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Dr Shereen Lim, 2/143 Grand Boulevard, Joondalup (2026)

24/03/2026

When babies struggle to latch, could facial tension be part of the picture?

These photos are of a 3 month old baby pre- and 6 days post release of 5 oral ties - upper and lower lip, upper cheeks (x2), and tongue-tie.

When I first saw her, she had refused the breast for three weeks, and feeding was not going well on the bottle.

Mum had been advised early on that her baby’s mouth was too small for her ni**le.

These photos illustrate clear reductions in tension in the lips and cheeks. I’m increasingly recognising this as very important for deep latching and efficient tongue suction. When these tissues are tight, a baby will not be able to sustain a deep latch and can start slipping shallow.

6 weeks later, mum happily reports she is feeding more on the breast than ever before. Not 100%, but improving with time.

Unfortunately, tongue-ties are still given limited attention in most healthcare training and can remain a source of debate. Whilst research has focused primarily on tongue-ties, other ties may also be overlooked. It’s why I had not looked at them as closely until recently. Now that I recognise their potential contribution to facial tension and oral dysfunction across my patients of all ages, I can’t unsee it.

Today I happened to consult with four babies - all had been offered ni**le shields early on when latch was poor.

From memory, at least two of them weaned from the breast early, as it was not helping.

Not one of them was advised to seek assessment for oral ties, or given an alternative pathway if the shields did not work (all four had stopped using them).

So I want to highlight this:

If you’ve been told your baby’s mouth is too small to get a good latch, or you’ve been offered a ni**le shield due to latching difficulties, make sure you are also seeing someone who can assess for all ties inside the mouth - not just the tongue.

In the case illustrated, as with all cases - the aim is not to jump in and release every tie. This family had multiple visits with IBCLC Brenda from The Gentle Village and our chiropractic colleague Dr Jean-Luc Sulon at Oceanside Chiropractic - Alkimos to address other contributing factors first.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

21/03/2026

Reflections

The last couple of evenings I have enjoyed some stunning sunsets on evening walks around Lake Monger.

And with my earbuds out of action yesterday I had a lot of time to get lost in my thoughts!

Mainly they were reflections of work.

I have been learning so much through my patients since I have paid more attention to cheek and lower lip ties.

It’s been challenging at times to look back and see things that I have missed, and to have new discussions on changing perspectives and approaches.

But overall, it’s been mind opening to see what’s possible and how much more predictable care can be with a bigger picture.

I love the discoveries, and also the changes that we see through our full scope of work every day. The facial changes, the better breathing and sleep, release of chronic tension, continually making good progress with oral function, building trust along the journey, and having entire families seek care with us after the first members successful outcomes.

Every day has many highlights but my biggest one for the week was oral releases for a 7 month old baby with Down Syndrome. She couldn’t take more than 10-20ml milk at a time and had been resigned to a feeding tube.

Mum sought external advice. And she ended up with me. There were several positive factors that influenced me to proceed despite all the healthcare resistance to this being explored.

So I was happy to hear she fed 60 ml on the day of her release. Mum noted her whole face had changed. I check in and on day 3 she had taken 120ml over 2 bottle feeds, and mum felt this was promising.

I know that not everyone will agree with stepping outside conventional pathways.

But when traditional pathways aren’t leading to progress, I believe it’s important to keep asking questions and exploring what else may help.

It also raises the question of whether children with syndromes or those born prematurely should be approached differently when families have gone the extra mile to optimise their starting point to be more similar to that of a non-syndromic child.

In the end, my focus, and what’s most rewarding is making a difference in the lives of our patients and their families.

20/03/2026

6x oral releases for 41 year old - upper and lower cheek ties, and lip ties (tongue-tie not addressed)

You may have seen my post yesterday, sharing how I had viewed a webinar on some research by US colleagues who have been finding a trend - that upper cheek ties releases appear to be the most impactful in increasing mouth opening - as measured by the maximum interincisal opening. Their cohort did not include any lower lip or lower cheek tie releases.

This inspired me today to take some measurements on a patient who was having six oral releases, excluding the tongue.

When I first consulted her almost a year ago, my plan was to only do upper lip and lower lip ties, and lower right and left cheek ties. My concern at the time with proceeding with tongue tie release was her extremely small tongue space, without palate expansion.

But she was having botox to address lower chin tension - and I had discussed there was still value in doing the lower release to help reduce this chin tension. We were also planning to release the upper lip tie as the upper lip was very tight.

Fast forward to today, when she presented for her releases following regular osteopathic support prior to the procedure. She was most looking forward to the lower cheek releases as they were holding the most tension.

Since her initial consult, I have performed a good volume of upper cheek tie releases and seen fairly consistent improvements in facial tension, and other changes. So I offered that today too, which she was happy to proceed with.

For the first time I took maximum interincisal opening measurements before and after each release.

Here’s what I found:

✅ Pre:procedure before anaesthetic: 40mm
✅ Pre:procedure after anaesthetic: 40mm
✅ Post upper lip-tie release: 44mm
✅ Post upper cheek-tie releases: 47mm
✅ Post lower lip-tie release: 48mm
✅ Post lower cheek-tie releasees: 54mm

Overall she had a 14mm increase in mouth opening. The photos are immediately pre and post-releases.

Although a single case - this tends to support my perception that we must pay attention other ties beyond the tongue to achieving an open wide latch for infants.

Following upper lip-tie release this patient also reported an immediate "sensation into her (left) nostril - like a hair tickling her nose and it lifted it up and kind of opened” and "an opening sensation in the palate.”

Later, when the anaesthetic wore off - the patient reported it was quite sore - and “It feels worth it”

She described, “I noticed my palate behind my top teeth expanding as I was driving back home! I can’t believe how much my mouth is shifting and so quickly. Feels like relief…at 41 years old.”

Lately, I have been in discussions with two US dental colleagues who have been doing lip and cheek ties pre-expansion (and the tongue-tie later after myofunctional therapy) as they perceive expansion works better. I also see some value in that except for needing an extra appointment, and also I believe it’s a better experience for children to start their experience with us on orthodontic visits.

But his patient’s feedback - is very interesting, and why I am very open to adopting this approach (to fight less against the muscles) on a case by case basis when the ties and oral dysfunction are more severe.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

19/03/2026

A link to a webinar highlighting research on buccal ties.

This team collected maximum interincisal opening measurements on 62 patients aged 4-77 years. This was done pre-release, and following release of upper cheek ties, upper lip-tie, and tongue-tie.

They found the most significant increase in opening following upper cheek releases, no matter which order the releases were performed in.

They suggested that this increased jaw opening could be impactful for infant latching, speech, chewing, dental visits, and minimising symptoms of TMD. (jaw joint and muscle dysfunction).

It's an interesting finding. I have had an intuition that cheek ties are linked to TMD and that when symptoms are greater on one side, that it is linked to greater tension from the upper cheek tie on that side.

These measurements are a great way to help towards explaining and quantifying what we are perceiving.

Link to access free webinar recording:
https://www.americanlaserstudyclub.org/video/webinar-recording-buccal-up-clinical-insights-and-new-research-on-buccal-ties/?ica_src=Email&utm_campaign=ALSC%20-%20Courses&utm_medium=email&_hsenc=p2ANqtz-95qgAxa2Xou4G067lmb78NVzhp0y2fYn4AmL7uVRSH4UdZKVhLNOYwjkiwok3YwMKUYEPsByVsFBZoTXWCuXH6iTsZpg&_hsmi=25336573&utm_content=25336573&utm_source=hs_email

17/03/2026

Oral releases and release of facial tension

In my quest to document facial tension changes pre and post oral releases, I decided on a new photo this week.

I’ve instructed patients to do a big wide smile with the tongue on the n-spot and with their mouth closed. I believe it will demonstrate facial tension differences better than regular smile photos, which can also be challenging to get some children to do reproducibly!

This patient had six oral releases - upper and lower lip, upper cheeks, one lower right cheek, and tongue-tie. She originally had crowding of her top and bottom baby teeth. We have completed a round of palate expansion.

She has been one of two children who I have released one lower cheek tie this week. These children had a blocked out lower canine tooth on one side. In this situation, the baby canine is lost early to make room for all the lower adult incisors to come through. Then there is no room for the adult canine tooth to fit. In the last few months, I have consistently noticed this is related to greater tension on the affected side from a cheek tie.

My perception is that releasing these ties will promote better arch development, or if the problem is more severe - make future orthodontic corrections more stable. I will be proposing these additional releases in this situation moving forward.

These photos were immediately before and after release. The patient is regional so we may not have an opportunity to take new photos in the very near future.

In these photos she is numb which may have affected the appearance.

However overall I see a reduction in facial tension around her mouth. In her full smile photo her upper lip length is longer and there appears to be less gum display.

For me these cases keep reinforcing a key point - the greater the orthodontic complexity and needs of a child or adult, it’s worth more attention to facial tension that may be associated with other oral ties beyond the tongue.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

16/03/2026

The American Association of Orthodontists (AAO) recently released an updated white paper on sleep-disordered breathing and orthodontics.

It emphasises the role of orthodontists in screening for risk and referring patients for medical diagnosis before airway-related treatment is considered.

But in everyday practice, many children show mouth breathing, snoring, restless sleep, oral dysfunction, and altered jaw development long before a diagnosis is made.

That raises an important question:

What role should orthodontic care play in supporting airway health and development earlier in life?

Here's the link to the 2026 AAO White Paper Update:
https://www.sciencedirect.com/science/article/pii/S0889540626000351

12/03/2026

One week review post oral releases for 5 month old

In conjunction with lactation support and chiropractic care, this bub had 5 oral releases - right and left upper cheek, upper and lower lip, and tongue ties.

There was significant reduction of facial tension with some changes in head shape.

Feeding changes include:

✅ Deeper latch on one side - the other still has significant ni**le damage from pre-release
✅ Staying on better
✅ Feeding more efficiently - longer between feeds. Today went three hours without screaming
✅ Less air intake
✅ Less arching

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

11/03/2026

Optimal latch is the foundation for optimal oral function and airway development.

In this video, look at how wide the mouth opens and how stable the seal is at the corners of the lips.

This was a beautiful latch immediately after oral releases of the upper cheek ties, upper and lower lip ties, and tongue tie that I had the privilege of seeing at the end of work yesterday.

Just before the procedure I also happened to observe a short feed. Bub was slipping on and off the ni**le. The seal at the corners of the mouth was poor, and it was clear he was frustrated and struggling to stay latched.

Seeing him afterwards was a very gratifying moment. He was calm, his mouth was wide open, and both parents described how different it looked, and commented it was the best feed of his life.

I left work reflecting on how many new insights I have gained about oral ties beyond the tongue in recent times from paying more attention. These insights come from connecting the dots between the problems I manage every day, from infants through to adults. And once patterns are seen - they can’t be unseen.

It has been terrific to see growing awareness of tongue tie and its implications for infant feeding, palate development, and breathing.

But what I am discovering and reinforcing every day is that as important as the tongue is, we also need to pay more attention to facial tension associated with upper and lower lip ties and cheek ties.

These other ties influence facial development, jaw growth, and dental development. When they remain untreated, they can contribute to instability of orthodontic results.

It has been humbling to see children who had tongue tie releases as infants return years later for orthodontic treatment, and to recognise other oral ties that I previously overlooked simply because I had never been educated to look for them.

And I can closely relate the facial tension to how the jaws have formed, and how the teeth fit together. Form follows function.

Many of these children did feed better after their initial tongue-tie and sometimes upper lip-tie release. Mothers reported less pain, babies showed reduced body tension, feeds became more efficient, and symptoms such as colic or reflux often improved. Families are grateful that the procedure saved their breastfeeding relationship.

What I now want promote is increased recognition of the facial tension created by lip and cheek ties that contributes to shallow latch.

The deeper the latch, the less the facial muscles need to overwork. The tongue has greater opportunity to practice full suction and optimal swallowing, and the lower jaw is stimulated to move backwards and forwards more.

This is fundamental for establishing good suction during sleep and breathing, and for good jaw and facial development.

For this reason I am now routinely assessing for 5 oral ties in the mouth - upper cheeks, upper and lower lip, and tongue-tie in all infants.

When we see babies slipping on and off the breast or struggling to maintain a seal, it is worth asking whether tension in the lips or cheeks is preventing a deep latch.

Of course, we should not rush into release and there are many other factors that can contribute to subotimal latch. This case was in collaboration with IBCLC Brenda from the Gentle Village, and chiropractor Dr Karli Plowright from Form Chiropractic.

It’s not my scope to assess the latch - and this was one of the very few patients I had opportunity to witness feeds immediately pre and post release. It made me feel more fulfilled to see first hand the potential the impact this work can I have.

I encourage my lactation colleagues to take more videos and study what the mouth is doing during feeding. I was taught to think the tongue was often the primary tie-related problem in infant feeding issues and that overuse of perioral muscles was compensation for restricted tongue mobility. Increasingly I am recognising that other oral ties contribute to specific patterns of compensation.

Airway health is the cornerstone of thriving health and vitality. The best time to unlock it is infancy.

And that begins with the depth of the latch.

Optimal latch is the foundation for optimal oral function and airway development.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

11/03/2026

So pleased to welcome back one of my former assistants, Lucie, who has rejoined our practice as Business Manager.

Lucie will be with us three days a week, helping to drive progress toward our bigger goals while supporting our Practice Manager Karli, who continues to play an invaluable role in streamlining systems throughout our entire practice, and doing a fantastic job supporting our families going through orthodontic and tongue-tie journeys.

Looking forward to growing together!

10/03/2026

Great to touch base with myofunctional therapy colleagues from speech, OT, and dental backgrounds - Claire-Marie Postma, Natasha Duffin, and Heidy Delfosse.

I’m grateful for their collaborative care and support of our mutual patients, and their dedication to keep on learning.

09/03/2026

Last weekend I shared here that I had set myself a goal of attending 12 music concerts in 2026.

So it was a fantastic surprise to receive a reminder the other day that I had booked a ticket to see Josh Groban and that it was on tonight!

What a captivating voice and person! I came home with a very full cup. It was a beautiful evening and a perfect way to cap off a great day.

Normally Mondays are my day off, but today I did a handful of releases for both an adult and some children. All of them were very nicely prepared myofunctionally and with bodywork, and each family had clearly put in a huge amount of effort to reach this stage.

I am grateful for our team at Sparkle, and colleagues beyond our practice who support families along the way, and for the families themselves who have trusted and committed to the process. It’s so rewarding to get to know our patients and families and see how far they have come.

All round, a wonderful day and start to the week 💕

08/03/2026

Reflections on the Term “DOME” in Adult Maxillary Expansion

Lately I’ve been reflecting on how the term “DOME” is being used in discussions around adult maxillary expansion.

I have followed the evolution of adult maxillary expansion with great interest over the years, particularly as the field has gradually moved toward broader acceptance, helping more adults achieve airway health and breathe well 24/7 rather than relying on nighttime band-aids for poor airway development and function.

Watching this shift has been fantastic and encouraging, as it reflects a broader move toward addressing the root causes of airway problems rather than simply managing symptoms.

The term DOME (Distraction Osteogenesis Maxillary Expansion) was originally introduced to describe a specific protocol for adult maxillary expansion aimed at optimising nasal breathing. It combined mini-implant assisted expansion with a Le Fort I surgical cut, which was a far less invasive surgery than had previously been thought necessary.

The work of these pioneers inspired me, as did their trail of publications and data supporting it. These studies helped demonstrate that expansion had value beyond straightening teeth. They showed that it could be a targeted intervention to improve nasal breathing and alleviate obstructive sleep apnoea in adults with narrow palates. For me, they also reinforced the importance of paying attention to healthy palate development much earlier in childhood.

Through this body of work, the authors were able to write chapters describing the DOME protocol and its value, which were included in ENT, sleep medicine, orthodontic and sleep surgery textbooks. This was an important step for integration across disciplines and something that continues to inspire collaboration between fields working to improve sleep and airway health.

This work laid an important foundation for the innovation that has followed. Advances in skeletal anchorage, imaging, and customised appliance design have expanded what is possible. With MARPE and MASPE protocols, along with improved screw design and placement strategies, many clinicians are now able to achieve skeletal expansion in adults, in many cases without the need for surgical cuts.

Recently, however, I have become aware of attempts to redefine DOME as a broader concept, using it as an umbrella term for any expansion aimed at widening a narrow, high-arched palate into a more dome-shaped form.

I loved and was inspired by the clever acronym when I was first introduced to this work. However, I am less convinced that broadening its meaning in this way is helpful for the field.

In medicine and dentistry, terminology works best when it maintains precision and consistency. When a term that originally described a specific surgical protocol with measurable and published outcomes begins to be used as a broader treatment concept, confusion can follow for clinicians, researchers and patients alike. It also becomes more difficult to interpret outcomes in the literature if different procedures are described using the same terminology.

Maintaining clarity between procedures such as:

• Surgically assisted rapid maxillary expansion (SARME)
• Mini-implant assisted rapid palatal expansion (MARPE) or MASPE approaches
• Other forms of skeletal expansion
• DOME as originally described, is still the protocol with the most published data supporting its role in improving nasal breathing and alleviating obstructive sleep apnoea in adults with narrow palates

helps ensure that conversations about treatment planning, research findings and clinical outcomes remain meaningful and interpretable.

The progress made in adult maxillary expansion over the past decade has been remarkable. Innovation will continue, and new techniques will inevitably emerge.

These reflections also remind me that our understanding continues to evolve. If I had the time and opportunity to revise Breathe, Sleep, Thrive, two areas I would expand on are the evolving landscape of adult maxillary expansion and my growing attention to cheek and lip ties, and the role that associated facial tension may play in altered latch, oral function and facial development.

The past decade has shown what is possible when innovation, research and collaboration come together. Protecting clarity in the language we use will help ensure that these advances continue to benefit both patients and the clinicians who care for them.

Note: This image is the illustration of DOME by Chris Gralapp for Stanford Medicine.

Dr Shereen Lim

24/03/2026

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20/03/2026

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