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Sleep Apnea in Dentistry: The Business of Treating the Disorder

Dentists are well-positioned to help patients with obstructive sleep breathing, however, if they’re thinking adding appliance-based therapy to their practices will create another profit center, they need to think again. Experts say effective sleep therapy happens when dentists commit themselves to being properly educated on the condition. It also requires collaboration with physicians – something that hasn’t happened historically in dentistry.
Ed Rabinowitz
PUBLISHED: Wednesday, April 26, 2017
Dentists are well-positioned to help patients with sleep apnea. However, they must prioritize educating themselves on the condition and working closely with physicians.

Late-night parties, exam-cramming, or Netflix marathons that extend into the wee hours of the morning may be why so many patients seem ready to doze off in the operatory — or not. Instead, it could very well be obstructive sleep apnea that’s to blame.
The Mayo Clinic defines obstructive sleep apnea (OSA) as “a potentially serious sleep disorder” that “causes breathing to repeatedly stop and start during sleep.” And it’s far from rare: According to the American Academy of Sleep Medicine (AASM), more than 25 million American adults have OSA. Harold Smith, D.D.S., president of the American Academy of Dental Sleep Medicine (AADSM), estimates that 20 percent of a dentist’s general practice is composed of patients with undiagnosed OSA.
RELATED: More Sleep Apnea Coverage
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“If a dentist is oriented to looking and screening for OSA, he’s going to be a very productive dentist in helping his patients have better qualities of life, catching serious comorbidities early, and possibly saving a life or two along the way,” Smith says.
Smith recalls that in 1993, the field of dental sleep medicine was in its infancy. There were no studies or evidence-based literature for dentists to rely on. Education was anecdotal, based mostly on talking to practitioners who had begun treating patients. But over the last 25 years, Smith says, there has been “a virtual explosion” of literature, evidence-based studies, and clinical trials.
“We’ve come a very long way,” he says. “We’ve come to the point where oral appliance therapy is recognized as a viable option” for treating adult patients with OSA who are intolerant of continuous positive airway pressure (CPAP) therapy.
Oral appliance therapy features a custom-fit oral sleep appliance that fits into a patient’s mouth, much like a sports mouth guard or an orthodontic retainer. It supports the jaw in a forward position to help maintain an open upper airway.
Medical studies have helped physicians understand that oral appliance therapy is a modality of treatment they can consider for patients who are diagnosed with OSA. But what has lagged, says former AADSM president B. Gail Demko, D.M.D., with Sleep Apnea Dentists of New England in Weston, Massachusetts, is an adequate number of educated dentists to fill the need physicians are creating.
Demko explains that OSA treatment is not an extension of what dentists learn in school. Crafting an appliance might be, but by engaging in oral appliance therapy, dentists are treating a medical disease, which falls outside of the typical dentist’s comfort zone.
“It’s incumbent upon us to understand that disease at the level of the physician, and dentists aren’t used to that,” Demko explains. “Any dentist can make one of these devices, but that isn’t the issue. The issue is understanding when to use them, when not to use them, and how the medical concerns of the patient play into it.”
Smith echoes those thoughts. OSA is not the usual type of profit center dentists bring into their general practice. Continuing education for many dentists, Smith explains, is going to a weekend course in periodontics, picking up a few pearls and bringing them back to their practice, and on Monday morning putting those pearls to use.
“Dental sleep medicine is an entirely different thing,” Smith says. “Dentists need to understand that obstructive sleep apnea and snoring are medical conditions, and we as dentists are treating these medical conditions. So the important thing for dentists to understand is they must be a valued part of the medical team in their community. And to become a valued part, you need to be properly educated.”
Story continues on the next page.

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