Look Before You Leap… The Treatment of Snoring and Obstructive Sleep Apnea

 By Gail Demko, DMD

Sleep Apnea and CPAP

All medical and dental professionals are looking for ways to offset decreases in reimbursement, often by acquiring new skills that allow expansion into previously untapped patient populations. Many dentists have become interested in providing oral device therapy for patients who snore and or have obstructive sleep apnea. All dentists possess the skills required to fabricate oral devices, we learned them in dental school. We are adept at using many different impression materials, adjusting and modifying multiple types of mouthpieces, can analyze occlusal contacts on complete dentures and have a passing knowledge of clonic bruxism and tonic bruxism (clenching).

The treatment of patients with snoring and obstructive sleep apnea requires not only these basic mechanical skills but an understanding of the overall disease process. This is a medical disease with medical complications and comorbidities. Just as untreated caries will lead to endodontic involvement and possible tooth loss, untreated sleep apnea can lead to hypertension, heart attack, stroke or an increased incidence of various cancers. Dentists are fully in control of treating all outcomes of the carious process but we are not trained to deal with the severe medical outcomes of untreated sleep apnea.

You must understand that we are part of the medical team. We work with physicians to appropriately treat patients with snoring and sleep apnea. Diagnosis of disease, be it snoring or sleep apnea, lies within the arena of medicine, not dentistry (just ask your malpractice insurer). To treat a patient who complains of snoring without appropriate medical consult and medical diagnosis may result in the resolution of snoring without control of the underlying sleep apnea. This patient could go on to suffer heart failure, have a motor vehicle accident or develop hypertension. Resolution of the patient’s symptom of snoring may allow both you and the patient to assume that the underlying sleep disordered breathing has also been controlled; snoring often resolves before there is control of the obstructive sleep apnea. This presumption can be very dangerous to the patient and could have serious consequences for your practice.

Many companies now market legal medical diagnostic sleep testing equipment directly to dentists. The sales rep tells you that this will allow you to “screen” patients in your practice for snoring and sleep apnea. These are not screening devices; these are legal medical diagnostic tools. The standard of care requires evaluation of the patient by medical provider not just remote evaluation of the data obtained through home sleep testing by a physician licensed in your state.

So approach this field in a responsible way. Learn about the diseases of sleep disordered breathing. Understand all available treatment options and know when oral appliance therapy may not be appropriate for the individual patient in your practice.

Treating medical diseases requires that you be part of the team. Physician, surgeon, general dentist, orthodontist, nurse practitioner and respiratory technician: all of these have a part to play. As dentistry evolves and continues to move back in synchrony with medicine it is time to forge new alliances with our medical colleagues to provide improved outcomes for all of our patients.

 

Demko

Dr. Gail Demko started her career in dental treatment of OSA at Beth Israel Deaconess Medical Center in 1989. In 1997, she was the first dentist in the US to limit her practice to the treatment of OSA. She became the expert advisor to the FDA in the area of oral appliance therapy in 2004 and has been active in professional groups for some time. At present , she is President of the AADSM, a member of  the Board of Directors of the Massachusetts Sleep Society, on the editorial board of the Journal of Sleep And Breathing and holds the distinction of having the first certified dental sleep medicine office in New England. She continues to practice full-time in Weston, MA.

 

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