ABDSM cheat sheet

STOP-BANG: 3 or more positive items indicates high OSA risk; scores 5 or more indicate high perioperative risk.

Berlin Questionnaire screens via 3 categories: snoring/witnessed apnea, daytime sleepiness, and hypertension/BMI; 2 or more positive categories = high risk.

Epworth Sleepiness Scale: 0-10 normal, 11-12 mild, 13-15 moderate, 16-24 severe excessive daytime sleepiness.

Excessive daytime sleepiness plus high-risk screen warrants referral for diagnostic sleep testing before appliance therapy.

Mandibular advancement is contraindicated in insufficient periodontal support, active caries, and inadequate tooth count for retention.

Minimum retention typically requires 6-8 teeth per arch with healthy periodontium; fewer teeth may still allow therapy with careful design.

Temporomandibular disorder symptoms (joint noise, pain, limited opening) require evaluation and documented baseline before appliance therapy.

Nasal obstruction reduces CPAP tolerance and can limit oral appliance effectiveness; evaluate patency and refer when indicated.

Body mass index, neck circumference, and Mallampati score are predictors of OSA severity and influence treatment selection.

Apnea: 90% or greater airflow reduction for at least 10 seconds; hypopnea: 30% or greater reduction with 3% or greater desaturation or an arousal.

AHI = total apneas plus hypopneas divided by total sleep time in hours; AHI 5-15 mild, 15-30 moderate, greater than 30 severe.

OSA diagnosis requires AHI 5 or greater with symptoms, or AHI 15 or greater regardless of symptoms.

Central apnea: absent airflow with absent respiratory effort; obstructive apnea: absent airflow with continued effort.

Oxygen desaturation index (ODI) counts desaturation events per hour and correlates with AHI but is not diagnostic alone.

Home sleep apnea test is valid for suspected moderate-to-severe OSA in adults without major cardiopulmonary comorbidity.

In-lab polysomnography is indicated for suspected central apnea, comorbid heart failure, severe COPD, or non-diagnostic home testing.

RERA: increasing respiratory effort leading to arousal without meeting apnea or hypopnea criteria; contributes to UARS.

Supine AHI can be markedly higher than non-supine AHI; positional OSA affects appliance and treatment planning.

Mandibular advancement device (MAD) protrudes the mandible to enlarge the pharyngeal airway; tongue-retaining devices (TRD) hold the tongue forward.

MADs are first-line for mild-to-moderate OSA and for CPAP-intolerant patients with moderate-to-severe OSA.

Effective protrusion is typically 50-70% of maximum mandibular protrusion; titration begins at 60-70% of that target.

Vertical opening should be minimized to reduce posterior mandibular rotation and airway narrowing while allowing adequate coupling.

Bite registration records maximum protrusion and vertical dimension; a George Gauge or equivalent records protrusive position.

Bilateral balanced contacts in the registration position reduce occlusal loading and prevent unintended tooth movement.

Custom titratable devices outperform non-titratable or thermoplastic devices in efficacy and adherence.

Appliance material choice (hard acrylic, dual laminate, flexible) affects durability, retention, and occlusal wear.

Post-insertion occlusal changes include reduced overjet and overbite; baseline cephalometric or occlusal records document change.

Titration advances the mandible in small increments (typically 0.25-0.5 mm per step) over weeks until symptoms resolve or efficacy is confirmed.

Objective efficacy is confirmed by follow-up sleep testing showing AHI reduction, often defined as AHI less than 5 or a 50% or greater reduction.

Initial follow-up occurs within 1-4 weeks of delivery to check comfort, retention, and tissue response.

Adherence is assessed by patient report, device wear time, and symptom control; MAD adherence is often defined as 4 or more nights per week.

Common side effects include salivation, dry mouth, tooth discomfort, and morning jaw soreness; most resolve within weeks.

Persistent pain, bite change, or TMJ symptoms warrant reducing advancement or revising the appliance.

Periodic reassessment (at least annually) monitors occlusal changes, appliance integrity, and continued efficacy.

Combination therapy with CPAP or positional therapy may be needed when MAD alone does not achieve target AHI.

Baseline dental records for appliance therapy include periodontal charting, caries assessment, occlusion, and TMJ evaluation.

Informed consent documents risks of occlusal change, tooth movement, TMJ symptoms, and the need for ongoing monitoring.

Adequate salivary flow and periodontal health support appliance tolerance; xerostomia increases caries and retention problems.

Appliance hygiene: daily cleaning and periodic professional evaluation reduce microbial load and tissue irritation.

Occlusal changes from long-term MAD use include mesial drift, reduced overjet/overbite, and anterior open bite tendencies.

Screening for dental contraindications includes unrestored caries, advanced periodontal disease, and inadequate abutment teeth.

Bruxism may increase appliance wear and fracture risk; night guards are not substitutes for advancement devices.

Record keeping includes photographs, mounted casts or digital scans, and bite registration to document baseline and change.

Dental sleep medicine practice requires physician diagnosis of OSA; dentists screen and treat but do not diagnose.

Collaboration model: physician orders sleep testing and diagnosis, dentist fabricates and titrates the appliance, physician reviews efficacy.

Objective follow-up testing after appliance titration confirms efficacy and supports documentation for the medical record.

Reimbursement often requires a physician diagnosis, documented AHI, and evidence of CPAP intolerance or patient preference.

Scope of practice varies by jurisdiction; dentists must confirm local regulations before providing appliance therapy.

Communication with the sleep physician includes appliance type, advancement achieved, and follow-up test results.

Documentation should include screening results, referral, diagnosis, device design, titration record, and adherence notes.

Patient education covers device use, cleaning, expected side effects, and the need for periodic reassessment.

STOP-BANG: 3 or more positive items indicates high OSA risk; scores 5 or more indicate high perioperative risk.

Berlin Questionnaire screens via 3 categories: snoring/witnessed apnea, daytime sleepiness, and hypertension/BMI; 2 or more positive categories = high risk.

Epworth Sleepiness Scale: 0-10 normal, 11-12 mild, 13-15 moderate, 16-24 severe excessive daytime sleepiness.

Excessive daytime sleepiness plus high-risk screen warrants referral for diagnostic sleep testing before appliance therapy.

Mandibular advancement is contraindicated in insufficient periodontal support, active caries, and inadequate tooth count for retention.

Minimum retention typically requires 6-8 teeth per arch with healthy periodontium; fewer teeth may still allow therapy with careful design.

Temporomandibular disorder symptoms (joint noise, pain, limited opening) require evaluation and documented baseline before appliance therapy.

Nasal obstruction reduces CPAP tolerance and can limit oral appliance effectiveness; evaluate patency and refer when indicated.

Body mass index, neck circumference, and Mallampati score are predictors of OSA severity and influence treatment selection.

Apnea: 90% or greater airflow reduction for at least 10 seconds; hypopnea: 30% or greater reduction with 3% or greater desaturation or an arousal.

AHI = total apneas plus hypopneas divided by total sleep time in hours; AHI 5-15 mild, 15-30 moderate, greater than 30 severe.

OSA diagnosis requires AHI 5 or greater with symptoms, or AHI 15 or greater regardless of symptoms.

Central apnea: absent airflow with absent respiratory effort; obstructive apnea: absent airflow with continued effort.

Oxygen desaturation index (ODI) counts desaturation events per hour and correlates with AHI but is not diagnostic alone.

Home sleep apnea test is valid for suspected moderate-to-severe OSA in adults without major cardiopulmonary comorbidity.

In-lab polysomnography is indicated for suspected central apnea, comorbid heart failure, severe COPD, or non-diagnostic home testing.

RERA: increasing respiratory effort leading to arousal without meeting apnea or hypopnea criteria; contributes to UARS.

Supine AHI can be markedly higher than non-supine AHI; positional OSA affects appliance and treatment planning.

Mandibular advancement device (MAD) protrudes the mandible to enlarge the pharyngeal airway; tongue-retaining devices (TRD) hold the tongue forward.

MADs are first-line for mild-to-moderate OSA and for CPAP-intolerant patients with moderate-to-severe OSA.

Effective protrusion is typically 50-70% of maximum mandibular protrusion; titration begins at 60-70% of that target.

Vertical opening should be minimized to reduce posterior mandibular rotation and airway narrowing while allowing adequate coupling.

Bite registration records maximum protrusion and vertical dimension; a George Gauge or equivalent records protrusive position.

Bilateral balanced contacts in the registration position reduce occlusal loading and prevent unintended tooth movement.

Custom titratable devices outperform non-titratable or thermoplastic devices in efficacy and adherence.

Appliance material choice (hard acrylic, dual laminate, flexible) affects durability, retention, and occlusal wear.

Post-insertion occlusal changes include reduced overjet and overbite; baseline cephalometric or occlusal records document change.

Titration advances the mandible in small increments (typically 0.25-0.5 mm per step) over weeks until symptoms resolve or efficacy is confirmed.

Objective efficacy is confirmed by follow-up sleep testing showing AHI reduction, often defined as AHI less than 5 or a 50% or greater reduction.

Initial follow-up occurs within 1-4 weeks of delivery to check comfort, retention, and tissue response.

Adherence is assessed by patient report, device wear time, and symptom control; MAD adherence is often defined as 4 or more nights per week.

Common side effects include salivation, dry mouth, tooth discomfort, and morning jaw soreness; most resolve within weeks.

Persistent pain, bite change, or TMJ symptoms warrant reducing advancement or revising the appliance.

Periodic reassessment (at least annually) monitors occlusal changes, appliance integrity, and continued efficacy.

Combination therapy with CPAP or positional therapy may be needed when MAD alone does not achieve target AHI.

Baseline dental records for appliance therapy include periodontal charting, caries assessment, occlusion, and TMJ evaluation.

Informed consent documents risks of occlusal change, tooth movement, TMJ symptoms, and the need for ongoing monitoring.

Adequate salivary flow and periodontal health support appliance tolerance; xerostomia increases caries and retention problems.

Appliance hygiene: daily cleaning and periodic professional evaluation reduce microbial load and tissue irritation.

Occlusal changes from long-term MAD use include mesial drift, reduced overjet/overbite, and anterior open bite tendencies.

Screening for dental contraindications includes unrestored caries, advanced periodontal disease, and inadequate abutment teeth.

Bruxism may increase appliance wear and fracture risk; night guards are not substitutes for advancement devices.

Record keeping includes photographs, mounted casts or digital scans, and bite registration to document baseline and change.

Dental sleep medicine practice requires physician diagnosis of OSA; dentists screen and treat but do not diagnose.

Collaboration model: physician orders sleep testing and diagnosis, dentist fabricates and titrates the appliance, physician reviews efficacy.

Objective follow-up testing after appliance titration confirms efficacy and supports documentation for the medical record.

Reimbursement often requires a physician diagnosis, documented AHI, and evidence of CPAP intolerance or patient preference.

Scope of practice varies by jurisdiction; dentists must confirm local regulations before providing appliance therapy.

Communication with the sleep physician includes appliance type, advancement achieved, and follow-up test results.

Documentation should include screening results, referral, diagnosis, device design, titration record, and adherence notes.

Patient education covers device use, cleaning, expected side effects, and the need for periodic reassessment.