Dental Sleep Medicine and NICE guidelines Professor Ama Johal

Join me for a summary looking at Dental Sleep Medicine and NICE guidelines. This summary describes obstructive sleep apnoea and the new guidelines of its management. There is a focus on the Mandibular Advancement Splint and the occlusal outcomes for patients using this appliance. This lecture was given by Professor Ama Johal. Ama is a member of the advisory committee to NICE sleep apnoea/hypopnoea syndrome

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
o = 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
o Filters air and pushes at high force
o To be effective 4-6 hours, 7 days a week – NOT curative
o 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
a. Mandible move forwards, tongue advances with it
i. 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
o 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
o 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
o Mesial molar movement
o Reduction of OJ and OB approx. 1mm
o 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.

Subscribe to get summary podcasts and blogs in orthodontics

свернуть