CORRELATION BETWEEN MODIFIED MALLAMPATI TONGUE SCORE WITH VARIATIONS IN DENTOALVEOLAR POSITION AND ANGULATION

Abstract

Introduction: When evaluating the etiology of a malocclusion, a multitude of analyses exist for evaluating skeletal, dental, and soft tissue features of the patient. However, there is no current systemized orthodontic protocol for evaluating the tongue position and size. The tongue is the largest organ in the oral cavity and has a significant impact on the positioning of the dentoalveolar structures. The Modified Mallampati Tongue (MMT) score is a reliable method of estimating tongue size and position relative to the oral cavity. While the MMT is commonly used in anesthesiology for pre-anesthetic airway assessment, it is a simple and reproducible test to evaluate the tongue size and position. This study aims to determine if the Modified Mallampati Tongue Score, along with cephalometric evaluation of the tongue height and size, can be used as a diagnostic tool to assist in determining the etiology of certain malocclusions.Materials and Methods: Pre-treatment photographs, lateral cephalograms, and intraoral dental scans of 450 patients treated at Temple University Kornberg School of Dentistry (TUKSoD) Department of Orthodontics were studied. The sample includes patients of any age group, gender, or ethnicity. Cephalometric linear measurements of tongue height and length, as well as molar position, were conducted on Amira Morphometrics software. Angular measurements of upper and lower incisor inclination were computed from lateral cephalograms on Dolphin Imaging software. Three- dimensional digital cast analysis, acquired from intraoral dental scans, were performed on Invisalign ITERO software to measure dentometric dimensions, such as arch perimeter, arch length, and arch width. Quantitative analysis was completed to compare tongue position and size to dentoalveolar arch dimensions, as well as tooth position and angulation. Probability values of <0.05 were accepted as significant. Results: A total of 189 patients (72.5% Female, 27.5% Male, 54% African American), with a mean age of 20 (Range 7-73), were included for the study. Lower incisor angulation was the only dental cephalometric measurement with positive correlation to MMT (p=0.038). Tongue length, however, correlated positively with all but one dental cephalometric measurement (p 0.004 to <0.001). Tongue height had positive correlations with both dental cephalometric and arch dimensional measurements: maxillary and mandibular molar position (p=<0.001), maxillary canine width (p=<0.001) and premolar width (p=0.011), and maxillary arch perimeter (p=0.046). Regression analysis showed that gender and ethnicity have statistically significant effects on multiple variables, where males and African Americans frequently had greater dentoalveolar measurements compared to females or other ethnicities, respectively. Conclusion: MMT scores do not help estimate dental arch size or tooth location. Tongue length and height, however, showed significant relationships to dental arch dimensions and tooth positions. This suggests that cephalometric soft tissue analysis of the tongue position is an effective predictor of dentoalveolar positioning, enhancing diagnosis, prognosis, and retention decisions in orthodontic treatment planning.