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Sleep-related breathing disorder treatment outlined in new policy

October 31, 2017

By David Burger

Atlanta — Dentists are the only health care provider with the knowledge and expertise to provide oral appliance therapy, according to Resolution 17H-2017 passed by the ADA House of Delegates at ADA 2017 – America's Dental Meeting.

The Council on Dental Practice developed the policy using an evidence brief researched by the Council on Scientific Affairs. Both actions were a result of a 2015 resolution calling for the development of the policy.

"The passage of the sleep-related breathing disorders policy statement is the culmination of several years of work on this issue through the combined efforts of the Council on Dental Practice and the Council on Scientific Affairs," said Dr. Craig Ratner, chair of the ADA Council on Dental Practice. "The consensus-based process engaged all interested parties. The end result is a comprehensive policy that can help dentists on the front lines help their patients with these potentially life-threatening disorders. Proper recognition and treatment can help prolong the health and lives of our patients."

Sleep-related breathing disorders comprise multiple diagnoses that involve difficulty breathing during sleep. The disorders, which include obstructive sleep apnea and snoring, can be potentially serious medical conditions caused by anatomical airway collapse and altered respiratory control mechanisms. Obstructive sleep apnea has been associated with metabolic, cardiovascular, respiratory, dental and other systemic diseases. In children, undiagnosed and/or untreated obstructive sleep apnea can be associated with cardiovascular problems and impaired growth, as well as learning and behavioral problems.

The policy emphasizes the dentists' role in screening sleep-related breathing disorders as significant since dentists are often the first to identify symptoms and discuss medical and dental history with the patient.  The policy recognizes the importance of referral of at-risk patients to a physician for diagnosis and treatment.  It emphasizes that dentists are the only health care provider with the knowledge and expertise to provide oral appliance therapy for those individuals with mild or moderate sleep apnea who are intolerant of continuous positive airway pressure (CPAP) therapy.

According to the policy, the dentist's role in the treatment of sleep-related breathing disorders includes, but is not limited to, the following:

  • In children, screening through history and clinical examination may identify signs and symptoms of deficient growth and development or other risk factors that may lead to airway issues. If risk is determined, intervention through medical or dental referral or treatment may be appropriate to help treat the disorder and/or develop an optimal physiologic airway and breathing pattern.
  • When oral appliance therapy is prescribed by a physician through written or electronic order for an adult patient with obstructive sleep apnea, a dentist should be the one to fabricate an oral appliance.
  • Dentists should obtain appropriate patient consent for treatment that reviews the proposed treatment plan, all available options and any potential side effects of using oral appliances.
  • Dentists who provide oral appliance therapy to patients should monitor and adjust the appliance for treatment efficacy as needed, or at least annually.
  • Surgical procedures may be considered as a secondary treatment for obstructive sleep apnea when CPAP or oral appliances are inadequate or not tolerated. In selected cases surgical intervention may be considered as a primary treatment.
  • Dentists treating sleep-related breathing disorders should continually update their knowledge and training of dental sleep medicine with related continuing education.

The resolution stated that once the policy is adopted, the Council on Dental Practice will sponsor continuing education opportunities to educate the profession about sleep-related breathing disorders as well as inform the council's medical colleagues of the policy and develop information for the public on dentistry's role in sleep-related breathing disorders.

More information is available at ADA.org/sleepapnea.