Tethered Oral Tissue(s) or TOTs is a topic frequently discussed in lactation, speech pathology, oral surgery, orofacial myology, and otolaryngology. Organizations like the IAOM and AOMT have highlighted this diagnosis and its implications for therapy and surgery.

Lingual TOTs is commonly known as “tongue-tie” or “ankyloglossia”. The Mayo Clinic (2016) indicated that tongue-tie can affect how a child eats, speaks, and swallows, and can interfere with breast-feeding. Increased interest stems from research linking sleep apnea to a short lingual frenulum, alongside awareness of breast feeding importance.

This course explores functional assessment using well-respected tools to describe structure. Lori and Robyn have developed the Merkel-Walsh & Overland TOTs Protocol which looks at structure, oral motor function, pre-feeding, feeding and speech. Participants learn a unique "task analysis" strategy to identify referral needs and functional impacts on feeding (breast, bottle, cup, straw, solids) and speech production.

The term TOTs was coined by Kimberly Benkert, RDH and Dr. Kevin Boyd in 2014 to describe restriction of the frena. This course focuses on an evidence-based approach to treatment, addressing "hot topics" like the necessity of surgery and pre/post-op care.

Based on the foundation that the oral sensory-motor system cannot be separated, this class walks through neuromuscular re-education techniques—ranging from passive to active—for clients across the life span. Techniques focus on the cheeks, lips, and tongue to improve feeding clarity for all mediums and oral placements for speech. A specific new section focuses on strategies for toddlers and success with this challenging population.

• List three forms of TOTs (Buccal, Labial, Lingual).
• Identify 3-5 functional impacts of TOTs on feeding skills.
• List at least 3 speech sounds that may be affected by TOTs.
• List at least 2 professionals for consultation after assessment.
• List at least 2 surgical techniques for TOTs.
• Identify at least 2 goals of a pre-op TOTs plan of care.
• Execute at least 3 neuromuscular education activities (1 buccal, 1 labial, 1 lingual).

This presentation focuses on treatment methods related to the use of TalkTools® OPT resources. Other similar treatment approaches will receive limited or no coverage during this lecture.