According to ResearchGate, the data illustrates that,
"Approximately 1 billion of the world's population of 7.3 billion people, between the ages of 30 and 69 years, are estimated to have the most common type of sleep-disordered breathing, obstructive sleep apnoea (OSA)."
With such staggering statistics, awareness for sleep health is now more crucial than ever; a sentiment felt by both medical and dental professionals who are collaborating more fequently to provide effective treatment solutions.
In this guide, learn how dentists can work with physicians and sleep clinicians to treat sleep apnea and the role that they play in dental sleep medicine.
What is Dental Sleep Medicine?
Dental sleep medicine is an area of dental practice that treats sleep related breathing disorders (SRBD), such as snoring and obstructive sleep apnea (OSA). Dentists collaborate with doctors and clinicians to find the best treatment plan to address a patient’s sleep disorder. Their role is to help identify and treat a patient’s snoring and OSA symptoms through oral appliance therapy (OAT), using appliances such as mandibular advancement devices (MADs).
Mandibular Advancement Devices (MAD)
Mandibular advancement devices, sometimes called dental sleep devices, are oral appliances often used as an effective alternative to continuous positive airway pressure (CPAP) therapy that doesn't involve masks, tubes or surgery. These devices, which look like mouthguards, fit over the upper and lower teeth and advance the lower jaw forward. In this position, the obstructed airway is cleared as the muscles tighten, preventing them from collapsing during apneas.
Some of the best MADs, such as SomnoDent Oral Devices, utilise a mechanism that advance the jaw in increments until the ideal balance between the back of the tongue and the soft tissue of the throat is reached. Trained sleep dentists can adjust the amount of movement, position and fit of the devices to increase comfort and effectiveness.
Why is Dental Sleep Medicine so Important?
The link between oral health and sleep health is undeniable. This puts dentists on the front line of noticing signs or symptoms of sleep disorders and is the reason why dental sleep medicine should be a significant part of every dental practice.
A comprehensive policy adopted in 2017 by the American Dental Association on dentistry’s role in sleep health states that,
"Dentists are the only health care provider with the knowledge and expertise to provide oral appliance therapy."
The goal of this policy is intended to help dentists with their patient’s health and well-being. This means that dentists play a key role to providing treatment for obstructive sleep apnea, especially when patients are non-compliant to CPAP therapy.
What is the Role of Dentists in Treating Sleep Apnea?
Though the responsibility of screening and diagnosing sleep related breathing disorders does not fall 100% on dentists, they can and do play an essential role in the multidisciplinary care of patients. The dentist’s role in the treatment of SRBD includes the following:
Screening and Assessment
Dentists are encouraged to screen patients for signs and symptoms of sleep disorders. Seen as one of their most significant roles, they help to evaluate a patient’s health risk to establish if further tests or diagnosis is necessary. If risk for sleep disorder is determined these patients are referred, as needed, to the appropriate physicians for proper diagnosis. If not, the patient is monitored on follow up visits in case of changes over time.
Referral to Appropriate Physicians
The next step after risk assessment, is a referral for further testing and diagnosis. In most cases, dentists can provide patients with a home sleep test, such as the NightOwl by EctoSense, which is then interpreted by a Certified Sleep Specialist to determine the diagnosis.
Treatment through Oral Appliance Therapy (OAT)
Collaborating with the sleep specialist and their diagnosis, dentists have the knowledge and expertise to determine if and what oral appliance therapy would work best for the patient. With some oral appliances the process can be complicated, which is why we recommend SomnoDent Oral Devices for their effective treatment and comfortable design.
Treatment Progress Communication with Other Healthcare Providers
Dental sleep medicine is a collaborative effort that brings dentists, sleep specialists, referring physicians and other healthcare providers together. So it is paramount to recognise the importance of communicating treatment progress to other healthcare providers involved in the patient’s diagnosis and treatment.
Maintaining Current Dental Sleep Medicine Knowledge and Training
As with many aspects of dentistry, continuing education in dental sleep medicine is part of filling this role. The world of sleep health is still growing and evolving as more studies are conducted and new information comes available.
How to Implement Dental Sleep Medicine in your Practice
There are many ways to implement dental sleep medicine in your practice. An easy, but effective place to start is by striking up a simple conversation with your patients to create awareness in the link between oral health and sleep health. Other methods to begin introducing dental sleep medicine include:
Screening Tools and Forms
As a dentist, you already complete a medical and dental history for patients, so screening for SRBD just involves adding sleep-related questions. Ask questions about symptoms such as snoring, choking, witnessed apneas and daytime fatigue, as well as evaluating them for risk factors of sleep disorders including obesity, hypertension, or a family history of sleep apnea. To further assist dentists in screening their patients, SomnoMed have compiled a comprehensive set of tools and forms that can be utilised. Learn about your patient's sleep health with SomnoMed's Sleep Health Questionnaire and create a Sleep Apnea Patient Identification Form Packet to properly identify at-risk patients.
Clinical Exams
Examination during regular cleanings or check-ups can also help in identifying airway issues, which is especially important in screening children for SRBDs. For children, it could be as simple as noticing swollen tonsils or adenoids blocking the airway, or detecting signs of deficient growth or development.
Treatment with Oral Appliance Therapy
Depending on the severity of sleep apnea, treatment with oral appliance therapy is a great alternative for many, especially in patients who are intolerant to CPAP therapy. According to an evidence brief on oral appliances for SRBDs by The Council on Scientific Affairs, OAT proved to have high compliance levels and efficacy due in part to the findings that oral appliances have less uncomfortable side effects than CPAP therapy.
The Benefits of Oral Appliances for Sleep Apnea Treatment
Comfortable
Oral appliances are removable and custom-made for patients, which ensures they fit well for maximum comfort throughout the night. Though it could still take some time to get used to wearing them, they are certainly more convenient and comfortable than CPAP machines.
Affordable
Oral appliances, compared to CPAP machines, are relatively inexpensive. Though adjustable appliances may sometimes cost more than fixed appliances, they are worth every penny. An article comparing adjustable and fixed oral appliances published by Journal of Clinical Sleep Medicine (JCSM), demonstrates that adjustable devices produced higher reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance.
Effective
Perhaps the largest advantage of oral appliance therapy is their efficacy. Not only are patients more compliant with this form of treatment, oral appliances can also help to strengthen the airway as muscles that collapse during sleep are trained to tighten. So that over time, apneas can be reduced or eliminated.
The quality of your patient’s sleep has a dramatic impact on their health, well-being and overall quality of life. Snoring and obstructive sleep apnea increases the risk of severe health issues. Many dentists are discovering the ability to transform their patient’s lives with SomnoDent oral devices to treat snoring and obstructive sleep apnea (OSA).
Are you ready to give your patient’s better sleep? Visit our sleep apnea device page here to learn more about the oral appliances that we offer as an alternative method to treat patients for snoring and OSA.
If you are a dentist and would like to get involved in dental sleep medicine, we'll be able to help guide you through your journey; from home sleep apnea tests all the way until the oral appliance is delivered to you.
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