AADSM President Reports on Growth, Significance of Dental Sleep Medicine Research

Harold A. Smith, DDS, discusses recent advances in oral appliance therapy.

By Peter Blais, RPSGT

For more than two decades, a growing wealth of research has confirmed the effectiveness of oral appliance therapy for treating obstructive sleep apnea (OSA) and, therefore, has significantly advanced dental sleep medicine, according to American Academy of Dental Sleep Medicine (AADSM) president Harold A. Smith, DDS.

“Research that demonstrates efficacy continues to help raise awareness and acceptance of oral appliance therapy among sleep physicians, patients, and payors,” Smith says. “Most notably, this results-driven growth has proven the value of oral appliance therapy to sleep physicians, leading to a collaborative treatment approach.

“Dentists and sleep physicians work much more closely now to help ensure that patients understand the process for diagnosis, treatment options, and the roles of their care providers. The success of oral appliance therapy as a treatment is reliant upon the success of the medical team approach—and research has helped establish this necessary collaboration between sleep physicians and qualified dental sleep medicine practitioners as standard practice.

“This teamwork among qualified dentists and sleep physicians guides the successful administration of oral appliance therapy and provides the best care for sleep apnea patients. Ultimately, research has paved the way for the overall advancement of dental sleep medicine through a more collaborative treatment environment and improved patient care.

AADSM supports research through several initiatives, Smith notes, such as the academy’s annual research awards competition and via the Journal of Dental Sleep Medicine, an online quarterly that offers original scientific investigations related to dental sleep medicine and sleep-disordered breathing, as well as case studies, literature reviews, and clinical commentaries. It also hosts the Annual Meeting as a way to exchange ideas, promote research and prepare members for the latest clinical challenges and changing healthcare landscape. The 2017 AADSM Annual Meeting will be held in Boston from June 2-4, 2017.

In addition, AADSM works to advance the dentist’s role in the treatment of sleep-disordered breathing through the development of research-supported practice standards. In response to the increasing need to identify the oral appliance features that are fundamental to treatment success, AADSM established the empiric definition of an effective oral appliance, with an emphasis on an oral appliance’s purpose, physical features, and function. The purpose of the definition is to foster consistency for both research and clinical practice, as well as establish the groundwork to guide future oral appliance research and effective OSA treatment. The definition and full review paper were published in the inaugural issue of the Journal of Dental Sleep Medicine in April 2014.

In June 2015, the AADSM and American Academy of Sleep Medicine (AASM) released the joint Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy in order to provide the best patient care and guide the successful administration of oral appliance therapy. The guideline updates the practice parameters published by the AASM in 2006 and supports evidence-based best practices in dental sleep medicine.

To develop the guideline, the AADSM and AASM commissioned a task force to perform an extensive review of the scientific literature to draft recommendations and supporting text. After a public comment period, the revised guideline was approved by the board of directors of both academies. Essentially, the six practical recommendations substantiate the effectiveness of oral appliance therapy, suggest best practices for administering treatment, and define the roles for both dentists and physicians in the patient care continuum.

Most recently, the AADSM announced its first research award program, in partnership with the American Sleep Medicine Foundation (ASMF). The goal of the program is to foster research and advance the field of dental sleep medicine by supporting applications focused on specific areas where research findings are limited.

Harold Smith, DDS

Given the increase in substantiating research, Smith was asked if insurance companies are just as likely to cover oral appliance therapy as they are CPAP machines?

“Most medical insurers, including Medicare, now cover oral appliance therapy, as they would a CPAP machine, if the patient has been diagnosed by a physician with OSA,” Smith says.”Prior to treatment, insurers typically require the patient to have an evaluation by a physician and a sleep study or home sleep apnea test. Then, the oral appliance must be ordered by the treating physician following review of the sleep study report. The guidelines for medical coverage are published online by all major medical insurers.

“As dental sleep medicine grows, payors and referrers are looking for proof of skill from dentists who practice dental sleep medicine in order to substantiate reimbursement for oral appliance therapy. Recognized designations in dental sleep medicine, such as American Board of Dental Sleep Medicine (ABDSM) Diplomate status and AADSM Dental Sleep Medicine Facility Accreditation, will become critical for dentists when working with payors and building their practice. The AADSM also has established the Qualified Dentist designation as an entry-level distinction for dentists who are working toward earning certification in dental sleep medicine or becoming the dental director of an accredited facility.”

Smith notes current dental sleep medicine research focuses largely on the overall efficacy of oral appliance therapy using different types of appliances and in a variety of patient populations. Research also has begun to focus on various treatment outcomes in addition to breathing during sleep, such as blood pressure control and quality of life.

The joint AADSM and AASM clinical practice guideline identified numerous unresolved issues that should be addressed by future research, he concludes. These include the need for a consistent and objective measure of snoring, standard protocols to document adverse effects related to oral appliances, and randomized controlled trials to compare objective oral appliance therapy adherence data with that of CPAP therapy. Furthermore, additional research support is needed for studies that assess the long-term outcomes associated with oral appliance therapy, conduct head-to-head comparisons of different devices, identify predictive factors for treatment success, and compare the cost-effectiveness of oral appliance therapy with CPAP therapy.