Frequently Asked Questions

What is TOTs?

TOTs stands for Tethered Oral Tissues. Tethered oral tissue refers to any tissue restricting functional movement in the mouth. These terms are most often used when referring to tongue, lip, or cheek ties. A tie is when the connective tissue under the lip, cheeks or tongue is tight, short or thick, or in any way restrictive. The presence of a frenum or even the appearance of restriction does not always indicate there is a tie. A full functional analysis must be performed in order to determine whether the tissue is problematic and warrants treatment.

How do I know if my baby has a tongue tie or tissue tie?

A list of symptoms that could indicate the presence of tethered oral tissue is below. Keep in mind that not every baby will have every symptom; some infants will have one or two, while others may have many. Some may also have symptoms not on this list. If you have questions about your child’s symptoms and are curious if a tie could be contributing, please call our office and we will be happy to talk with you.

  • Pain or discomfort associated with nursing
  • Gas
  • Frequent hiccups
  • Reflux
  • Frequent thrush
  • Clogged ducts, engorgement, or mastitis
  • Leaking milk while at breast or bottle
  • Excessive spit up
  • Frequent nighttime waking
  • Falling asleep during feeds and waking up hungry
  • Colic
  • Overly fussy
  • Clicking while eating
  • Trouble transitioning to solids
  • Choking or gagging
  • Shallow latch
  • Weight issues including loss or slow/no gain
  • Popping on and off bottle or breast to latch
  • Fussy while eating
  • Arching
  • Nipple damage
  • Chewing or biting breast or bottle
  • Picky eating
  • Refusal of certain textures

What is the cost?

The cost varies based on the specific procedures needed. Regardless of your circumstances, it is first priority to get you and your baby the help you need. We would love to talk with you about your unique situation. We are in network with several dental insurance providers, take most major credit cards, work with Care Credit, and have payment plans available. We will work to find the best financial situation for you and your family.

Is this covered by insurance?

At Richmond Smile Design we believe in giving our families the time and comprehensive care needed for such a delicate clientele and procedure. We will bill our in-network dental insurances on your behalf, but they do not always share our view on the necessity of this type of care, therefore, they will not cover the full cost. We can also provide each family with a super bill to submit to your medical or out-of-network insurance carrier after your balance is paid in full. Hopefully they will see fit to reimburse a portion of your out of pocket cost, but we make no guarantees. We have options available for financing and take most major credit cards.

What is a CLC?

CLC stands for Certified Lactation Counselor. There are several certifying bodies. Our on-staff CLC is certified by the Academy of Lactation Policy and Practice. For more information about her background, please check out her bio here.

Are Drs. Foley and Jacobson trained to do this procedure?

Both doctors have several years of education and experience in dentistry (read their bios on the website for more details). This specialty is not taught in general dentistry education, therefore they sought out and completed additional education and opportunities specific to tethered oral tissue. The TOTs clinic may be new to Richmond Smile Design, but the delicate tissue of the mouth is not at all new to Drs. Foley and Jacobson. Your infant is in kind, capable hands.

Can I have my baby evaluated and treated the same day?

At Richmond Smile Design we know that optimal outcomes require a whole body approach. Because of this, most babies are not ready for a procedure the same day as their initial evaluation. We have lactation support in our office and also work with an excellent network of therapists outside of our practice. Each patient will receive comprehensive care including bodywork and oral therapy both before and after procedures. If you would like more information about how the process works or why we incorporate these additional therapies, please reach out to our office.

How do I get an appointment for my baby?

There are two ways to request an appointment. You may call our office at 859-623-3818 and speak to one of our front office staff members, or you may fill out the appointment request form below. In either case you will answer a few questions and your request will be sent to our TOTs program director, who will give you a call back at her earliest opportunity.

Struggling With Tongue Tie?

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