Collaboration with physicians is key to the success of dental sleep medicine. In order to be an effective treatment for obstructive sleep apnea, oral appliance therapy relies upon cooperation between board-certified sleep medicine physicians and qualified dentists who have the necessary knowledge and technical skill to provide high-quality care for patients with sleep-disordered breathing.
It cannot be emphasized enough that dentists and doctors must collaborate from the start. If a dentist identifies that a patient is at risk for sleep apnea, then the patient needs to be referred to a board-certified sleep physician for a consultation. The physician will determine if the patient needs to be evaluated through polysomnography, which is an overnight sleep study at a sleep disorders center, or a home sleep apnea test.
If the physician diagnoses the patient with obstructive sleep apnea, then the leading treatment options are continuous positive airway pressure (CPAP) therapy and oral appliance therapy. After a physician prescribes an oral appliance, the device should be custom-fabricated and fit by a qualified dentist who has clinical competence and experience in dental sleep medicine.
The Medical Environment
By providing oral appliance therapy, a dentist is entering a medical environment. Therefore, a dentist-physician team approach is essential. Because sleep apnea is a medical condition, a physician must make the diagnosis. Furthermore, dentists’ sleep apnea patients must be under the direct care of a physician throughout the treatment process.
Sleep apnea is associated with an increased risk of numerous health complications that require ongoing physician supervision, including hypertension, cardiovascular disease, and type 2 diabetes. Dentists need to understand that communication with physicians about treatment progress is a basic requirement in helping to provide optimal patient care. Dentists also should verify that their patients return to see their sleep physician for regular follow-up assessments.
The entire field of dental sleep medicine, including the dentist-physician partnership, is rooted securely in evidence-based practices. The American Academy of Sleep Medicine (AASM), which represents physicians and other medical professionals dedicated to sleep medicine, and the American Academy of Dental Sleep Medicine (AADSM), the only nonprofit professional association dedicated exclusively to the practice of dental sleep medicine, issued the joint Clinical Practice Guideline for Oral Appliance Therapy in July 2015 to guide the successful administration of oral appliance therapy.
Most significantly, the clinical guideline defines the interaction between the dentist and sleep physician to ensure an effective, working relationship that involves teamwork from the outset. The patient care model outlined in the Clinical Practice Guideline for Oral Appliance Therapy—evaluation and diagnosis by physicians and collaborative treatment involving dentists—helps ensure the highest quality of care for patients.
Expanding Your Practice
In addition to being a key to the provision of optimal patient care, the collaborative approach also can help dentists expand their practice. Sleep physicians recognize dentists’ role in treating sleep-disordered breathing, and they seek qualified dentists who can demonstrate a commitment to obtaining sleep-related continuing education, fabricating and adjusting oral appliances with proficiency, and understanding the value of teamwork. To be an excellent dental sleep medicine practitioner, dentists must make it a priority to seek continuing education opportunities and ensure that their skills are known in the medical community.
Dentists who want to provide sleep solutions to their patients can rely on professional associations to equip them with the needed qualifications and connections. The AADSM gives its member dentists access to educational resources, practice management support, and networking opportunities. The AADSM also works constantly to further the practice of dental sleep medicine nationwide by fostering high standards of care and positioning member dentists as instrumental to any sleep medicine team.
Ultimately, a collaborative, referral-based relationship between a board-certified sleep medicine physician and a qualified dentist provides the best avenue for treating a sleep apnea patient with oral appliance therapy.
Dr. Smith is the president of the AADSM and the clinical director of Dental Sleep Medicine of Indiana. He also serves as the dental consultant to the major Indianapolis hospital sleep disorder centers and is on the faculty at Indiana University School of Medicine’s Fellowship program in sleep medicine. As a distinguished speaker and American Board of Dental Sleep Medicine (ABDSM) Diplomate, he also is a Fellow of the American College of Dentists and is an active member of the AASM, ADA, Indiana Dental Association, Indianapolis District Dental Society, and AGD. He is a graduate of the Indiana University School of Dentistry. And, Dr. Smith served as president of the AADSM from 2002 to 2004, received the AADSM Distinguished Service Award in 2006, and acted as president of the ABDSM from 2008 to 2010.