Understanding Oral Ties - The Pediatric Breathing Project [Ep 2]

Oral ties (tongue-ties and lip-ties) are one of the most debated topics in both the parenting and professional dental world. 

Are they over-diagnosed? A trend? Or a critical piece of airway and functional health that we’ve been overlooking for far too long?

In this episode, Dr. Piya Gandhi shares her perspective as both a pediatric dentist and a mom. She breaks down the myths, explains why oral ties are not “new,” and outlines how they can affect feeding, speech, breathing, jaw growth, and overall development at every age.

You’ll learn:

• Why oral ties matter for infants, toddlers, children, and even adults
• How tongue-tie and lip-tie symptoms often go unnoticed (and why screening is inconsistent)
• The importance of function-first treatment: therapy ➝ procedure ➝ therapy
• Why “just clipping” isn’t enough for long-term results
• What parents should look for in a provider and evaluation process
• Resources for finding trusted airway-focused practitioners

Whether you’re a parent struggling with feeding challenges, a provider curious about functional dentistry, or someone who’s just now learning about airway health — this episode will leave you with the knowledge and confidence to advocate for the right care.

Resources Mentioned: 

Airway Circle Provider Directory: https://airwaycircle.com

The Breathe Institute: https://www.breatheinstitute.com

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The Pediatric Breathing Project with Dr. Piya Gandhi explores how airway health, jaw development, and sleep impact childhood wellness. Parents and practitioners will learn to spot early signs of sleep-disordered breathing and discover practical solutions for healthier futures.

If you’re a parent, dentist, pediatrician, or healthcare professional passionate about giving children the best start in life, this podcast is your guide to better breathing, better sleep, and better development.

Piya Trehan Gandhi, DDS

BOARD CERTIFIED PEDIATRIC DENTIST, AIRWAY AND TONGUE TIE RELEASE SPECIALIST

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Transcript

0:08

let's talk about oral ties. I'm Piya Gandhi and welcome to my podcast. Oral ties have been a hot topic for the past few years, and are a part of conversation in the professional dental world, but also amongst many parents. Most of the patients that I get are parents that have heard about ties on. Not just their infant, but maybe their child or even as an adult themselves, they've discovered that they have an oral tie. Oral ties are not something new. They have existed for a long time. There are many adults and young and old adults that are living with ties. So it's not a life or death situation, but oral ties generally affect your quality of function in some sort of way. And that's something that I think is a misconception that tongue tie, lip ties are a new thing. We just didn't know how important oral function, specifically tongue function was in our overall health. Breathing, sleeping, speaking as an infant feeding. And the more research we've done on it, the more we've discovered. That a tongue that moves well is crucial to many parts of growth and development. Sleeping, breathing and functioning. So let's start with the infants. And I would say that's the most commonly known association with a tongue tie is, I can't breastfeed or I'm having trouble breastfeeding. Does my baby have a tongue tie? Well, one thing to note is sometimes babies with ties can actually breastfeed fairly well, but then they struggle on a bottle, and that's because breastfeeding is a two part situation. So if a mom has a great milk supply, then the baby actually doesn't have to work very hard to feed, whereas it may require more activity from the baby to feed from a bottle. So we really can't just restrict it to a breastfeeding issue. And so the reason why this is coming up more often is more parents are choosing to want to breastfeed, and so we're catching these things earlier and because there's been more education and more buzz about this, there is generally more screening. Unfortunately, the screening is still not universal, and so it's kind of the luck of the draw. Did you see the right lactation consultant? Does your pediatrician know about it or believe in it? Because we do run into this issue of healthcare providers that are not very educated on ties that think that this is a whole bunch of like hocus pocus or something that dentists invented so that they could use their lasers. I will say I've lived this as a parent firsthand, and a tongue tie is definitely a relevant medical diagnosis and something that we need to pay attention to. And so, if you feel like there is something going on with your baby and you have, you know, every parent has an instinct, I would say just keep going until you find someone that's gonna listen to you and actually know how to screen your baby correctly. And what does that mean? Screening your baby correctly. That means that we're not just taking a quick peek under a lip in the tongue to see what things look like. We're not just asking like, oh, is your baby gaining weight? Okay? Everything must be fine. No, it's a thorough consultation process that looks at the anatomy of the tongue and the tie or the frenulum that tests the range of motion of what the tongue and lip can do. And then really digs deep into what you're experiencing. What are your symptoms? What are baby's symptoms? And so, it's really important that you go to someone that does this type of comprehensive diagnosis. The other thing you want to be aware of is a simple clip. Snip laser release is generally not enough to get the tongue and the lip functioning correctly, and that's at any age, but even at the Infini age. So you really want to find a practitioner that is partnering. With functional or therapy providers. And so for an infant that's very commonly like a lactation consultant that's gonna help in the breastfeeding process, or a speech language pathologist that's gonna help in the bottle feeding process, but also someone that's gonna address body tension. So our mouth is attached to a body. Just like anything else in medicine, we should be looking at the entire body system, not just treating an isolated area. So the process of treatment should really be therapy, procedure therapy, and that is what we use here. Are there providers that do a sniff or clip without any of those things? Absolutely. And so some of this is your decision as a parent. What do you believe in? I, as a parent and also as a practitioner that's been doing this for eight plus years. Know that the therapy procedure, therapy model, or what we call the function first model is the best way to get predictable outcomes long term, in my opinion, the best time to treat is infancy. The earlier we get those tongue muscles and lip muscles moving correctly, the more of a positive impact it's gonna have on your child's growth and development, their airway development, their feeding development, their speech development. And so this is not something we kind of wanna sit and wait on. As soon as you identify it, I think it's appropriate to go ahead and treat it in a comprehensive manner. With that said, not everyone finds a practitioner during infancy, or they may not have known about a tongue tie during infancy. And so now maybe you have a child that is struggling transitioning to solid foods or have some delayed speech, or they're showing a mouth breathing tendency. Well, it's never too late to treat, so you don't wanna think that, oh, I missed it during infancy, and now we just have to live with this situation. Well, that's not the case. Treatment is available at every single age. It just looks a little bit different. During the toddler phase, sometimes the procedure is a little more complicated. We sometimes have to use a sedation in order to keep the child still enough, still incorporating the appropriate therapy, more likely speech language, pathology for feeding and speech. Again, a body worker, which in you know, in, in the Houston area we use chiropractors a lot. But the treatment is still possible and still extremely beneficial as we progress to the older child population. And when I say older, I mean really four plus. Sometimes we have to incorporate things like palatal expansion before we do a tongue tie release. And that's because in order for a tongue to work well. It needs the proper space. And some of these children, when the tongue hasn't been moving dynamically, it hasn't been pushing on the upper jawbone to spread it out. So now we need to help that along first and then do the tongue tie release. So this is why treating during infancy is the best time because it's the least complicated and can really help guide a lot of this growth and development. But treatment is possible at every age. I actually treat birth all the way through adults. It just tends to get a little more involved as we get older. But I have many adults that I have treated their tongue ties and they see huge benefit. So my point is it's never too late. Don't ignore tongue ties because they are a thing and they can have a huge impact. Just know that it's not universally streamed for, it's not universally educated. So you may have to go to a couple of places, but eventually you will find somebody. And if you're not close to me, reach out. We can help you find a practitioner, hopefully closer to you. And that really looks at things comprehensively so that you can get all the beautiful benefits of a well done tongue tire release. So there's a couple of good resources. If you are not in the Houston area. The Airway Circle has a great directory. And those are everything from therapists to providers that actually do tongue tie releases. The other website that has a great directory is the Breathe Institute website. And that website has practitioners that have gone through their training, which is where I got the majority of my training done. And so either one of those websites are really great resources to start finding practitioners hopefully close to.