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Welcome to the

Center for

Tethered Oral Tissues

Specializing in the Diagnosis and Treatment of Tethered Oral Tissues

~Tongue-tie/Lip-tie ~

in Adults, Children and Infants

What are

Tethered Oral Tissues?

Tethered Oral Tissues (TOTs) are restricted soft tissue (frenula) in the mouth, also known as tongue-tie, lip-tie and cheek-tie. TOTs impact function, growth and development of the jaws, mouth, teeth and airway. TOTs related issues include: 


Infantspainful breastfeeding, difficulty breast or bottle feeding, refux or colic symptoms, and/or failure to thrive

Toddlers, Children & Adolescents:

difficulty swallowing solid foods, speech/articulation disorders, orthodontic issues, as well as possible sleep and breathing problems. 

Adults: snoring, obstructive sleep apnea, neck tension, TMJ pain and disfunction, and headaches.

What are Tethered Oral Tissus
What are TOTs



A tongue-tie, also known as ankyloglossia, is a condition in which the frenulum or attachment of the undersurface of the tongue to the floor of the mouth is tight and restricts function.  It is a very common cause of painful or difficult breastfeeding in infants.  Many infants have disorganized swallowing and do more ‘gulping’, have higher rates of reflux and colic symptoms, fatigue quickly, and may be constantly hungry from the poor transfer of milk.  Difficulties may be present with bottle feeding as well. Untreated tongue-tie can often lead to many problems as children grow and develop..



A lip tie is when the maxillary (upper) or mandibular (lower) labial frenulum tissue that connects the lip to the gums is tight and restrictive to both function and form. In infants, it may prevent flanging of the lips to ensure an adequate seal around the nipple, in many instances, this can break the latch or allow babies to suck and swallow air and develop symptoms of reflux or colic. As teeth erupt it may cause excessive gaps or diastema and lead to orthodontic issues and dental decay. They also may lead to speech and articulation issues where lip mobility is impaired, such as difficulties with letters ‘b, f, m, p, v’ amongst others.



A buccal or cheek-tie is a restricted frenulum that connects the cheek to the gums. These can restrict the function of the cheeks and lips that are needed for feeding and/or speech. They have also been shown to cause issues with gum recession and orthodontic problems.


Why CO2 Laser?

Dr. Scott A. Siegel, a Diplomate of the American Board of Laser Surgery (DABLS), has 20+ years of offering his tongue-tie and lip-tie patients the clinical benefits of using a carbon dioxide (CO2) laser vs. scissor. There is an ability to accurately and delicately cut and coagulate soft tissue simultaneously. Benefits include minimal bleeding, less trauma to the tissue, reduced postoperative pain, and increased visibility of the surgical field. This helps reduce the amount- if any- of anesthesia needed, as well as not needing sutures.  A secondary benefit is that the laser also sterilizes the wound leading to decreased infection rates.

Why CO2 Laser?



Will my child grow out of the tie?

Unfortunately, no. Current and ongoing research and experience have shown that these restricted frenula tissues grow with the child and often impact function and growth and development.


Can we stretch the tie out?

Published research has shown that the tie can only be stretched to about 3%. This is due to the collagen type found in these tissues which is similar in comparison to a tendon or ligament which can only be stretched a very small amount.


I was told that this is a ‘fad’...?

There is a misconception that frenectomy is a new diagnosis or procedure.

Diagnosis and treatment of ties before the ‘formula age’ was commonplace. As breastfeeding rates have been climbing in the past decade there has been more awareness again about ties in infants.


As for older children and adults, there has been increasing research and experience understanding the impacts of untreated ties on functions listed above. 


Will my child require general anesthesia?

No. Dr. Siegel typically utilizes various means of pain control and patient management. 


Infants to 3 year olds: 

a topical anesthetic cream/gel 


Age group 3-5 years:

a local anesthetic and in some cases an oral sedative may be added for comfort and safety

Young children through adults: combinations of topical, local anesthetics and possible inhalational analgesic-like sweet air (nitrous oxide).

No. Dr. Siegel typically utilizes various means of pain control and patient management. 

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