Sleep apnea is a sleep disorder that affects approximately 25 million people in the U.S, but this number is misleading. Another estimated 80% of people with moderate to severe sleep apnea remain undiagnosed. Many people hesitate to visit a sleep clinic for diagnosis, but there is another measure that evaluates the possibility of sleep apnea: the Mallampati score.
What is the Mallampati score?
The Mallampati score evaluates the opening of your airway. It’s the opening your doctor sees when they ask you to stick out your tongue and say, “AH.”
This evaluation includes looking at the space between the tongue, soft palate, tonsils, and the uvula. The soft palate is the area behind your hard palate (which is located at the front of the mouth in the upper jaw). The soft palate does not contain any bones and assists in swallowing. The uvula is the small bit of tissue that hangs down at the back of your throat. This is used as a landmark for classifying the Mallampati score into one of four levels.
A high Mallampati score is a good predictor of an increased risk of obstructive sleep apnea, the most common (and dangerous) form of sleep apnea. Additionally, people with Mallampati 4 are harder to intubate if needed, and women in labor may experience a closing of the airway as labor progresses. Should labor and delivery complications arise, this narrow airway can make intubation or mask ventilation challenging.
What does a Mallampati score of 4 mean?
To understand the significance of a Mallampati score of 4, it is important to know what each of the other levels mean.
For a Mallampati 1, the bottom of the uvula is visible and the airway is open with no real obstructions. The next two levels are a bit more subjective, but for Mallampati 2 and 3, the uvula is either partially covered (Mallampati 2) or nearly completely covered (Mallampati 3). As more of the uvula is covered, the airway narrows.
Mallampati 4 is the most serious obstruction, with the uvula completely covered by the back of the tongue. Many people who experience this condition have difficulty getting enough oxygen and may be prone to panting with their mouths open.
Those with Mallampati 4 may also experience hoarseness in addition to the visible obstruction of the throat.
Do I have sleep apnea?
Mallampati 4 can be a good first indicator of the possibility of obstructive sleep apnea (OSA), a sleep disorder that affects more men than women. Estimates of incidence suggest about 24% of men and 9% of women suffer from it.
OSA occurs when the throat muscles relax so much that your airway becomes blocked. The brain notes the oxygen deprivation and wakes the sleeper. This waking is abrupt and often accompanied by a loud, gasping breath. If the airway is already blocked to the Mallampati classification of 4, then the chances of OSA are high.
Symptoms of OSA include:
- Daytime fatigue and excessive sleepiness
- Snoring
- Fogginess and difficulty concentrating
- Breathing stops while sleeping, followed by a choking intake of air
- Dry mouth or sore throat upon awakening
- Morning headache
- Loss of sex drive
- Nighttime sweating unrelated to another condition (e.g., menopause)
- High blood pressure
Sleep apnea complications
Treatment of sleep apnea is crucial. Not only does helping patients get a good night’s rest improve the quality of their lives, but it also prevents serious sleep apnea complications such as:
- High blood pressure
- Heart disease
- Atrial fibrillation
- Stroke
- Type 2 diabetes
- Depression
- Risk of early mortality
How to treat sleep apnea
Treatment options for sleep apnea start with lifestyle changes. Obesity, smoking, and consumption of alcohol are all risk factors for obstructive sleep apnea.
Losing weight, quitting smoking, and limiting alcohol consumption (especially before bed) can all kickstart treatment for sleep apnea.
Sleep apnea devices
There are also a number of sleep apnea devices for treatment, the first of which is available to you through your dentist.
People who suffer from sleep apnea often have wear patterns in their teeth that are different from other patients. During a regular dental appointment, your dentist may spot the signs of sleep apnea (or note Mallampati 4 narrowing) and refer you to a sleep center for a thorough evaluation. Once your diagnosis is confirmed, a custom-fitted oral device for sleep apnea is a possible OSA treatment option.
Dental devices for sleep apnea can be an effective first-line treatment for many people who suffer from this condition. These devices have the same design as a custom athletic mouthguard, but they do more than protect your teeth.
A custom-fitted oral device for sleep apnea gently re-positions your jaw and tongue to keep airways clear and open all night long. Even for patients with a Mallampati 4 but no diagnosed sleep apnea, a dental device for sleep apnea can help reposition the jaw to keep the airway clear all night long.
CPAP machines
One of the most well-known treatments for obstructive sleep apnea is the CPAP (continuous positive airway pressure) machine. The CPAP machine delivers pressurized air that keeps the throat open continually.
The BiPAP (bilevel positive airway pressure) and VPAP (variable positive airway pressure) supply air on a variable schedule (or in a different manner). For all options, the sleeper wears a snug mask over the mouth and nose and sleeps as normal.
When worn regularly, positive airway pressure devices have been proven to dramatically improve a person’s quality (and quantity of sleep). But this is one of the downfalls of this treatment option. Because of the noise, the discomfort of the mask, and the overall hassle of the machine itself, compliance with this treatment can be very low. And the treatment does not work when the machine and mask sit idly next to the bed.
Get help
Starting with a dental device for sleep apnea has a number of benefits. Dental devices are small and silent so that you can travel easily with them and not wake your partner every night.
They have been proven as effective as a CPAP machine but wearers report being more comfortable at night with a small dental device (as opposed to a bulky mask).
Evaluation of your Mallampati score is simple and completely non-invasive. If you have signs of obstructive sleep apnea and are ready to open your mouth and say “Ah” to check your Mallampati score, give AZ Dentist a call.