Guidelines for treatment of sleep apnea with oral appliance therapy

In the first official joint guideline from the American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM), oral appliance therapy is recommended for the treatment of adult patients with obstructive sleep apnea (OSA) who are intolerant of continuous positive airway pressure (CPAP) therapy or prefer alternate therapy.

This AASM and AADSM guideline supports increased teamwork between physicians and dentists to achieve optimal treatment of patients with OSA. While their recommendations were published in 2015, it is important that we make sure we are familiar with them. Their recommendations are vital to our care for our patients with sleep apnea.

The AASM and AADSM have six recommendations for dentists to follow.

  1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD)
  2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE)
  3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD)
  4. We suggest that qualified dentists provide oversight—rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE)
  5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE)
  6. We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits—as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE)

For more information on their recommendations, such as the summary for each, download the document. I hope this helps moving forward for a better understanding of what the AASM and AADSM recommend for treatment of sleep apnea with oral appliance therapy.  

3 dental sleep medicine courses to start 2019 with

As with every New Year, we always want to start with our best foot forward. I know it is only November, but now is the time to get started on your preparation for 2019. If you start now, you can get the best deals on airfare (if needed) and hotels.

Here are three dental sleep medicine courses to attend in the first couple months of 2019.

January 25-26 in Jupiter, Florida. The topic is TMJ for the Dental Sleep Medicine Practice. In this lecture we will take a look at the connection between TMD and sleep apnea. With 36 states now mandating TMD coverage in health care plans, it is important to understand how to incorporate these services into your practice. A dental professional is the primary care provider for TMJ dysfunction because they are capable of significantly improving the quality of life and overall health of these patients. And in the realm of dental sleep medicine, the American Academy of Sleep Medicine practice parameters for OSA put the responsibility clearly on dentists to catch and treat TMD problems in sleep apnea patient follow-up exams. Sign up for this course to gain step-by-step guidance on identifying, diagnosing and implementing TMD treatment.

February 8-9 in Atlanta, Georgia. If you have not already attending the first three sessions, this might not be for you. However, it is a great sleep and pain mini residency. Session 4 is the last of this mini-residency 2. The program is designed to give dental practices the knowledge and guidance to fully incorporate obstructive sleep apnea treatment into their practice. It also aims to help dentists overcome obstacles in order to grow and flourish in dental sleep medicine.

March 8-9 in Atlanta, Georgia. This is the third installment of the Sleep and Pain Mini Residency. If you weren’t able to sign up for the previous sessions, now is the time to sign up for session one! This is a 4-part, 64 CE credit program led by Dr. Mayoor Patel and Dr. Terry Bennett. By attending this mini-residency series you will learn about dental sleep medicine with an emphasis on hands-on and practical learning. Dentists will gain the skills and confidence they need to incorporate sleep apnea treatment into their practice successfully.

To learn more about upcoming lectures, please visit http://mpateldds.com/upcoming-lecture/. I look forward to seeing you an an upcoming lecture or mini-residency!

Dental sleep medicine mini-residencies: Prepare for 2019

To help you better serve your patients and provide advanced care in your dental office, mini-residencies might be just what you need. For 2019, make the most of your year by signing up for dental sleep medicine mini-residencies. These residency series are a 4-part, 64 CE credit programs that provide a completely comprehensive educational experience for implementing dental sleep medicine in your dental practice.

Mini-residency overview

These sessions are taught by leading educators in dental sleep medicine, Mayoor Patel, DDS, MS, and Terry Bennett, DMD. Each course will emphasize hands-on and practice learning. Dentists who attend these sessions will gain the skills and confidence you need to incorporate sleep apnea treatment into practice successfully.

Dentists will receive two sleep apnea oral appliances and will go through the entire experience of examination, impression and bite registrations, appliance delivery and fitting, and follow-up/calibration exams. There is also an opportunity to shadow an American Academy of Sleep Medicine accredited sleep lab throughout the program.

After each session dentists will be given homework assignments to complete, but don’t worry, these won’t be too hard. The assignments will include literature to read and cases to prepare. Team members will also be given tasks to work on, including communication scripts and physician outreach goals.

At the end of the fourth session, each dental practice should feel confident in their ability to:

  • Treat obstructive sleep apnea patients.
  • Have referral networks in place.
  • Medical insurance reimbursement implemented.
  • Ready for various dental sleep medicine accreditation programs.

Sign up for our dental sleep medicine mini-residency programs in 2019. We look forward to seeing you at an upcoming lecture!

Team-based care works in dental sleep medicine

Just like any sporting event, teamwork means success. While you won’t be choosing a whole roster, you will need to find  a sleep physician to work with. Collaboration with a sleep physician allows your office to generate a diagnosis for your patient while also receiving referrals for sleep apnea treatment. Let’s learn more about this team-based care approach to treating sleep apnea.

Receive a diagnosis. This is important to note. Dentists DO NOT diagnose–it is important to remember you need a diagnosis from a sleep physician before beginning treatment. By building a rapport with a sleep physician you can send your patients their way for a proper diagnosis. Begin now by introducing yourself, and providing information about what you know and services you offer your patients–the more they know the better.

Receive referrals. Many are unaware of the availability of oral appliance therapy, which often is the same for many sleep physicians. By not only educating your patients, but sleep physicians, too, you can begin receiving referrals to your office. As you know, mild to moderate sleep apnea can often be treated with oral appliance therapy.

Physicians who understand oral appliance therapy can frequently refer patients to your office for proper care when CPAP therapy is not working or the patient doesn’t want to utilize a CPAP machine. It can also be beneficial for combination therapy with both the oral appliance and the CPAP machine.

To learn more about building a relationship with a sleep physician, sign up for an upcoming lecture, or schedule a consultation and shadowing options. Together we can improve your service offerings.