The Function First Model for Treating Tethered Oral Tissues (TOTS)

The Function First Model for Treating Tethered Oral Tissues

Tethered Oral Tissues (TOTS)—including tongue, lip, and cheek ties—can significantly affect health, development, and quality of life across all ages. From difficulties with breastfeeding and speech delays in infants and children, to headaches, jaw pain, and digestive issues in adults, the ripple effects of untreated TOTS are far-reaching.

That’s why at Flourish Airway Collective, we use Dr. Piya Gandhi’s Function First Model. This model doesn’t just look at the structure of the oral tissues—it prioritizes function as the foundation of care. Here's how it works:

Step One: A Team-Based Collaborative Care Approach 

The Function First Model begins with a team, as no single provider can address the full scope of TOTS. Instead, a multidisciplinary team works collaboratively, often including:

• The family or caregiver, who observes the day-to-day function
  
  
• A primary care provider to help identify symptoms early
  
  
• A functional specialist (such as an orofacial myofunctional therapist, speech therapist, lactation consultant, or bodyworker), to assess and support function before and after treatment
  
  
• The release provider, pediatric dentist (Dr. Ozzie!)

This collective effort ensures that the individual’s function—how they breathe, speak, chew, swallow, and move—is at the center of care. The team supports the patient both before and after the release procedure to prepare the tissues, retrain habits, and prevent complications or regression.

Step Two: A Functional Diagnosis

Unlike approaches that rely solely on visual or structural assessments (e.g., "the tie looks tight"), the Function First Model uses a functional diagnosis. This means evaluating how the oral tissues impact movement, posture, coordination, and other aspects of daily life.

A tongue-tie may look mild visually, but if it's limiting speech, causing feeding struggles, or contributing to sleep-disordered breathing, then it's functionally significant. This approach ensures that only necessary releases are performed—and that when they are, they're done for the right reasons, with the right support.

Why It Matters

Traditional tongue-tie treatments often focus only on the physical release, without preparing the body or addressing the functional aftermath. This can lead to underwhelming results—or even worsen symptoms.

By contrast, the Function First Model:

• Leads to more accurate diagnoses
  
  
• Improves patient outcomes and long-term function
  
  
• Reduces the need for repeat procedures
  
  
• Empowers families and patients with education and support

Final Thoughts

The Function First Model offers a comprehensive, patient-centered path to treating Tethered Oral Tissues. It’s not just about cutting tissue—it's about restoring function. This model is a reminder that successful outcomes begin with collaboration, education, and a deep understanding of how structure impacts everyday life.

If your child is experiencing symptoms that might be related to TOTS, please reach out to our team at Flourish Airway Collective. We’re here to help your kiddo flourish!