due to limited range of motion and elevation of all parts of the tongue required to produce various sounds.

Sleep issues – Children and adults can be predisposed to certain types of sleep apnea as a result of an undiagnosed tongue tie.  The tongue remains ‘down and back’ in the mouth which leads to restriction of the airway. Snoring, exhaustion, attention deficit disorders, and behavioral issues are often connected back to breathing-related sleep disorders.

If you have any questions or would like to book a consultation, please contact our office and we can provide assistance on the next steps to take.

Related Blog Posts

The TOT Spot is a tethered oral tissues treatment center in Simpsonville, SC located within the Greenville metro area. Led by Dr. Ann Bynum, the center focuses on properly diagnosing tongue & lip ties and providing
CO2 laser surgery to quickly and painlessly release ties. Our practice serves patients throughout the Greenville, South Carolina area, as well as Atlanta, Asheville, and other areas of SC, NC, and GA.

Copyright © 2024 The TOT Spot. All Rights Reserved.
Website Design & Marketing by Carolina Creative