3 minute read
Research
from Summer 2022
Dr. Unger-Boyd Authors Tethered Oral Tissue Chapter of Pediatric Chiropractic Textbook
Mary UngerBoyd, DC (’97), CACCP, DICS, professor in Logan’s Doctor of Chiropractic (DC) program, authored a chapter for the third edition of the Pediatric Chiropractic textbook, published in May 2022. The chapter is titled “Chiropractic Considerations with Tethered Oral Tissue” and explores tethered oral tissues (TOTs) incidence, signs and symptoms, examination and management as it relates to Doctors of Chiropractic.
“Our role as Doctors of Chiropractic includes identification, referrals and comanagement to obtain optimal function of the tongue and restoration of normal oral motor function and its effect on swallowing, feeding, breathing, airway, facial growth and development, and speech,” wrote Dr. Unger-Boyd.
Several years ago, Dr. Unger-Boyd invited a mother to share her birth story with students in a pediatrics course at Logan. Her child was experiencing difficulty nursing, and she was having a hard time finding a health care provider who could help. The mother believed the nursing issues were her own fault, was in physical pain and developed postpartum depression. It wasn’t until she expressed her concerns with other moms that she first learned about tonguetie, began researching it and was finally able to get the answers and help she and her baby needed. After explaining her challenging journey to the class, the mother pleaded with the students to learn more about these issues and advocate for their patients.
It was this story and many others like it from patients in her private practice that inspired Dr. Unger-Boyd to begin researching this topic and help educate the chiropractic profession.
“As portal-of-entry doctors, it’s important for us to recognize these issues and advocate for our patients,” said Dr. Unger-Boyd. “Many physicians are not aware of the many effects that tethered tissue can have on a child. If we cannot provide the care ourselves, it’s important for us to know who in our community provides exceptional care for tongue-tie so that we can refer our patients to them.”
Dr. Unger-Boyd has 25 years of experience in pediatrics and presents at various conferences. Thanks to her work in this area, textbook editor Claudia Anrig asked Dr. Unger-Boyd to serve as a contributing author for the TOTs chapter, which is new to this edition of the textbook. Previously, Dr. Unger-Boyd was a contributing editor for the chapter entitled, “Sacro Occipital Technique” for the textbook’s second edition in 2012.
In the chapter, Dr. Unger-Boyd explains that TOTs affect not only the infant but also the mother, and that symptoms may vary by age. For the infant, for example, “symptoms may fall into areas of ability to suck properly (latch/feeding), swallowing pattern and breathing (airway), and the effects of these dysfunctions.” This can lead to additional stress to the mother’s nipple, causing them to crease, crack, blanch or bleed. Additionally, “inefficient feeding can lead to poor or incomplete drainage of the breast, an oversupply of breast milk and engorgement. With inefficient milk delivery, the ducts may become plugged. Mastitis or nipple thrush can develop.”
To address these issues, a visual and physical examination for TOTs is required. Dr. Unger-Boyd encourages chiropractors to evaluate soft tissue,
Dr. Mary Unger-Boyd function (suck-swallow-respiration pattern, tongue mobility and motion), associated musculoskeletal and fascial balance, cranial range of motion and sutures, and primitive reflexes for feeding.
Finally, Dr. Unger-Boyd concludes the chapter by offering techniques for DCs to consider when addressing the neuromuscular and developmental deficits noted in the evaluation. She also emphasizes the need for developing a management team for referrals and/or co-management and notes that the DC is “an integral part of the management team pre- and post-revision.”
Dr. Unger-Boyd contributed the new “Chiropractic Considerations with Tethered Oral Tissue” chapter to the third edition of the Pediatric Chiropractic textbook.
