{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:36:52Z","timestamp":1787841412981,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The evaluation of tonsil size, Friedman Tongue Position (FTP), and Friedman staging in pediatric obstructive sleep apnea (OSA) holds significant clinical importance, offering manifold advantages in diagnosis and surgical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives:<\/jats:title>\n                    <jats:p>This study aimed to assess the reliability of pediatric OSA evaluation by determining inter-examiner agreement among pediatric dental specialists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Conducted at the Department of Pediatric Dentistry, PMS College of Dental Science and Research Hospital (2023-2024), this observational study utilized conventional consulting rooms, headlights, and examination chairs. Thirteen medical practitioners reviewed video recordings of the oropharyngeal regions of twelve pediatric patients exhibiting mouth breathing. Friedman staging was determined based on tonsil size and tongue position gradings.Inter-examiner agreement was evaluated using Fleiss kappa analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Observers, including residents and practitioners in pediatric dentistry, demonstrated poor agreement regarding FTP and tonsil grading.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Understanding the nuances of tonsil size and FTP in pediatric OSA evaluation, along with identifying avenues for refinement, can enhance medical decision-making among healthcare providers, including pediatric dentists.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jisppd.jisppd_85_24","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T05:01:40Z","timestamp":1719982900000},"page":"91-97","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Interexaminer agreement among pediatric dental specialists in assessment of tonsil size, Friedman tongue position, and Friedman staging of obstructive sleep apnea in children: An observational study"],"prefix":"10.4103","volume":"42","author":[{"given":"Lekshmy S. R.","family":"Nair","sequence":"first","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sageena","family":"George","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Anandaraj","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Anuja","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. V.","family":"Naveena","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Aishwarya","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"key":"R1-20240905","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1136\/thx.2003.007203","article-title":"Sleep 8:Paediatric obstructive sleep apnoea","volume":"60","author":"Nixon","year":"2005","journal-title":"Thorax"},{"key":"R2-20240905","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1136\/adc.88.12.1043","article-title":"A controlled study of sleep related disordered breathing in obese children","volume":"88","author":"Wing","year":"2003","journal-title":"Arch Dis Child"},{"key":"R3-20240905","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1542\/peds.109.4.704","article-title":"Section on Pediatric Pulmonology Subcommittee on Obstructive Sleep Apnea Syndrome American Academy of Pediatrics Clinical practice guideline:Diagnosis and management of childhood obstructive sleep apnea syndrome","volume":"109","year":"2002","journal-title":"Pediatrics"},{"key":"R5-20240905","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1097\/00005537-200403000-00013","article-title":"Staging of obstructive sleep apnea\/hypopnea syndrome:A guide to appropriate treatment","volume":"114","author":"Friedman","year":"2004","journal-title":"Laryngoscope"},{"key":"R6-20240905","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1016\/S0031-3955(16)36806-7","article-title":"Modern assessment of tonsils and adenoids","volume":"36","author":"Brodsky","year":"1989","journal-title":"Pediatr Clin North Am"},{"key":"R7-20240905","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1093\/sleep\/29.12.1537","article-title":"Prediction of uvulopalatopharyngoplasty outcome:Anatomy-based staging system versus severity-based staging system","volume":"29","author":"Li","year":"2006","journal-title":"Sleep"},{"key":"R8-20240905","doi-asserted-by":"crossref","first-page":"181","DOI":"10.4103\/jisppd.jisppd_226_23","article-title":"Knowledge, attitude, and practice regarding different domains of pediatric obstructive sleep apnea among pediatric dentists from Kerala:A cross-sectional study","volume":"41","author":"Nair","year":"2023","journal-title":"J Indian Soc Pedod Prev Dent"},{"key":"R11-20240905","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1177\/0194599812473413","article-title":"Diagnostic value of the Friedman tongue position and Mallampati classification for obstructive sleep apnea:A meta-analysis","volume":"148","author":"Friedman","year":"2013","journal-title":"Otolaryngol Head Neck Surg"},{"key":"R12-20240905","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1093\/sleep\/29.7.903","article-title":"Physical examination:Mallampati score as an independent predictor of obstructive sleep apnea","volume":"29","author":"Nuckton","year":"2006","journal-title":"Sleep"},{"key":"R13-20240905","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.otohns.2008.06.017","article-title":"Interexaminer agreement of Friedman tongue positions for staging of obstructive sleep apnea\/hypopnea syndrome","volume":"139","author":"Friedman","year":"2008","journal-title":"Otolaryngol Head Neck Surg"},{"key":"R14-20240905","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1007\/s00405-018-4970-z","article-title":"Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection","volume":"275","author":"Sundman","year":"2018","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"R15-20240905","first-page":"p. 664","article-title":"Pediatric Airway Assessment","journal-title":"The Reference Manual of Pediatric Dentistry; 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