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I recently learned about the mallampati/friedman classification of tongue positioning from my physician. He said I'm a level III, nearly IV. What specific oral appliances could I ask my sleep physician about that are better for a very small mouth cavity and that tongue position?
There are no validated scientific studies proving which devices do better for which patients and to what extent. Theories? Yes. Classifications? Yes. Anecdotal "findings"? Yes. Any way of consistently figuring out (predicting) which 50% of patients will get a 50% reduction in AHI with which device? No. That is the present state of the oral appliance beast at this point in time, as I understand it.
wiredgeorge
+1 point
·
over 6 years
ago
Sleep
Enthusiast
There are a number of bona fide medical professionals with sleep dentistry credentials. I think it wise to wait for one of these folks to respond. We seem to be getting more and more medical advice from folks who specialize in google or anecdotal medical practice.
The Mallampati throat form is a quick way to classify the size of the tongue base (since you have to stick out your tongue to make a determination). The Friedman score looks at the size of the body of the tongue (what sits inside the teeth when your tongue is in a relaxed position). I use the Mallampati to determine if I have to use an appliance with a very thin profile inside the teeth: EMA, Narval, MicrO2 and well made Herbst devices. Bulk outside the teeth does not crowd the tongue. A dentist has no use for the Friedman throat form and this was developed by Michael Friedman, MD (Chicago) to determine how likely soft tissue throat surgery might work; irrelevant for dentists.
A Mallampati 4 throat form means that ,when you stick out your tongue, all that can be seen is the roof of your mouth; this indicates that you have a lot of tissue (ginormous comes to mind) sitting in your airway 24/7 which must be moved to allow you to breathe at night. IT tells me I need both a thin contour of appliance, but I also I need to open between the teeth to give the tongue some place to go to get it out of the airway. I have one lecture slide of a patient with a Class 4 tongue size and I had his teeth almost 3/4" apart ( I normally keep that to 5 mm). He put in the device and his tongue naturally moved forward to fill the opening between the teeth and the patient was very happy with this solution.
B. Gail Demko.DMD
Associate Editor Journal of Dental Sleep Medicine
SleepDent
+0 points
·
over 6 years
ago
Sleep
Commentator
The anterior open appliance sounds like a really plausible approach, but. as we know, what sounds plausible is not always viable in real life. Have you seen any efficacy data on these anterior open design appliances? I have looked at the Moses, the Oravan OSA, and the Luco Hybrid and, so far, have come up empty for online published efficacy results. Also, they seem to open up the bite significantly vs. the typical appliance. Have you observed any patient comfort complaints due to the more open VDO. Arthur B. Luisi, Jr., D.M.D.
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