Dental Sleep Medicine and NICE guidelines Professor Ama Johal. Episode 148. May 18th 2022

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Farooq Ahmed

Dental Sleep Medicine and NICE guidelines Professor Ama Johal

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Obstructive sleep apnoea –

  • Sleep related breathing disorder
  • Poorly understood
  • 70% collapse retroglossal area
  • Stops breathing
  • Body movement occurs – body tries to wake patient up as suffocating
    • = disturbed sleep


Health consequences

  • Day time sleepiness
  • Hypertension, heart disease, stroke – all stroke patients screened for OSA



  • Severe / mod- gold standard Continuous positive airway pressure CPAP
    • Filters air and pushes at high force
    • To be effective 4-6 hours, 7 days a week – NOT curative
    • Compliance / adherence 30%


NICE guidelines 2021

  • Symptomatic receive CPAP
  • if not comply then if a person Mandibular Advancement Splint
  • Require good dental and periodontal health
  • Age 18 +


MAS appliance

  1. Anatomical – increase size of pharyngeal airway
    1. Mandible move forwards, tongue advances with it
      1. Post lingual – Best impact of patients who have tongue contribution to collapse 70% of patients
    2. Reduces airway collapsibility
    3. Physiological role – stimulate dilation of upper airway muscle – improving muscle strength and control


MAS appliance

semi customised Vs customised

Johal 2018 S/R

  • Overall effects better with customised Vs semi customised
    • AHI 3
    • Daytime sleepiness 1
    • Self reported wear: 7 Vs 3 nights per week
    • Pt preference 95% prefer customised to semi-customised


Ideal design features  customised Johal 2018

  • Good retention – customised
  • Semi adjustable – incremental advancement
    • Allowing for further advancement and slow increase in airway
  • Full occlusal coverage
  • Minimal vertical opening

In high angle cases clockwise rotation of mandible – compresses post-palatal area and worsens airway IF increase vertical opening. Minimal occlusal opening prevents clockwise rotation



Follow up long term

  • Unwanted occlusal change
    • Mesial molar movement
    • Reduction of OJ and OB approx. 1mm
    • Proclination of 1mm lower incisors


Thank you to the sponsors who have allowed the podcast to continue, Triple O, Orthocare and the Aligner Intensive Fellowship.


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