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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

First, dental patients must receive a diagnosis from a physician.

Patients with OSA must first be diagnosed by a physician, and the patient can then be referred to a dentist. But dentists can play an important primary role in terms of screening. Smith points out that a dentist often sees a patient more frequently than does that patient’s primary care physician.
“Standard care for every patient who comes into a dental office for an examination is an oral cancer screening,” he says. “And an extension of that … is screening for obstructive sleep apnea.” During an oral cancer screening, a dentist can look for the anatomical markers that are fairly common in most OSA patients.
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He cautions, too, that it’s important not to pre-judge patients. “All of us have patients who you would never think have sleep apnea because they’re fit, thin, active and young,” Smith says. “But anatomically, their airway closes at night.”
Demko is also an advocate for screening, favoring a method called the STOP-Bang Sleep Apnea Questionnaire that’s used by physicians. It takes into account a range of criteria, including snoring, fatigue, blood pressure, and body mass index.
“There are no studies supporting that a physical examination of a crowded oral pharynx leads to sleep apnea,” Demko says. “But the STOP-Bang Questionnaire is highly indicative of obstructive sleep apnea, and it’s used by anesthesiologists screening patients prior to general anesthesia.”
In July 2015, the AASM and the AADSM issued the first joint clinical practice guidelines for oral appliance therapy. The guidelines are a pathway for sleep physicians and dentists to work together to treat OSA.
It’s not the only collaborative effort underway. In February, the AASM held Sleep Medicine Trends 2017 in Phoenix, Arizona, and dentists were invited to collaborate with physicians in a day-and-a-half workshop, “Oral Appliance Therapy: A Model for Physician-Dentist Collaboration.” Demko was one of the participants.
“It was huge,” she says of the first-of-its-kind collaborative workshop. “The more that  physicians understand that we are there to give them another modality for treating their patients that may be more acceptable, more comfortable, and that improves compliance, the better.”
Demko notes that in Europe, about half of all patients with mild to moderate sleep apnea receive oral appliances as a first-line therapy. “It’s nowhere near that in this country because physicians give us two pushbacks,” she explains. First, physicians worry that dentists may not understand the fine points of adjusting devices, as well as the related medical aspects. Second, they’re afraid of losing patients to dental offices, and that patients won’t return for proper follow-up.
It’s up to the dentist to allay physicians’ fears, says Demko. “In the past dentists haven’t been playing as team members,” she admits. “And I think now with Trends, where the AASM is giving us a true chance to come in and be a part of the team on an equal standing with physicians, that’s going to make a huge difference in how physicians perceive oral appliance therapy.”
Story continues on the next page.

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