Archives for posts with tag: Mallampati

1. Mallampati Airway Exam  

2. Scalloped tongue

 

 

During an apnic event the tongue will force itself forward to remove itself as an air-blocking barrier.  Repeated compressions like this, pushing against the teeth, will leave impressions in the lateral edges of the tongue. The patient subconsciously  tries to force the tongue to move forward from the air tract and forces it against the teeth.This sign is readily detectable. This is also called Crenulated Tongue.

 
This indicator is nearly infallible; it must be differentiated from a similar condition (sign) in  a thyroid disorder.
 
 
We are in an excellent position to screen for sleep apnea and to help identify our undiagnosed (and therefore, untreated) OSA patients.
How can you miss these clinical signs?
You…..
• have direct observational access to the physiological structures of your patients’ upper airways
• are already screening chair side for other health conditions that can be easily spotted during a dental visit
• may see these patients more frequently than primary care physicians will, and are nearly one quarter more likely to see a dentist than a physician over any given time period.

Your field of operations is right next to the opening of the airway.

                  MALLAMPATI EXAM

The Mallampati Scale is a simple but effective test to assess your patient’s (or your own) airway .

The subject should be sitting or standing with their head on a 90 degree axis to the floor.
They protrude their tongue (not necessary to say “ahh”) and with a direct light into the  mouth, look in and/ or take a picture.
 
Class III or IV conditions are certain candidates for further testing and possible therapy.
The tongue is the most common factor in Obstructive Sleep Apnea.

Now that you learned this you will probably be heading for a mirror. How did you rate?                                     

                                  MALLAMPATI EXAM

The Mallampati Scale is a simple but effective test to assess your patient’s (or your own) airway .

The subject should be sitting or standing with their head on a 90 degree axis to the floor. They protrude their tongue (not necessary to say “ahh”) and with a direct light into the  mouth, look in and/ or take a picture.
 
Class III or IV conditions are certain candidates for further testing and possible therapy.
The tongue is the most common factor in Obstructive Sleep Apnea.
Now that you learned this you will probably be heading for a mirror. How did you rate?   
Studies show that people suffering from sleep-disordered breathing have an increased risk of developing cancer and are up to five times more likely to die from the disease.   Once again the culprit is HYPOXIA. The lack of oxygen (hypoxia) caused by untreated Obstructive Sleep Apnea (OSA) can be a catalyst for a process called neovascularization (the creation of new blood vessels), giving a blood supply that can encourage tumor growth.  Snoring may be a warning that you may have OSA.

Cancer cells thrive in a low oxygen environment. Hospitals will put a patient on oxygen if their O2 levels drop below 92. Untreated OSA can cause oxygen levels to drop anywhere from the 90’s, 80’s and even in the 50’s.

Sleep apnea causes sustained low blood oxygen.

One of the biggest problems with sleep apnea is the way in which it deprives the body of necessary oxygen. Frequent apneas (pauses in breathing that last at least 10 seconds, but often last much longer) lead to nocturnal intermittent hypoxia.

Dentists perform exams of  patient’s mouth, neck, and airway on a regular basis while screening for oral cancer. These health screenings are important, lifesaving moments in a patient’s health journey– we can do that with a similarly deadly condition like untreated sleep apnea.

Detecting OSA and leading the way for treatment can add YEARS to a  patient’s lifespan while significantly improving quality of life. Both cancer and OSA have symptoms that can be easily recognized in the chair during a regular checkup. While checking the mouth for masses and swelling, you can also check on the Mallampati score  and be alert to possible concerns you may have.

 

MALLAMPATI EXAM

Symptoms of both oral cancer and sleep apnea should be screened for everyone, especially for heavy drinkers and tobacco users. The irritation from cigarettes and other forms of tobacco may cause inflammation that’s disruptive to the airway. Smoking, of course, is known for its carcinogenic properties, but perhaps more surprising is that around 70% people diagnosed with oral cancer turn out to be heavy drinkers. Alcohol use is also known to cause apneic events by relaxing muscles in the airway (this is particularly dangerous when people use alcohol to help get to sleep due to an already existing issue with sleep apnea).

WOMEN WITH SLEEP APNEA HAVE INCREASED RISK OF CANCER 

We know that men are more at risk of developing sleep apnea. But if you happen to be a woman and you suffer from OSA your risk of developing cancer is more than your male counterparts, says a recent research published in the European Respiratory Journal. During the study the scientists collected data of 20,000 patients with OSA. It was found that around 2 per cent of these patients were later diagnosed with cancer.

Researchers analysed data based on age, gender, alcohol consumption, body mass index and smoking. Again, there was a strong association between sleep apnea and higher cancer prevalence. Additionally, the link was stronger in women than men.

A 2012 study identified a link between sleep and aggressive breast cancers. Ref: American Cancer Society

MORE CASE STUDIES

In 2013, Spanish researchers reported that people with severe sleep apnea had a 65 percent increased risk for cancer. They suggested the risk is associated with increased hypoxia, a condition where the body is deprived of oxygen.

Another study from the University of Wisconsin found people with sleep-disordered breathing are five times more likely to die from cancer than people without sleep apnea. Researchers from the American study admit the study is limited in that there are no studies to compare it with that look at cancer survival in people with sleep apnea.

One recent study reported in the Journal of Sleep Medicine shows moderate and severe cases of sleep apnea are associated with increased cancer risk. That study also showed an increased risk for all “all-cause mortality” and cancer mortality due to cancer. The 20-year study showed that people with moderate to severe cases of sleep apnea are two and a half times more likely to develop cancer and three times more likely to die from cancer. The authors noted these findings confirmed previous research conducted by American and Spanish researchers.

Animal studies have also confirmed previous findings. One 2014 study  reported in the journal Cancer Research linked sleep apnea with aggressive cancer growth in mouse models. Mice with tumors were placed in low oxygen environments that mimic the effects of sleep apnea and tumor growth in the mice progressed rapidly.

 

With a convincing condemnation of Sleep Apnea as a cause of cancer we need to be more serious about screening patients for cancer and OSA.

 If you have any concern about your risk, ask us about it.  We’re here to help.

MALLAMPATI EXAM

Are you concerned about Obstructive Sleep Apnea?  You should be because it is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed.
 

Here is a simple yet accurate diagnostic test you can use to see the opening of your airway.

Stand in front of a mirror and protrude your tongue. Aim a light toward the back of your mouth.
Is your airway open like the diagram on the left? You are safe.
SIZE DOES MATTER
If your airway is obstructed by the base of your tongue, or a droopy soft palate, or from side to side by the pillars or tonsils, then this should concern you.
WHAT IS OBSTRUCTIVE SLEEP APNEA?
Obstructive Sleep Apnea (apnea=without breath) occurs while you are at sleep and not even aware of it. (Your bed partner may be well aware of your symptoms.)  During an apnea event you will not be able to inhale for 10 seconds and even up to a full minute until your body forces an autonomic response: your tongue will push forward in an attempt to open the airway, your teeth will gnash and grind.  When you are awake you may be able to see these signs in your mouth but you are unaware while asleep.
This dangerous cycle may repeat throughout your night and it may average 30 such episodes per hour. A severe case of obstructive sleep apnea (OSA) could produce 240 episodes during an eight hour sleep. This is not uncommon.
Imagine how much life-supporting oxygen is being transported to your heart, your brain, and other organs. Well-known mental effects of OSA are chronic daytime fatigue, irritability, confusion, inability to concentrate, dementia, and Alzheimer’s disease.
High blood pressure, strokes, heart attacks are also connected to OSA.
FOR DENTISTS:
If you want to learn about the treatment protocol, case planning, insurance coverage, and the rewards, I strongly recommend this 2 day, 16 CEU course for dentists and hygienists. Dates and cities here:        http://join.sleepgroupsolutions.com/seminars/
By registering with this promo code CK200 you will save $200 off the cost of the tuition and bring a hygienist tuition-free,  In this website you’ll see the cities and dates for this training course.
Add a valuable service to your resume’ free of charge.
You will receive the same benefits as your dentist including 16 CE units.
Help your doctor treat patients that have Obstructive Sleep Apnea.

MALLAMPATI EXAM

Why You will want to do this:

-Free attendance at this important training seminar.
Learn how to screen and treat Obstructive Sleep Apnea (OSA)
-16 CEUs -FREE
-Have a key role in your practice as a sleep coordinator. 
-Increased value to your practice
-Potential of greater income for you
-A more relaxed patient service
-Admiration by your peers for your leadership.
-Respect from your patients for helping them with a needed medical service.
-The great feeling of knowing that you are truly saving lives.

 


This offer is valid only through August 31, 2019.

Eligible Dental Assistants may also qualify.

Email or IM me for a list of locations and dates of this tuition-free course.  Cskdoc@aol.com
 
Charles Kravitz, DDS
Professional Relations Director
Sleep Group Solutions

WHAT IS MISSING IN YOUR COMPREHENSIVE DENTAL EXAM?

A truly professional comprehensive dental exam examination (D0150 or D0180) should include much more than what the CDT codes delineate.
What is essential?
Beyond the obvious FMX, charting of existing and needed dental and periodontal conditions, and an oral cancer screening, there are many other evaluations which are directly related to our services and are within our authority and responsibility.
The Comprehensive Exam should also include measurement of vitals such as blood pressure, etc. and a sleep dysfunction screening with a sleep questionnaire and a careful discussion of any notable items (alerts) in the patient’s med and sleep history. These things don’t need to be spelled out in the CDT code. They come with our desire to do what we know is right.

MALLAMPATI EXAM

TMJ exam, facial muscle palpation, Mallampati classification  (correlates tongue size to pharyngeal size) and an oxygen saturation test will provide critical information.  Any dentist/hygienist/team will chose how extensive they wish their dental exams to be and what should be included.

Would we be “spending too much time” in a dental exam visit?

Not if we care about our patient’s total well being, our conscience, and our dental license.

And is this “nearly always accepted by patients with huge value and appreciation”? YES, it is when the dental team shows their patients how much passion, care and skill they have. I see it in many dental offices. The really successful ones.

5-20-12 HUMAN PYR

Do you want to do more?
Here’s your opportunity to increase your service to your community, to create your “niche”, and  to stand out in your community as a complete care-giver. Your rewards will be enormous!
It is reported that 34% of the population has sleep breathing symptoms. One of the next three patients that walk thru your doors is your candidate.

Are you able to help them?

Does your New Patient Exam include a screening for Sleep Apnea?1-21-13 LOGO DENTAL PROS SHARING

 

Interested? Then check this out: http://sleepgroupsolutions.com

or ask me:  cskdoc@aol.com

This Dental Sleep Training course may be the most valuable CE Seminar you have taken. *

Here’s one example of a very useful test that anyone can do to determine the likelihood of Obstructive Sleep Apnea.
The  Mallampati Score is a very simple exam and is an effective indicator of a compromised airway.   The subject can be sitting or standing with a vertical axis of their body and head.  As long as the tongue is protruding we are able to see the airway. The variables are, above, the soft palate and uvula, laterally, the walls of the fauces (or the tonsils and adenoids), and below, the base of the tongue.
The tongue is the most common offender for obstructive sleep apnea. Macroglossia can be effectively dealt with by oral appliance therapy- a mandibular advancement device (MAD).
Imagine trying to breathe with an obstructed airway… and a nasal obstruction!
Your Sleep Coordinator or Hygienist can do this exam as part of routine screening on every patient. Class III and IV must be treated.

About the SGS Course Instructor: Dr. Jeff Horowitz

Dr. Jeff Horowitz, a native of Old Bridge, New Jersey, completed his undergraduate studies at the University of Pittsburgh , receiving early admission to dental school after his junior year. In 1991 he earned his Doctorate of Dental Medicine degree from the Medical University of South Carolina. Dr Horowitz has dedicated himself to continuing education, earning him the fellowship award from the Academy of General Dentistry.  Dr. Horowitz is also a member of the American Association of Dental Sleep Medicine.

* You will receive 16 CE credits and a training in the most exciting and rewarding dental service.

Read the course outline and register here with Promo Code TN500 to get a 50% tuition saving:    

http://join.sleepgroupsolutions.com/seminars/nashville-tn-4/

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You are in an excellent position to screen for sleep apnea and to help identify your undiagnosed (and therefore, untreated) OSA patients.

How can you miss these clinical signs?

You…..

• have direct observational access to the physiological structures of your patients’ upper airways

• are already screening chair side for other health conditions that can be easily spotted during a dental visit

• may see these patients more frequently than primary care physicians will, with nearly one quarter more likely to see a dentist than a physician over any given time period. 

Your field of operations is right next to the opening of the airway.

Clinical signs of Obstructive Sleep Apnea:
~constricted airway – measured by a Mallampati score *
~ large neck circumference

          Over 15 inches in women
          Over 16 inches in men
  
~ oversized and/or inflamed uvula
~ extra large tongue
~ scalloped tongue edges-caused by tongue forced against the teeth, gasping for breath.
~ enlarged tonsils     
~ a droopy soft palate
 ~ retrognathic mandibular jaw.
~ obesity
~ heavy or struggled breathing
~ bruxism
~ obvious lack of energy
~ lack of focus in children causing ADHD -in 20% of ADHD victims.
~ sleepiness during dental appointment.
                                                                                                   *MALLAMPATI CLASSIFICATION

   Want more information, email me cskdoc@aol.com.