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

Dental Sleep Medicine and NICE guidelines Professor Ama Johal

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Introduction

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

Treatment

• 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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