TOTs 5-Step Screening Tool

TOTs 5-Step Screening Tool


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Course Description

Tethered Oral Tissue(s) is an abnormality of one or more of the seven
frena in the oral cavity including: maxillary buccal, mandibular buccal,
maxillary labial, mandibular labial and lingual frena. Abnormalities of the
frena, such as tightness, atypical location and/or appearance are often
missed in speech and feeding evaluations because many medical and
educational professionals have not been trained in the diagnostic
procedures for structural and functional red flags of TOTs.

This course will discuss how medical and education professionals such as
IBCLCs, occupational therapists, physical therapists, speech-language
pathologists, dentists, ENTs, pediatricians, orthodontists etc. can quickly
assess for TOTs and make the proper referrals to a specialist who has
specialized training in this diagnosis. Common symptoms will be
highlighted such as sleep disorders and dysphagia. Clarification of a TOTs
team and suggested referrals will also be covered.

Learning Outcomes
  1. Participants will be able to identify at least 3 signs and symptoms of
  2. Participants will be able to identify the location of the seven frena.
  3. Participants will be able to list at least 2 reasons to warrant a referral
    to a TOTs trained specialist.

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

 (pending AOTA approval)


Robyn Merkel-Walsh, MA, CCC-SLP, COM®️ Bio and Financial Disclosure

Timed Agenda
  • 20 Minutes: Background - what is TOTs?
  • 30 Minutes: What are frena
  • 30 Minutes: Red flags of TOTs and proper assessment 
  • 50 Minutes: Assessing the oral frena and using the screening tool
  • 20 Minutes: Wrap up
Learning Options
  • Online ONLY for 1 learner -- ACCESS TO ONLINE COURSE (downloadable handout and additional resources)
  • Online + Supplies for 1 learner -- (1) TOTs book 
    • Group Rate for 5 learners
      • ACCESS TO ONLINE COURSE for 5 learners
      • (5) TOTs books
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