As more physicians and dentists team up to treat obstructive sleep apnea (OSA) patients with oral appliance therapy, there is a need to clarify the best practices for patient-centered care. In response, the American Academy of Dental Sleep Medicine (AADSM) recently published in the Journal of Dental Sleep Medicine its policy statement defining the role of dentists in treating sleep apnea.
“Inter-disciplinary collaboration provides the best avenue for treatment when a patient who has sleep apnea is non-adherent with CPAP therapy,” said Harold A. Smith, DDS, president of the AADSM. “The AADSM wants to help physicians and dentists work together to successfully treat adults who have OSA.”
Two key issues that the AADSM policy statement addresses are OSA diagnosis and educational requirements for dentists.
Physician vs. Dentist Role
In the multidisciplinary model outlined by the AADSM, the physician is principally in charge of the patient’s medical evaluation, diagnosis and long-term management, while the dentist plays a necessary and collaborative part of the treatment team. Dentists should screen patients for sleep apnea by using questionnaires and evaluating the airway, and then referring at-risk patients to a physician. If oral appliance therapy is prescribed by the physician, then the dentist selects, fits and adjusts the oral appliance.
Continued communication between sleep physicians and qualified dentists during follow-up visits also is imperative to confirm efficacy and increase treatment success.
“Without collaborative relationships with physicians, dentists’ efforts to provide an acceptable standard of care are compromised,” said Dr. Smith. “Because OSA is a medical disorder, it must be diagnosed by a physician, and a dentist should provide oral appliance therapy in tandem with a medical counterpart in order to decrease a patient’s vulnerability to the adverse health effects and comorbidities associated with OSA.”
Dental Sleep Medicine Education
In order to bring the expected level of expertise to their physician partnerships, dentists must prepare themselves with the proper dental sleep medicine educational opportunities. The successful delivery of oral appliances requires technical skill, acquired knowledge and judgment regarding outcomes and risks of the therapy, all of which can be acquired through adequate continuing education (CE).
The AADSM recommends that dentists have at minimum: a valid state dental license, proof of liability coverage and at least 25 hours of recognized CE in dental sleep medicine provided by a non-profit organization focused on dental sleep medicine or accredited dental school, within the last two years. Furthermore, the policy statement advocates that all dentists who provide oral appliance therapy should earn the Qualified Dentist designation, which indicates that the dentist has met all minimal requirements outlined above. This designation can be achieved as a dentist works toward becoming board certified by the American Board of Dental Sleep Medicine, the premier credentialing board in the field of dental sleep medicine.
By underscoring the vital importance of the physician-dentist team and the necessity of strong educational requirements, the AADSM policy statement establishes oral appliance therapy as a patient-focused solution that requires a multidisciplinary approach to successfully treat people who have sleep apnea.