The tongue is a complex part of the body. We can see some of it with our own two eyes by simply looking in the mirror. But aside from the tip and apex of the tongue, there’s a whole lot going on in areas we can’t readily see.

In fact, doctors estimate that upwards of two-thirds of the posterior (back part) of the tongue has been excluded in some modern metrics used in assessing a tongue tie.

In a report published earlier this year in the Journal of Oral Rehabilitation, a team of doctors challenged the notion that the tongue’s mobility (referred to as the Tongue Range of Motion Ratio, or TRMR) could be accurately assessed without sucking the tongue to the roof of the mouth. By incorporating this lingual palatal suction (LPS) as part of the assessment, interventionists are able to determine treatment based on a more comprehensive understanding of the entire tongue.

Why Does This Matter?

Quite simply: this is complicated stuff!

Tongue tie procedures are getting more publicity lately, and there are some cases where patients are dissatisfied with their outcome. In a quick-fix society, many have become accustomed to visiting a proceduralist, receiving a treatment, and going about their lives pre-procedure.

While we’d love for it to be that easy, the truth with tongue ties is that it isn’t that simple.

In order to accomplish a successful outcome, you’ll be required to put in some work. Fairly simple work, yes, but work nonetheless.

What Does Pre- and Post- Tongue Tie Therapy Look Like?

Typically, both before and after a tongue tie release, you’ll be required to do a variety of stretching and strengthening exercises. In some cases, your myofunctional therapist may work with you to retrain your natural habits. Or if you’re the parent of a little one, the therapist will serve as a coach of sorts to help you facilitate the therapies at home.

The benefits of tongue tie release are many, but to reap those benefits requires a degree of diligence and commitment. This is complicated stuff.

At Untethered, we want to help you get the best outcome possible. That requires a comprehensive assessment of the whole tongue, the latest and greatest in pre- and post-procedural myofunctional therapy, and the least invasive tongue tie surgery possible.

We live and breathe this work and invite you to reach out with any questions!

You’ve heard the saying before: “If you want to go fast, go alone. If you want to go far, go together.”

While that’s true in many instances – the power of collaboration, though sometimes more cumbersome, will yield better long-term outcomes – it couldn’t be more true when discussing the treatment of tongue ties.

Why A Multidisciplinary Approach Is So Important

First, let’s think about the high-level needs in order to achieve a favorable outcome:

1. Pre- and post-procedure exercises. While many people would love to show up, have a surgery and leave “cured,” that is unfortunately not the case with tongue ties. Doing exercises before the surgery set you up for better success. Doing exercises after the surgery, much like physical therapy, retrains your oral muscles and prevents the tether from reattaching.
2. The tongue tie release procedure. Called a frenectomy or frenuloplasty, a tongue tie release surgery can take many different forms. At Untethered, we use a CO2 laser on our babies. For big kids and adults, we follow The Breathe Institute’s functional frenuloplasty approach.
3. Ongoing maintenance and monitoring. After the tether is released, there is still work to be done. Not just a day’s worth, or a week’s worth, but ongoing and simple retraining over the long haul. During the time of the tongue tie, the body learns many bad habits and compensations for the physical deficiency. We need to make sure that we’re overcoming those bad habits to ensure long terms health.

The point of this post is to point out the importance of all three of these needs, collectively.

Do the exercises and skip procedure? You’ll probably be unhappy with your results. Do the procedure and skip exercises? Same deal. Choose to overlook the enduring nature of the issue? You’re likely to deal with it again down the road.

So if you’re bought in to the idea that there’s much more to a release than the procedure itself, the next question becomes: who is on my multidisciplinary team? And the answer is that you should have three primary providers who are all talking and collaborating:

1. A myofunctional therapist. Think of this person as a physical therapist for your mouth. They will give you the exercises for pre- and post-procedure as indicated in step 1 above.
2. A proceduralist who is actively engaged with tongue tie research. Oftentimes an ear-nose-throat doctor, this person performs the release surgery. More commonly, this is something your dentist can do. They will conduct the wok described in step 2 above.
3. A general dentist. This tongue tie stuff is not a one and done kind of thing. You’ll need to use your regular cleanings and exams as a chance to check in and evaluate progress. Your dentists will conduct the work described in step 3 above.

There are additional multidisciplinary team members that could help with your release: a chiropractor, a sleep hygienist, and more. But the core team consists of the members outlined in the list above. Be judicious when evaluating your options, and bring up the value of each of these roles to any provider who claims that they are able to solve your tongue tie challenges as a party of one.

How We Measure a Tongue Tie at Untethered

Releasing a tongue tie is as much about pre- and post-procedure therapy as the procedure itself.

The tongue is a complex part of the body, some of which we can see with our own two eyes by simply looking in the mirror. But aside from the tip and apex of the tongue, there’s a whole lot going on in parts that we can’t readily see. Doctors estimate that upwards of two-thirds of the posterior (back part) of the tongue has been excluded in some modern metrics towards assessing a tongue tie.

In a report published earlier this year in the Journal of Oral Rehabilitation, a team of doctors challenged the notion that the tongue’s mobility (referred to as the Tongue Range of Motion Ratio, or TRMR) could be accurately assessed without sucking the tongue to the roof of the mouth. By incorporating this lingual palatal suction (LPS) as part of the assessment, interventionists are able to determine treatment based on a more comprehensive understanding of the entire tongue.

Why does this matter?

Well, quite simply: this is complicated stuff! Tongue tie releases are getting more publicity lately, and there are some cases where patients are dissatisfied with their outcome. In a quick-fix society, many have become accustomed to visiting a proceduralist, receiving a treatment, and going about their lives pre-procedure. While we’d love for it to be that easy, the truth with tongue ties is that it isn’t that simple. In order to accomplish a successful outcome, you’ll be required to put in some work. Fairly simple work, yes, but work nonetheless.

What does that work look like?

You’ve heard the saying before: “If you want to go fast, go alone. If you want to go far, go together.”

While that’s true in many instances – the power of collaboration, though sometimes more cumbersome, will yield better long-term outcomes – it couldn’t be more true when discussing the treatment of tongue ties.

Why A Multidisciplinary Approach Is So Important

First, let’s think about the high-level needs in order to achieve a favorable outcome:

1. Pre- and post-procedure exercises. While many people would love to show up, have a surgery and leave “cured,” that is unfortunately not the case with tongue ties. Doing exercises before the surgery set you up for better success. Doing exercises after the surgery, much like physical therapy, retrains your oral muscles and prevents the tether from reattaching.
2. The tongue tie release procedure. Called a frenectomy or frenuloplasty, a tongue tie release surgery can take many different forms. At Untethered, we use a CO2 laser on our babies. For big kids and adults, we follow The Breathe Institute’s functional frenuloplasty approach.
3. Ongoing maintenance and monitoring. After the tether is released, there is still work to be done. Not just a day’s worth, or a week’s worth, but ongoing and simple retraining over the long haul. During the time of the tongue tie, the body learns many bad habits and compensations for the physical deficiency. We need to make sure that we’re overcoming those bad habits to ensure long terms health.

The point of this post is to point out the importance of all three of these needs, collectively.

Do the exercises and skip procedure? You’ll probably be unhappy with your results. Do the procedure and skip exercises? Same deal. Choose to overlook the enduring nature of the issue? You’re likely to deal with it again down the road.

So if you’re bought in to the idea that there’s much more to a release than the procedure itself, the next question becomes: who is on my multidisciplinary team? And the answer is that you should have three primary providers who are all talking and collaborating:

1. A myofunctional therapist. Think of this person as a physical therapist for your mouth. They will give you the exercises for pre- and post-procedure as indicated in step 1 above.
2. A proceduralist who is actively engaged with tongue tie research. Oftentimes an ear-nose-throat doctor, this person performs the release surgery. More commonly, this is something your dentist can do. They will conduct the wok described in step 2 above.
3. A general dentist. This tongue tie stuff is not a one and done kind of thing. You’ll need to use your regular cleanings and exams as a chance to check in and evaluate progress. Your dentists will conduct the work described in step 3 above.

There are additional multidisciplinary team members that could help with your release: a chiropractor, a sleep hygienist, and more. But the core team consists of the members outlined in the list above. Be judicious when evaluating your options, and bring up the value of each of these roles to any provider who claims that they are able to solve your tongue tie challenges as a party of one.

How We Measure a Tongue Tie at Untethered

Releasing a tongue tie is as much about pre- and post-procedure therapy as the procedure itself.

The tongue is a complex part of the body, some of which we can see with our own two eyes by simply looking in the mirror. But aside from the tip and apex of the tongue, there’s a whole lot going on in parts that we can’t readily see. Doctors estimate that upwards of two-thirds of the posterior (back part) of the tongue has been excluded in some modern metrics towards assessing a tongue tie.

In a report published earlier this year in the Journal of Oral Rehabilitation, a team of doctors challenged the notion that the tongue’s mobility (referred to as the Tongue Range of Motion Ratio, or TRMR) could be accurately assessed without sucking the tongue to the roof of the mouth. By incorporating this lingual palatal suction (LPS) as part of the assessment, interventionists are able to determine treatment based on a more comprehensive understanding of the entire tongue.

Why does this matter?

Well, quite simply: this is complicated stuff! Tongue tie releases are getting more publicity lately, and there are some cases where patients are dissatisfied with their outcome. In a quick-fix society, many have become accustomed to visiting a proceduralist, receiving a treatment, and going about their lives pre-procedure. While we’d love for it to be that easy, the truth with tongue ties is that it isn’t that simple. In order to accomplish a successful outcome, you’ll be required to put in some work. Fairly simple work, yes, but work nonetheless.

What does that work look like?

Typically, both before and after a tongue tie release, you’ll be required to do a variety of stretching and strengthening exercises. In some cases, your myofunctional therapist may work with you to retrain your natural habits. Or if you’re the parent of a little one, the therapist will serve as a coach of sorts to help you facilitate the therapies at home.

The benefits of tongue tie release are many, but to reap those benefits requires a degree of diligence and commitment. This is complicated stuff. At Untethered, we want to help you get the best outcome possible. That requires a comprehensive assessment of the whole tongue, the latest and greatest in pre- and post-procedural myofunctional therapy, and the least invasive release procedure possible. We live and breathe this work and invite you to reach out with any questions!

Typically, both before and after a tongue tie release, you’ll be required to do a variety of stretching and strengthening exercises. In some cases, your myofunctional therapist may work with you to retrain your natural habits. Or if you’re the parent of a little one, the therapist will serve as a coach of sorts to help you facilitate the therapies at home.

The benefits of tongue tie release are many, but to reap those benefits requires a degree of diligence and commitment. This is complicated stuff. At Untethered, we want to help you get the best outcome possible. That requires a comprehensive assessment of the whole tongue, the latest and greatest in pre- and post-procedural myofunctional therapy, and the least invasive release procedure possible. We live and breathe this work and invite you to reach out with any questions!

Airway issues and oral dysfunction are critically important to address. Early intervention is key, and often involves addressing issues that reside at the palate level. The roof of the mouth IS the floor of the nose… a narrow palate not only is a risk factor for dental problems (crowded teeth, gum and bone issues, TMJ pain) but also makes it harder to breathe through the nose by providing a narrow base of the nose! A narrow base of the nose comes with a high likelihood of a deviated nasal septum, limiting the needed space to optimally breathe from the nose.

Palatal development starts incredibly early. Most research states that during the embryonic stage, around five weeks into a person’s pregnancy, is when the primary palate is formed. By about week 12 of a pregnancy, the secondary palate is formed and the palate has reached completion.

But don’t worry, your airway fate isn’t sealed forever.

That being said, it’s essential that children born with deficient palates are monitored for development. In many cases, myofunctional therapy is the path of least resistance. By retraining proper oral habits and nasal breathing patterns, narrowed palates can be overcome without orthodontic interventions. A myofunctional therapist can work with you and your child to take steps toward closed mouth posture, keeping teeth together, and suctioning the tongue to the roof of the mouth. Over time, the amazing tongue muscle expands the size of the palate naturally. This is especially true if addressed in childhood, when the soft tissues are malleable and conducive to change during the growth process.

In other cases, an ortho intervention may be needed. This involves your dentist placing an appliance in the child’s mouth over a period of time. Labs today can create both permanent and removable palate expanders that allow the parent to gradually, over time mechanically expand the palate. It’s a painless endeavor that yields dependable results. But don’t forget, the appliance doesn’t stay in forever – it’s essential to supplement the expander with exercises that retrain the tongue. It will serve the role of maintaining palatal space once the appliance is removed.

Palate expansion must take place, and the question is whether the tongue can do the hard work or if an appliance is needed. If you have questions, we’d love to talk about this critical step. Feel free to reach out any time if you’d like to learn more!

My name is Marissa Delwiche, and I’m the mom to two beautiful boys, Wesley (currently 3) and Bradley (currently 14 months). Both of my boys are what you would consider physiologically normal and have no known health issues – unless you considering their refusal to chill out at bed time an issue!

I have to admit that prior to having Bradley just a little more than a year ago, I knew nothing about tongue ties. So my husband and I were surprised when our pediatrician diagnosed Bradley with just that. Wasn’t tongue-tied just an expression for someone who had a hard time finding the right words? Turns out it’s much more than an expression.

When we first heard about the tongue tie, we were skeptical. None of my mom friends were talking about this. I Googled it, like any good couch-doctor does, and was a little confused because Bradley didn’t present in the way I was seeing online. To my surprise, after asking around a bit, I learned that our dentist knew a thing or two about tongue ties. So, off to the dentist we went.

Dr. Graham noticed that Bradley had not just a tongue tie, but also a lip tie. While no parent wants to hear that their baby has a problem, we were so reassured learning more about the intricacies of a tongue/lip tie, what diagnosis entails (turns out it’s more intensive than just me looking under my baby’s tongue :/ ), and some of the tell-tale signs of a baby with tie issues. They all fit for Bradley: gassy, trouble feeding, frustration any time he was nursing, etc. At this point, we were convinced of the issue and its validity. Given the depth of knowledge and concern we received at the dental office, we decided to ask if they offered treatment options. We were made so much more comfortable knowing that Bradley could undergo the procedure with minimal discomfort.

Untethered seemed to have more technologically-advanced equipment than the ped office, which was more than just a nice-to-have. After Bradley’s tongue tie procedure, he had no problem falling right to sleep as though nothing happened. That gave us great peace of mind, knowing that he wasn’t in any kind of pain or discomfort.

The next couple weeks, we were diligent about keeping up with his exercises and stretches. If I’m being totally honest, staying on top of the therapies afterwards is the trickiest part. Life is busy, we let our guard down, etc. It has helped to download an app, set reminders on our phones and get the whole family in on the routine to make it seem more fun. Definitely a work in progress for us! My parting wisdom, aside from avoiding Google as a means of evaluating your child’s health, is this:

Ask questions, get informed and work with a dentist you trust. In our case, this has made the biggest difference. Good luck to you all!

We hope that this finds you well and in good health, as we continue to forge through these strange, uncertain, and scary times that is the Coronavirus pandemic that we’re all facing. By this point you’ve undoubtedly been inundated with information, sometimes conflicting information, and all-around a flood of “what to do’s”. We’re right there with you and we understand that this cacophony of best practices and news reports can certainly be draining. With that, please know that it is with great importance that we share this post with you.

The precautionary measures that we’re all being asked to take are all certainly beneficial in slowing the spread of COVID-19, however there are advisory topics such as fitness, diet and exercise, and breathing (our favorite) that haven’t been touched on nearly enough. All of these factors are also extremely important in combating COVID-19 and any illness. Within this blog we are going to cover why nasal breathing is vital for your safety and protection.

To maintain good health and receive the highest supply of oxygen for your body, breathing through your nose is imperative. Through research and our experience, it’s known that many people through their mouth without even realizing it. Mouth breathing leads to hyperventilation, lowers the circulation of blood flow, and causes our airways to vasoconstrict. Over time mouth breathing will have a detrimental effect on systemic health such as hypertension, asthma, allergies, obstructive sleep apnea, and anxiety. In this time of combating the Coronavirus, if one breathes through their mouth they are increasing their risk of intaking airborne contaminants within their body.

Nasal breathing can protect the body from such contaminants, as your nasal passages filter out impurities, warm, and moisten the air before it enters the rest of the body. This in turn helps to reduce the likelihood of developing illnesses, including contraction of the Coronavirus.

Our bodies produce a signaling molecule called Nitric Oxide (NO) in our nose and paranasal sinuses. NO is responsible for so many things in our body! -It is a vasodilator that lowers blood pressure and makes it easier for blood to flow to our organs.

• It enhances our ability for learning and memory
• It regulates bladder function, erectile function, and respiration
• It has an anti-inflammatory action in blood vessels
• It decreases blood clotting and obstruction in arteries
• It’s especially relevant during the COVID-19 pandemic as it plays a role in our immune defense by destructing parasitic organisms and viruses!

As an added bonus, nasal breathing can also assist in stress relief, as taking slow breaths in and out of the nose has a calming effect on the body by stimulating the parasympathetic nervous system. We all are living in a time of extreme stress and anxiety, to be able to naturally calm ourselves and improve our sleep is so important!

While reading this it’s very likely you paid attention to your breathing, and that’s great! We want people to take notice of how they breathe. If you mouth breathe or notice that your child is mouth breathing, please contact us at Untethered Airway Health and Tongue-Tie Center, as we are here to assist with any breathing-related issues.

Mouth breathing can have such an adverse effect on the body, and we don’t to see anyone suffer when such a delicate change can be made. To focus on correcting mouth breathing, we suggest taking time during a relaxing part of your day to sit down and cognitively breathing through your nose, intentionally keeping your mouth sealed shut. Practicing this regularly can be a great start, and you’ll also be able to take note of the calming effect that this has. In the time that we’re in, we can all certainly use some extra calm that right now.

To learn more about proper breathing techniques and airway health, schedule a consultation with our team by calling 414-935-8460. We wish you continued health and safety, which includes better breathing!

When it comes to tongue tie releases, just like any procedure, patient care is of the highest importance, especially for little ones! As parents do their research on tongue tie releases and the process involved, they usually arrive at the significant question of, “is a tongue tie release provider better because they use a laser?”

At Untethered Airway Health & Tongue-Tie Center, I have chosen to perform all infant tongue tie releases with a C02 LightScalpel, as my surgical instrument. I believe strongly in its benefits for this procedure. Please watch my video on why I operate with the C02 LightScalpel, as I expound and go into greater detail as to why I have chosen this approach. Ultimately, is laser versus scissors a tale of old school operating versus modern methodology? In the opinion of some practitioners, yes. In mine, even though I have chosen to use the CO2 laser for infant tongue tie releases, I still believe that the overall care that a provider gives is the factor that is of the utmost importance.

Yes, the surgical instrument is vital, but it is the skill set of the provider that is even more crucial. Their experience and knowledge of how the tongue tie affects each patient should be of greater significance, more so than the chosen tool. A doctor or a dentist may have a laser at their office, but it’s main purpose may be for other procedures, and they may have only used their laser for a minimal amount of tongue tie releases. Where on the other hand, another provider may have performed hundreds of successful releases with scissors. Again, a provider’s experience is far more powerful than the tool in their hand.

So, what’s the difference between using a laser versus a scissors for a tongue tie release? Currently there is no specific medical study that compares these two techniques, and thus, much of the information, decisions, and providers choices are strictly opinion based. Also, there are multiple different types of lasers. For example, there is the diode laser, which in essence heats a glass tip to 500 – 900 degrees Celsius, and the soft tissue is burned off on contact with the hot charred glass tip.

Overall, there are definitely some distinct differences. We can begin simply by stating that performing the scissor procedure is actually faster than the laser procedure. However, the scissor procedure often requires an injected local anesthetic to control both bleeding and pain. Where the pain associated with the laser procedure has a delayed effect, which doesn’t present issues during the procedure. There are specific safety measures that must be followed with the laser procedure, the biggest being limiting those in the treatment room, and thus parents are not allowed to accompany their baby during the laser procedure. Parents are typically allowed into the treatment room if the procedure is being performed with scissors.

No matter their preferred approach, I think that any tongue tie practitioner would admit that CO2 lasers do simply offer a complete precision that scissors simply cannot provide. A laser is more effective in removing the entirety of an upper lip tie the restriction, whether it is lip or tongue. Plus, the ability to control bleeding by using the CO2 laser, provides superior visualization.

With that, I think it is vitally important to equip families with the right questions when seeking out a provider for your child’s tongue tie release surgery. When consulting with a provider, be sure to ask the following questions:

“On average how many tongue tie procedures do they perform in a month?” There isn’t a specific number that you should be looking to hear, however if it is in the 8 – 10 range, they’re performing multiple procedures each week, which is a positive sign.

“Is general anesthesia required for the procedure?” This speaks a lot to their experience as most procedures can be performed safely without GA in an office treatment room.

“Do they treat posterior tongue ties as well?” A provider must be fully aware of the anatomy, and approach the procedure with the knowledge that all tongue ties have a posterior component as well as a submucosal component.

Lastly, it’s important to discuss after care with a provider. You’ll want to hear that they take an interdisplinary approach and have an outlined stretching routine for you to follow so that the healing and functionality of your baby’s tongue is optimal.

Just as with any other important medical health decision, asking the right questions is important when choosing the provider for your child’s tongue tie release. In the debate of laser versus scissors, it’s not the instrument that matters as much as the provider themselves! Know what to ask to determine their experience. And the best thing that you can be equipped with is the right questions to determine the best tongue tie release provider for your child.

Within this post I want to touch on how the frenulum, otherwise known as “that tiny cord under the tongue”, can make such a negative impact on nursing, breathing, sleeping, and more!

We all have a frenulum, or frenum, underneath the tongue (as well as from our upper lip to our upper jaw). It connects the tongue to the floor of the mouth and it is NORMAL anatomy unless it causes restricted movement of the tongue. Fascia is an entire network of connective tissue that holds our bodies together! In normal human development the fibrous connective tissue called fascia separates while in utero. Starting right around the second trimester the tongue begins to separate from the floor of the mouth. However, sometimes it doesn’t disconnect as far as it needs to, resulting in a taut, restrictive cord… a “tongue tie” or ankyloglossia.

If this string of tissue is so tight that it restricts normal movement we learn very early to compensate in order to function. These compensations can lead to a long list of problems such as feeding and speech difficulty, abnormal jaw development, breathing and sleep disorders, and poor posture and alignment. Not all frenums are abnormal and certainly not all of them require intervention. However, if there are symptoms that don’t resolve on their own or therapy is not possible due to the tethered oral tissues, treatment such as a frenectomy or functional frenuloplasty may be in order.

We are very careful in our diagnosis and intervene whenever the problem is identified. That can be anywhere from infancy to late adulthood. We believe STRONGLY in an interdisciplinary, team approach to addressing these types of issues. A tongue tie “clip” without proper pre and post operative myofunctional therapy and body work is unlikely to help the situation and can make the problem much worse. Our approach includes some combination of the following team members in order to achieve optimal results: physical therapists, International Board Certified Lactation Consultants (IBCLCs), occupational therapists, chiropractors, oromyologists or myofunctional therapists, craniosacral therapists, speech therapists, feeding specialists, orthodontists, and physicians. The more the merrier!

If you have questions, concerns, or would like to make an appointment to meet with our team, please reach out. We’d be honored to help you on your journey to healthier breathing, sleeping and living!