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Written by

Amanda Hill

Written On

February 20, 2021


As dentistry evolves, forward-thinking clinicians aren’t just looking at the teeth and gums but moving beyond into the airway.  Science is showing us proper breathing affects a multitude of systems in our body.  Proper nasal breathing can lower stress, help with sleep quality, ward off infection, and more.  

What does this have to do with dentistry?  Well, we are indeed already looking in the mouth and hopefully down the airway during an oral cancer exam.  So why not evaluate the airway while we’re there?  Much like the oral cancer exam, no one is asking you to become an expert, but learning enough to know when to refer could make a significant impact on your patients’ lives.

Here are some steps to help you look for clues for airway issues:

Medical history

Start with your medical history.  Are there any questions about snoring? Sleep apnea? Sleep quality?  ADHD? Understanding a patient’s history gives you clues to look deeper.

Clinical Evaluation

1. Neck Circumference

I’m not suggesting you whip out the measuring tape here, but get to know what neck circumference looks like.  For women, a measurement over 16” and 17” for men is associated with increased soft tissue in the throat area and can affect the airway. Men who wear dress shirts already know this number, so you can simply ask them!

2. Mallampati Score

The Mallampati Score is a popular assessment of the space from the base of the tongue to the roof of the mouth.  That space is what makes up the airway.  This assessment is easy to perform while doing an oral cancer exam. The score is determined by asking the patient to open the mouth and stick out their tongue as far as possible, then rating what you observe.

  • Class 1: Soft palate, uvula, fauces, pillars visible.
  • Class 2: Soft palate, uvula, fauces visible.
  • Class 3: Soft palate, base of uvula visible.
  • Class 4: Only only soft palate and tongue, no uvula.

A higher Mallampati score is a predictor for risk of Obstructive Sleep Apnea (OSA) and can be a helpful screening tool during the clinical examination. 

3. Scalloped Tongue

The presence of tongue scalloping has shown a high correlation for airway issues. The presence and severity of tongue scalloping has a positive correlation with a higher Mallampati score. In high-risk patients, tongue scalloping has been found to be predictive of sleep issues. 

4. Tongue Resting Posture

The tongue should be resting on the roof of the mouth, not on the floor of the mouth.  Ask your pt where their tongue rests. If it’s on the floor, find out why? Is there a tongue tie? Ask your pt to open wide and have them reach for the roof of their mouth.  Can they touch it?  If not that might be a sign of a tongue tie.  Or if they report their tongue resting on the floor of their mouth it could be a habit that can easily be relearned.

5. Lip Resting Posture

Proper lip resting posture is lips together, not mouth open.  Pay attention to the patient while they are sitting in your chair.  If their lips are apart while resting they breathing through their mouth.  Look into the why.  Is it an obstruction or a habit? Either way, it’s not ideal for the patient’s overall health.


Not interested in treating airway issues? Get to know other practitioners in your area.  Who is the sleep guru?  Develop a relationship with an ENT.  Additionally, find a myofunctional therapist to refer to. These therapists have changed lives teaching patients how to properly breathe and place their tongue through exercise therapy—often helping patients avoid further treatment. 

Knowing just the basics of airway assessment and when to refer can have a considerable impact on your patients’ quality of life.  No one expects you to know it all.  But just like referring to the endodontist for that tricky root canal, sending a patient off to an airway specialist could be exactly the expert they need.

Amanda HIll

Amanda Hill, RDH, BS has been in the dental industry for over 30 years, she earned her B.S. in Dental Hygiene at Old Dominion University in Norfolk, Virginia and has had the opportunity to experience dentistry around the world.   Amanda  has a love for learning and is obsessed with continuing education in all its many forms.  Amanda practices part time clinically and is an industry educator for the nation’s largest dental job board, DentalPost.net.  Amanda is a proud Navy spouse and mom of 3.

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