The American Dental Association recently came out with a Policy Statement on Breathing Related Sleep Disorders (BRSD) or Sleep Disordered Breathing (SDB). These disorders are often related to smaller jaws, high narrow palates, enlarged tonsils and adenoids and narrowed noses, all of which result in collapsible airways. The ADA recommends that all dentists screen all their patients for BRSD.
Last year, the American College of Prosthodontists published a position paper on Oral Devices for SDB. They recommend screening all patients for sleep disorders prior to fabricating a nightguard or beginning restorative dentistry.
In the statement from the ADA it is recommended that dentists monitor the effectiveness of oral appliance therapy (OAT) with home sleep testing.
“Dentists who provide OAT to patients should monitor and adjust the Oral Appliance (OA) for treatment efficacy as needed, or at least annually. As titration of OAs has been shown to affect the final treatment outcome and overall OA success, the use of unattended cardiorespiratory (Type 3) or (Type 4) portable monitors may be used by the dentist to help define the optimal target position of the mandible. A dentist trained in the use of these portable monitoring devices may assess the objective interim results for the purposes of OA titration. “
This testing is done to insure efficacy of treatment prior to referring the patient back to their sleep MD, cardiologist or internist.
The American Academy of Sleep Medicine (AASM) feels threatened by dentists and has come out with position statements and editorials stating that only a physician can order a HST which should only be evaluated by a board-certified sleep specialist. The American Academy of Dental Sleep Medicine (AADSM) supports titration of oral devices with home monitoring on a state by state basis based on the laws in that state and the position of the state board on AASM’s position on sleep testing.
The dental team is uniquely qualified to recognize the signs and symptoms of SDB and BRSD from snoring to UARS to OSA in both children and adults. These patients are sitting in our chairs and are usually seen at least twice a year in the name of prevention. Many dentists have shifted to an oral systemic focus with an emphasis on Complete Health Dentistry. Opening the airway to manage SDB plays a pivotal role in lowering systemic inflammation and preventing and reversing cardiovascular disease and dementia.
Once the patient has been titrated with an oral device, and snoring and gasping have been alleviated, we evaluate the other chief complaints. These include: unrefreshing sleep, difficulty concentrating, memory problems, irritability, anxiety, depression, bruxism and morning headaches. Once the device has been ideally titrated, a HST or PSG should be recommended.
For convenience in certain states, the dentist can order the HST and share the results with the referring or treating physician, cardiologist and internist. In the near future, the patient will be monitoring the efficacy of treatment with a FitBit or other apps which will empower the patient and give them the feedback and motivation to improve their health and wellbeing.