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Tethered Oral Tissues (TOTs)

Tethered Oral Tissues (TOTs)

Many people hear Tethered Oral Tissues and they think of ankyloglossia, or tongue tie. Robyn treats issues related to all seven frena (1 lingual, 2 labial, and 4 buccal). Tethered Oral Tissues can affect the way an individual eats, speaks, swallows and can interfere with sleep as well. While we commonly see research and hear about how TOTs impacts breastfeeding, there are many other functional problems that from TOTs. Along with Lori Overland, Robyn has taught over 1000 professionals on TOTs and has published a text and, research papers, blogs and podcasts on this topic.

TOTs is not a fad ! The increase is the number of patients being identified is due to 1) increase in breastfeeding 2) awareness , 3 ) epigenetic factors and 4) training of professionals. No one should rush to surgery without proper assessment and pre-op care. Functional assessment and therapy is key for optimal resolution of symptoms that may include:

1) feeding challenges
2) GERD/reflux
3) speech sound/articulation disorders
4) dental cavities , especially the molars
5) voice issues such as limited vocal range
6) oral habits like thumb sucking
7) sleep issues
8) snoring
9) TMJ
10) picky eating habits

Robyn provides specialized assessments of oral motor, feeding, and speech that may be the result of TOTs. A unique pre and post operative plan of care that involves the patient and their caregiver) is implemented BEFORE a release in order to :

1) Acclimate the CLIENT to intra-oral stimuli and reduce fascial restrictions to optimize the release;
2) Train the CAREGIVER on what is expected after the release and teach the oral motor interventions and
3) Establish rapport with the CLINICIAN for better clinical outcomes.

Robyn works collaboratively with preferred providers (surgeons) , lactation specialists (IBCLCs) and bodyworkers (OTs/PTs etc.). Each patient is approached with a global understanding that different problems require different professionals.

Visit the schedule page to make an appointment for your pre- and post-operative care, or to simply start the process in ruling TOTs in or out .

For preferred surgery providers , visit:

Dr. Youngnan (Jenny) Cho:

Dr. Scott Siegel:

For Robyn's book on TOTs , please visit the publications page.

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