23.08.2014
In increasing numbers, dental professionals are building their practices by adding dental sleep medicine services. Parker explains that problems with crowding in the throat can lead to sleep apnea and snoring. Familiarity with the oral cavity makes dentists especially qualified to treat sleep apnea and snoring. In many cases, an oral appliance can be effective in treating sleep apnea, and appliance design is constantly improving. Patients need a diagnosis from a medical professional before a dental practitioner can begin treating a sleep disorder. Screening for sleep apnea might be a top priority, but dental practitioners can also help identify patients with other sleep-related problems. Those with obstructive sleep apnea may snore loudly and stop breathing for short intervals during the night.
Oral appliances are indicated for mild to moderate obstructive sleep apnea and snoring, and fall into two categories: tongue-retaining appliances or mandibular-repositioning appliances. While dentists can identify potential issues, dental sleep medicine requires a collaborative effort with a physician or other medical specialist trained in sleep medicine. According to Parker, the collaboration may be as simple as a phone call to confirm the diagnosis, and then the dentist receives a referral in writing from the physician, which is included in the patient’s chart.
According to Bennett, insurance reimbursement to the dental practice typically requires a baseline sleep study and a referral from a physician. Treatment for obstructive sleep apnea is based on a fairly simple principle: Keep the airway open. According to Correa, sleep apnea tends to occur mainly at the base of the tongue, but the patient may have a different type obstruction at a different level of the airway. Although most oral appliances are sold direct from the manufacturer, sales reps can dream up potential sales by playing the role of guidance counselor and helping practitioners choose a lineup of appliances that offers dental professionals the right armamentarium to ensure treatment success.


Kathleen Bennett, DDS, president of the American Academy of Dental Sleep Medicine (AADSM), whose Cincinnati practice specializes in oral appliance therapy, expresses a similar sentiment about the growing acceptance of dental appliances to treat sleep disorders. Jonathan Parker, DDS, president of the American Board of Dental Sleep Medicine, who runs the Snoring and Sleep Apnea Dental Treatment Center in Edina, Minnesota, has also seen the tide turn in favor of oral appliances. Correa, BDS, MS, an associate professor and division head of Dental Sleep Medicine at Tufts University School of Dental Medicine in Boston, says that when a dentist looks into a patient’s mouth, he or she can identify certain features that tend to contribute to a small airway. In addition, many dental providers include a sleep history assessment in their patient health questionnaires, which can be an eye opener for those who have never taken the time to assess their quality of sleep. Bennett says that knowing what questions to ask and how to refer a patient for a sleep study can help immensely with several metabolic problems, including blood pressure and obesity. Obstructive sleep apnea is the most common and occurs when tissue in the back of the throat collapses and blocks the airway when the person inhales. A tongue-retaining appliance holds the tongue in a forward position via a suction bulb, which helps prevent the back of the tongue from collapsing during sleep and obstructing the airway. Considered the gold standard, it is prescribed by a physician, based on the sleep-study results. And they continue to be improved upon, which will no doubt lead to even better patient compliance.
Although there are only a few dental schools that have incorporated dental sleep medicine into their required curricula, Correa reports that courses are available, and that continuing education programs are offered for practicing dentists interested in entering this area of practice. Correa, BDS, MS, an associate professor and division head of Dental Sleep Medicine at Tufts University School of Dental Medicine in Boston, has been seeing patients at the school’s sleep center for more than 10 years.
He gets referrals from both sleep physicians and primary physicians, especially for patients diagnosed with sleep apnea but who can’t tolerate using a sleep apnea machine.
Central sleep apnea involves the central nervous system and is a result of the brain failing to tell the body to breathe. A mandibular-repositioning appliance also holds the lower jaw and other structures in a stable position to prevent the patient’s mouth from opening during sleep.


A CPAP machine is prescribed by a physician for those who have moderate to severe obstructive sleep apnea. But oral appliances have a large volume of research to support their use, so they are becoming more common in treating obstructive sleep apnea. Centers for Disease Control and Prevention, up to 70 million American adults suffer from sleep and wakefulness disorders.
Mixed sleep apnea, or complex sleep apnea, is a combination of both obstructive and central sleep apneas. The CPAP device increases air pressure in the throat to prevent the airway from collapsing when the patient breathes in. In fact, an estimated 22 million Americans suffer from sleep apnea, a condition defined as the involuntary cessation of breathing that occurs while a patient is asleep. Statistics, however, also indicate that as much as 80% of those suffering from moderate to severe obstructive sleep apnea remain undiagnosed, and therefore are not receiving treatment.
Oral appliances, on the other hand, are effective in treating mild to moderate obstructive sleep apnea, and are often a welcome relief for patients who cannot tolerate CPAP therapy.
Fortunately, a routine trip to the dentist can oftentimes be the first wake-up call for those suffering from sleep apnea and other sleep-related disorders — including snoring.
They must be prescribed by a physician, and then fitted by a dentist or oral surgeon experienced in sleep medicine.



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