(717) 259-9596 • East Berlin, PA

Treatment for Tongue-ties (Ankyloglossia) and Other TOTs

Dr. Lori Cockley has a special interest and advanced training in the diagnosis and treatment of TOTs (tethered oral tissues), commonly known as “tongue-ties” and “lip ties.” She is a member of the International Affiliation of Tongue-tie Professionals (IATP) and has trained nationally and internationally with some of the most renowned names in the field. She is a member of several internet tongue-tie forums and the co-author of an article published in the Winter 2015 edition of the Journal of the American Orthodontic Society describing the significance of tongue-ties in orthodontics.

Between 4% and 15% of children are born with tongue-ties. This means their tongues have a congenital abnormality characterized by an excessively short, tight membrane of tissue (frenum) connecting the tongue to the floor of the mouth. These vary greatly in degrees of severity but may cause impingement of mobility and function of the tongue. This can cause anything from moderate inconveniences (e.g., inability to lick an ice cream cone), to more severe impairments (e.g., inability to breastfeed in infancy and the development of significant speech impediments).


A diagnosis of TOTs is based on symptoms as well as clinical appearance. Some TOTs are obvious, while others, such as posterior tongue-ties, require careful examination to detect.

A frenectomy is a delicate surgical procedure to release these restrictions. It is done with a diode laser with little to no anesthetic, no pain, and typically no bleeding. The procedure takes only a few moments. While Dr. Cockley performs these frenectomy procedures on patients of all ages, she is one of the few practitioners in the area who is experienced in treating infants as young as 24 hours old.

For your convenience, consultations and procedures may be done at the same visit. Immediately after the procedure, our comfortable, private breastfeeding area is available for you to bond with your baby.

Infant symptoms of tongue-tie/lip tie may include the following:

  • Poor or unsustainable latch
  • Clicking noises with baby repeatedly “clicking off” the breast while feeding
  • Exhaustion and falling asleep at the breast before full
  • Frequent coughing or choking on milk
  • Gasping for air mid-feed
  • Frequent release and re-latch
  • Unsatisfied after prolonged feeds
  • Poor weight gain/failure to thrive
  • Gas/reflux/colic/hiccups due to swallowing of air
  • Frequent and prolonged nursing sessions
  • Fussing, fighting, or crying or seeming frustrated during feeding sessions
  • Lip blisters
  • Milk leaking from the corners of the mouth during feeding
  • Gumming and chewing on the nipple
  • Unable to open wide to latch

Some symptoms for breastfeeding mothers include the following:

  • Severe pain during breastfeeding
  • Poor or incomplete milk transfer (breasts don’t feel emptied after feedings)
  • Undersupply or oversupply
  • Mastitis and/or thrush
  • Cracked, sore, or damaged nipples

For those who do not undergo frenectomy in infancy, potential complications may include the following:

  • Poor oral hygiene (due to the tongue not having freedom to effectively cleanse the oral cavity)
  • Difficulty swallowing or the development of an abnormal swallow pattern such as tongue-thrust
  • Loud slurping/gulping sounds when eating
  • Needing to drink a lot during eating
  • Messy eating
  • Choking/gagging easily
  • Disruption of normal oral and facial development
  • Low resting tongue posture
  • Sleep-disordered breathing/sleep disturbances
  • Delayed speech or significant speech impediments
  • Gum recession
  • Cavities
  • Periodontal disease
  • Tightness of the neck and shoulders
  • TMJ symptoms
  • Headaches/migraines
  • Orthodontic concerns such as an open bite, gaps, tipping of teeth
  • Social concerns (licking an ice cream cone, kissing)

A Multidisciplinary Effort

Many times, the surgical release of the restriction alone is not adequate for full function. We encourage follow-up with the appropriate practitioner, whether it be a speech language pathologist, chiropractor, body worker, myofunctional therapist, or lactation consultant. We work closely with our multidisciplinary team to ensure you have full support.

We now offer tongue-tie supportive therapy through our office in the newly opened PA Tongue-Tie Center, located on the second floor of East Berlin Smiles.

  • Body Work/Craniosacral Therapy (CST)
  • Oral Myofunctional Therapy (OMT)
  • Lactation Counseling (LC)

For more information or to make an appointment for CST, OMT, or LC, contact us at (717) 259-9596.

Helpful Links for More Information

Dr. Kotlow Articles

Dr. Ghaheri Blogposts 


Infant Aftercare Video

American Academy of Physiological Medicine and Dentistry

Frenectomy Before

Frenectomy After

“Don’t mind me, bawling like a baby (happy tears). My son’s Upper Lip tie and Posterior Tongue-tie were revised at 2:30. He wouldn’t nurse in the office, but I decided on the drive back to wake him and try again (2-hour drive). Most amazing latch ever and I am feeling nothing (except a tug from an amazingly strong latch)!!! I HIGHLY recommend East Berlin Smiles in East Berlin PA. The staff and Dr. Cockley are truly a gift from above!!! They are so friendly, understanding, compassionate, and genuinely caring!!!!” —K.R.



East Berlin Smiles
Lori Cockley, DDS, MAGD
418 West King Street
East Berlin, PA 17316

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(717) 259-9596

Monday 7am - 7pm
Tuesday 7am - 7pm
Wednesday 7am - 7pm

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418 West King Street • East Berlin, PA 17316
(717) 259-9596