Tethered oral tissues (TOTS) can consist of either a tongue tie (where the thing piece of skin under a baby's tongue restricts movement of the tongue) or a lip tie (where the upper lip is restricted due to being anchored to the gum). This thin membrane of tissue should undergo cell death during embryonic development but in some cases will fail to do so, thus creating a "tethered-lie" cord of tissue. TOTS is a condition that often runs in families and is said to have a genetic component.
Research implicating tongue tie with difficulties in breastfeeding suggests a broad span; anywhere from 25-60% incidence of breastfeeding associated difficulties such as: failure to thrive, maternal nipple damage, maternal breast pain, poor milk supply as well as difficulty latching and refusing the breasts. Some studies have shown that for every day of maternal pain during the first 3 weeks of breastfeeding, there is a 10-26% risk of stopping breastfeeding. However, difficulties with breastfeeding alone should not be the only concern in order to consider evaluating a baby for TOTS and for possible intervention.
In one study, tongue tie was associated with the displacement of the epiglottis and larynx. Infants with this disorder were known to have difficulty breathing. These infants' arterial oxygen percent saturation levels were measured during 3 different times; asleep, awake, and suckling. The results showed that their SaO2 was unstable and slightly low; symptoms similar to those observed in victims of sudden infant death syndrome (SIDS) before their death. Unstable or low Sao2 levels may also lead to neurological and developmental issues in children.
In the case of an upper lip tie (ULT), the baby may not be able to obtain a proper latch or seal on the breast. A successful latch occurs when the baby is able to flair their upper lip and take booth the areola and the nipple in their mouth. When a baby has an upper lip tie, they are unable to flair their top lip out effectively (like fish lips) and may only take the nipple into their mouth. This may lead to a poor seal and swallowing excessive amounts of air during feeding. The air in the baby's bell can then lead to symptoms of colic or reflux and unneccesary medications may be prescribed. Lip ties can also hold mother's on the front surface of the upper front teeth during night time as-will feeding, leading to tooth decay.
Symptoms related to TOTS
* several unsuccessful attempts at nursing
* colic, gassy, reflux
* failure to gain weight or thrive
* unsustained latch
* calloused or blistered lips
* sinus congestion or snoring
* painful latch
* cut or cracked areas
* bleeding nipples
* flattened, blanched, or creased nipples
* failure to bond with infant (leading to depression)
* plugged/clogged ducts
As children get older, if the tongue tie isn't helped, may also have speech difficulties that may require extensive speech therapy.
One theory in relation to the rise in the number of detected cases of TOTS is the fortification of foods with folic acid. In 1998, folic acid was added to foods such as most enriched bread flours, cornmeal, pasta, rice and grains in the US and Canada. The intent behind adding this synthetic B vitamin to foods was to help prevent neural tube defects (NTD) in babies.
Although adding folic acid to our food sources has reduced the number of NTDs, it may have also lead to the rise in children being born with a particular genetic defect in what is called the "MTHFR" gene and subsequent poor postnatal folate status. This particular gene is a key regulator of "methylation"' one of the most important biochemical reactions in our body needed for healthy DNA function and overall health. It is recommended that women take the natural active form of folate, not folic acid, during pregnancy. Folate is also found in its natural form in dark green leafy vegetable.
How TOTS Affects Structure & Function
TOTS is considered a "mid-line" defect; meaning it affects the center or core of our body. The tongue is anatomically attached to the bone and facial structures of the head and torsum. The tension caused from the tethered tissues can create long-lasting structural changes to the musculoskeletal system; especially in the neck, cranium, and face. The changes in these regions can then lead to adaptive changes throughout the rest of the body and then present as postural abnormalities or asymmetries. In infants, these postural challenges can lead to difficulties in reaching various developmental milestones such as: rolling over, creeping or crawling.
TOTS can also affect the subtle "pumping" movement of the cranial bones. This action is necessary in order for the cerebral spinal fluid, the fluid that protects the brain and spinal cord, to move toxins away from the brain. The cerebral spinal fluid is like a sewer system that eliminates waste but the the cranial pumping motion is inhibited, the toxins can affect brain function and development.
Why Chiropractic & Cranial Sacral Care is Important
Due to the structural changes associated with TOTS, it is imperative that the care includes chiropractic spinal adjustments and cranial-sacral therapy. The spinal column; especially the cervical spine (neck region) has a vast amount of neurological sensory input protecting to the brain. If there are structural stressors on the spin or cranium, this will lead to poor neurological communication for the body to the brain which will alter proper neurological function and development. Specific spinal adjustments can restore proper musculoskeletal structure, which in turn will restore neurological function.