Thesis advisor: Britt F. Pados / Background. Ankyloglossia, commonly known as tongue-tie, reduces tongue mobility through restriction of the lingual frenulum. A recent professional consensus notes that tongue-tie is one possible reason for breastfeeding challenges. Prevalence reporting of tongue-tie has been variable, and an understanding of which infants benefit most from treatment is unknown.Screening and treatment guidelines have not been developed, mainly due to low-level evidence in published research. Despite this, there has been a substantial increase in tongue-tie treatment via frenotomy in the last 15 years. Purpose. The purpose of this program of research was to improve our understanding of tongue- tie and its impact on infant feeding. Eight specific aims were developed to achieve this purpose: 1) identify the prevalence rate of anyloglossia in infants age birth through 12 months; 2) review and evaluate the diagnostic criteria used to diagnose ankyloglossia; 3) identify and summarize original research addressing the impact of ankyloglossia on infant feeding, comparing symptoms of problematic feeding before and after frenotomy; 4) review the quality of the feeding-related outcome measures and psychometric properties of the assessment tools used; 5) describe changes in problematic feeding symptoms, as measured by the NeoEAT, pre- and post-frenotomy; 6) explore the contribution of infant age to the magnitude of change in problematic feeding pre- and post-frenotomy; 7) describe changes in maternal symptoms pre- and post-frenotomy; and 8) evaluate the relationships between maternal symptoms and symptoms of problematic feedingpre- and post-frenotomy. Methods. First, we performed a systematic review and meta-analysis of the literature on tongue- tie to determine the prevalence of the anomaly in the infant population and critiqued the methods used to achieve tongue-tie diagnosis. Second, we identified and summarized original research addressing the impact of tongue-tie on infant feeding, comparing symptoms of problematic feeding before and after frenotomy. In this same study, we evaluated the psychometric properties of the assessment tools used in the published research. Next, we assessed maternal and infant symptoms of problematic feeding pre- and post-frenotomy. In this same study, we utilized a comprehensive evaluation of infant feeding symptoms using a validated measure. Results. Cumulatively, this dissertation research has identified symptoms in both mothers and their infants in the setting of tongue-tie. Each of the eight specific aims proposed for this dissertation were addressed. Specifically, through the meta-analysis and systematic review, we determined 1) prevalence of tongue-tie is higher than previously thought, affecting 8% of the infant population, 2) current screening tools for tongue-tie require psychometric evaluation, 3) LATCH scores and maternal self-efficacy improve following frenotomy but little is known about the effect of frenotomy on infant feeding, and 4) infant feeding has not been evaluated comprehensively or with a validated measure for babies with tongue-tie. The research study conducted in Chapter IV found that 5) infants with severe tongue-tie experienced significant improvements in problematic feeding symptoms following tongue-tie correction as measured by the NeoEAT, 6) regardless of infant age, improvements in symptoms of problematic feeding were seen post-frenotomy in babies with severe tongue-tie, 7) maternal symptoms previously thought to occur in the setting of tongue-tie improved following frenotomy (e.g., painful or difficult latch), and 8) symptoms that have not been assessed in earlier research also improved after tongue-tie correction (e.g., chewing on nipple, incomplete breast drainage, and over supply of breastmilk). Conclusions. The program of research in this dissertation has made meaningful contributions to the literature on tongue-tie. Through the production of the first meta-analysis of prevalence data, a thorough evaluation of the available research, and the determination of maternal and infant symptoms associated with tongue-tie, we have crafted recommendations for future research and recommendations for improvements in the clinical management of infants with this oral anomaly. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The present investigation was undertaken to collect normative data on a teenage population and a young adult population in order to assess tongue sensitivity regarding the identification of various geometric shapes. The research, was conducted to answer the following questions: 1. Is there a significant difference between a teenage group and a young adult group regarding lingual discrimination? 2. What is the range and variability between and within the two groups? 3. Is the teenage group significantly better than the elementary school age group previously tested by Weiss (1973b)? There were 50 normal-speaking subjects in the teenage group ranging in age from 13 through 15 years, and 50 normal-speaking young adults ranging in age from 22 through 26 years. The subjects in the teenage group were volunteers from the public schools of Portland, Oregon, and Camas, Washington. The adults were from the same areas and were either employed in responsible jobs or were enrolled in graduate study programs. All subjects were administered a passive and an active test of lingual discrimination. Each test included 24 identifications of plexiglass geometric shapes. Selection of the shapes were made by the subject pointing to his choice on a response sheet, after the geometric shape had been removed from his mouth. The results were analyzed statistically to assess mean, range, and variability within and between the groups. A t-test was used to determine a significance of differences. The questions posed by this investigator were answered in the following manner: There was no significant difference in performance between a teenage group and a young adult group regarding lingual discrimination. This would appear to contraindicate the belief by some authorities (McDonald and Aungst, 1967) that lingual discrimination abilities continue to improve until the mid-teens. In discussing the results between the groups, the means of the active scores for both age groups were significantly greater than those achieved on the passive test. The variability on the passive test was significantly greater (p > .05) for the teenage group than for the adult group. The adults tended to be more variable on the active test. This would tend to indicate that both age groups were receiving more discriminative cues on the active test than on the passive test. 2. In comparing the teenage group to a group of 8 year-oIds previously tested by Weiss (1973b), it was found that the older group performed significantly better. These findings held true for both passive and active tests. This finding is not surprising in that one would expect maturation in this discrimination task over time as a result of human development.

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Introduction: The Modified Mallampati Tongue Score (MMT) is commonly used in anesthesiology for the pre-anesthetic assessment of the airway in patients. This score roughly estimates the size and position of the tongue relative to the oral cavity, with higher scores associated with difficult intubation and increased incidence of breathing interferences, such as obstructive sleep apnea. The distance from the tongue base to roof of the mouth decreases from MMT-I to MMT-IV. The tongue shape and position impact the airway patency in the hypopharynx, contributing to changes in craniofacial head posture followed by changes in craniofacial morphology. This present study examines the pattern of associations between the Modified Mallampati Tongue Score positions and 1) the postural relationship of the cranium, hyoid bone, cervical column, and tongue 2) size, shape, and position of the craniofacial components, as depicted in a lateral cephalogram. Methods: This retrospective study was performed on 200 subjects (145 female, 55 male) prior to starting orthodontic treatment. MMT was assessed from one photograph of maximum mouth opening and tongue protrusion. Pretreatment cephalograms were analyzed to evaluate craniocervical posture, resting tongue position, hyoid bone position, or sagittal and vertical skeletal relationships. MMT (I-IV) was also compared to basic demographics (age, gender, race/ethnicity). One-way ANOVA, Chi-square test, and correlation analysis were used for statistical analysis. Probability values <0.05 were accepted as significant. Results: A total of 200 patients (72.5% Female, 27.5% Male, 54% African American), with a mean age of 20 (Range 7-73), were included for the study. MMT-III was most prevalent (34%). MMT was not associated with age, gender, or race/ethnicity. Mean cephalometric measurements of hyoid position (p=0.06-0.03), mandibular position (p=0.006), ANB (p=0.009), and SNB (p=0.023, were shown to have significant differences with MMT. MMT positively correlated with the ANB (p=0.001), Wits (p=0.016), vertical position of the hyoid bone to neck (p=0.004) and mandible (p=0.048); and inversely correlated with the SNB (p=0.003) and Pog:Na-Perp (p=0.045). Conclusion: A higher MMT correlates to a Class II skeletal morphology and extended craniofacial posture. Preliminary results suggest high tongue position influences Class II craniofacial morphology, enhancing maxillary prognathic growth and mandibular deficiency. This indicates that MMT can be a potential predictor of craniofacial growth patterns, strengthening the prognosis and long-term stability of orthodontic treatment. / Oral Biology

The purpose of this study is the challenges that the teaching of SO subjects faces in the multicultural classroom. These challenges pose a problem in the process of developing students with a foreign background. The aim of this study is to highlight the challenges and opportunities that the teacher faces with students in the multicultural classroom as well as the solutions and strategies that the teacher uses to develop multicultural students. Therefore, empirical material from in-depth interviews was used about how teachers work and challenges and strategies related to this teaching area. I found few studies that address challenges and difficulties for those who have to learn socially relevant subjects in Sweden. The method that has been used is to interview four teachers in two schools. The result of this study shows that teachers use different ways to support the students in their learning of the SO subjects, for example, by using lists of important terms and words, or by using a teacher assistant in the mother tongue. By the teacher supporting the students in the right way, the students can apply new knowledge. Keywords: multicultural classroom, mother tongue and teacher assistant.

The purpose of this study was to understand the issue of the language of instruction to school literacy learning in rural Haiti. Using a narrative approach, 10 participants who live and work in a rural village in Northern Haiti were involved. I sought to examine their experience and perspectives on the issue as well as their level of awareness and the ways they navigate through the system to succeed in life. The dissertation also investigated their struggle to learn using a language over which they do not have much command and that they do not speak at home and in their community. This dissertation drew from critical pedagogy, as a conceptual framework that advocates for emancipation by providing quality and equitable education for all students as agents of change filled with intellectual potentiality and the ability to address oppressive patterns in society and challenge the status quo. Data from subjects were collected from focus groups, in-class observations, and semi-structured interviews. The analysis of the data was done utilizing three coding cycles and three themes were identified: 1) Students’ production based on the language in use, 2) The importance of the setting for language mastery and literacy learning, and 3) The role of language mastery in students’ success in school and in the workplace. The study suggests implications for future research, parents, and school leaders. The findings identify gaps and purpose to add to the literature given the paucity of research on the issue of the language of instruction as applied to schools in rural Haiti.Keywords: literacy learning, language of instruction, mother tongue, bilingualism, code-switching

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The use of self-ligating brackets has gained popularity recently in orthodontic treatment. The Damon philosophy is a system that employs passive self-ligation with the use of light forces to achieve arch development and to relieve dental crowding. The philosophy of the system is that the use of light forces does not overpower the forces of the lips, tongue, and other peri-oral soft tissue thereby allowing for optimal equilibration of forces that is customized to every individual. If this actually occurs, changes in the posture of the tongue and hyoid would be expected as is seen after orthognathic surgery and rapid maxillary expansion. The purpose of this study was to evaluate if these postural adjustments do occur, and, if they do, to assess if there is a stratification of treatment effect based on dental classification. A customized cephalometric evaluation was designed from an amalgamation of previous cephalometric studies. This cephalometric study not only evaluated changes due to treatment but also assessed changes in cervical postural position to validate the quality of the measurements and to verify that radiographs were taken in a correct and repeatable head position. Cephalometric measurements were correlated with measurements of posterior dental expansion at the premolars and molars. Results of the study showed a correlation in tongue length and hyoid to mandible measurements. Lack of significance in the cervical posture cephalometric changes validated the cephalometric design and the quality of radiograph included in the study. Significant posterior dental expansion was documented although this expansion was limited to the premolar regions. Changes in tongue length correlated with dental expansion, particularly in the lower premolars. Lastly, increases in upper airway space correlated with dental expansion, particularly in Class III patients. This finding is very interesting and suggests the need for further research in this area. Additionally, replication of this study with more subjects may yield very interesting results. Overall, this study supports the fact that studies of soft tissue changes in relation to orthodontic treatment need further investigation as these tissues are involved in the equilibrium of forces and are directly related to the stability of orthodontic treatment. / Oral Biology

Objectives: Orthodontic arch development expands and broadens the dentition beyond the confines of the original arch perimeter. This is often accomplished by means of self-ligating fixed appliances. When movements take the teeth outside those confines, without adoption, the muscular forces are unbalanced and may lead to dental relapse. Muscle spindles and associated reflex loops within the tongue provide feedback to arch perimeter changes that may produce postural changes to the new archform. Resting posture has long been accepted as aiding in tooth position. The objective of this study was to assess the oral and pharyngeal postural changes that result from arch development with the Damon system and report the amount of expansion accomplished. Methods: Pre- and post-treatment models and lateral cephalograms were collected on 69 previously treated orthodontic patients from four different private practices. Expansion was measured from the buccal cusp tips of the first and second premolars and first molars. A new cephalometric analysis was implemented to diagnose both variations in malocclusion and variations in posture of the head, neck, pharynx, hyoid bone and tongue. Results: Both tongue height and length increased, 2.9mm (P-value 0.001, SEM=1.06) and 3.76mm (P-value 0.00002, SEM=0.62) respectively, following posterior dental arch expansion using Damon archwires. Hyoid position was not significantly different. Conclusion: As dental arches are expanded the tongue increases in both length and height to fill the space and therefore may aid in stability during the retention phase of treatment. The lack of change in hyoid bone position, as one would expect with a rise in tongue position, might be explained by either slight changes in head position or the need to maintain the airway. / Oral Biology

Instances in which we cannot retrieve information immediately but know that the information might be retrieved later are subjective states that accompany retrieval failure. These are expressed in feeling-of-knowing (FOK) and Tip-of-the-tongue (TOT) experiences. In Experiment 1, participants with Parkinson's disease (PD) and older adult controls were given general questions and asked to report when they experienced a TOT state and to give related information about the missing word. The PD group experienced similar levels of TOTs but provided less correct peripheral information related to the target when in a TOT state. In Experiment 2, participants were given a Semantic (general knowledge questions) and an Episodic (word pairs) FOK task. PD patients failed to accurately predict their future memory performance (FOK) in response to both episodic and semantic cues. Results are interpreted in the context of recent frameworks of memory and metacognition.