What are Tethered Oral Tissues?

Tethered Oral Tissues (TOTs), otherwise known as tongue, lip and/or buccal ties, can cause problems with swallowing, speech sound production, chewing, breathing, and sleeping.


Melissa treats infants that exhibit signs and symptoms often related to tethered oral tissues:

- Difficulty latching while breastfeeding
- Prolonged or frequent feedings
- Colic
- Aversion to certain positions or tummy time
- Excessive fussiness
- Clicking noises while breastfeeding
- Difficulty introducing solid foods
- Excessive fussiness
- Poor weight gain

When breastfeeding, mothers may exhibit signs and symptoms that may indicate their infant has tethered oral tissues. Signs and symptoms to lookout for are:
- Flattened, blistered, bruised, cut and/or bleeding nipples
- Plugged ducts
- Breast swelling
- Using nipple shield to breastfeed
- Engorged or unemptied breasts
- Mastitis

Melissa treats adults that exhibit signs and symptoms often related to tethered oral tissues:
- Headaches
- Sleep disorders
- Jaw pain and TMJ related disorders
- Tightness on one side of the body: shoulder, neck, or even hip pain from an imbalance throughout the musculoskeletal system


Melissa provides clinical services and support to children that have Tethered Oral Tissues (TOTs). Melissa supports oral movement patterns, oral and facial structural development, and optimal functional patterns needed for breastfeeding, breathing, swallowing, oral resting posture, chewing, and speech sound production. Melissa has attended numerous specialty training sessions to treat TOTs. Melissa is a Certified Orofacial Myologist (COMĀ®), has attended training related to the assessment and remediation of TOTs, and is trained in the Beckman Oral Motor Protocol, which uses assisted movement and stretch reflexes to quantify response to pressure and movement, range, strength, variety and control of movement for the lips, cheeks, jaw, tongue and soft palate. Melissa uses peer-reviewed research, training, and her expertise to create an individualized treatment plan to remediate the signs and symptoms associated with tethered oral tissues.