Dentist-Physician Collaboration of Utmost Importance

By Peter Blais, RPSGT

Dentists should be thoroughly educated in oral appliance therapy and proper protocols, as well as understand how to work in a medical environment, in order to build a productive collaboration with sleep physicians.

“This is not dentistry. It is dental sleep medicine,” said Harold A. Smith, DDS, the new president of the American Academy of Dental Sleep Medicine (AADSM). “We custom fit a medical device to help patients sleep better. We bill medical insurance. We need to position ourselves as valuable assets to the medical community.”

Only a fraction of patients are being treated for obstructive sleep apnea (OSA). Most patients remain undiagnosed and untreated. Many people think that snoring is just a social issue, but it may indicate OSA. Dentists trained in dental sleep medicine can help identify signs of sleep apnea in their patients. Once symptoms are identified, dentists should advise patients to see a board certified sleep physician for further evaluation, which may possibly include an overnight sleep study for OSA.

“Dentists who want to treat sleep apnea patients need to understand that they will be part of a medical team,” Smith said. “The treatment of sleep apnea with an oral appliance requires the ongoing cooperation of dentist, physician, and patient.”

Developing professional relationships with sleep physicians and sleep lab personnel is extremely important. “Sleep physicians only want to work with qualified dentists,” said Smith. “It is important that dentists demonstrate their credibility, knowledge, and understanding of the field when establishing relationships with medical professionals.”

Smith is also a Diplomate with the American Board of Dental Sleep Medicine. “This is the designation any dentist interested in dental sleep medicine should strive to achieve because it demonstrates expertise in oral appliance therapy.”

Knowledge and follow-up with patients are key. Patients need to understand that treating sleep apnea with oral appliance therapy requires a long-term relationship with their dentist and sleep physician.

“Take the time to educate your patients. Untreated sleep apnea can increase the risk of serious health problems such as stroke, high blood pressure, diabetes and heart disease,” said Smith. “An important thing to remind patients is that oral appliances may need adjustments over time to ensure maximum effectiveness, so making follow up appointments is essential.”

A major step in the growing cooperation between physicians and dentists is the publication of the “Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy” by the American Academy of Sleep Medicine (AASM) and AADSM. This first official joint clinical guideline recommends oral appliance therapy for the treatment of adult patients with OSA who are intolerant of CPAP therapy or prefer alternate therapy, and supports increased teamwork between physicians and dentists to achieve optimal treatment of patients with OSA.

Published online in the July 2015 issues of the Journal of Clinical Sleep Medicine and the Journal of Dental Sleep Medicine, the clinical practice guideline updates the practice parameters that were published by the AASM in 2006. The updated recommendations are based on a systematic review of the relevant scientific literature, which has grown considerably in the past decade.

“The first AADSM and AASM joint clinical guideline is a testament to the importance of dentist-physician relationships in treating OSA with oral appliance therapy,” Smith concluded. “The guideline provides a framework for physician and dentist collaboration that will ultimately benefit patients.”