The role of the sleep-disorders dentist in the management of sleep-disordered breathing is expanding and most medical sleep teams are including a properly trained dentist.
The duties of the dentist include:
- Case detection (not diagnosis)
- Assess candidacy for oral appliance (OA) therapy
- Select OA design
- Construction, delivery of OA
- Titration of OA
- Treatment follow-up and monitoring
- Collaboration with MD
When to refer
The recently revised American Academy of Sleep Medicine Practice Parameters indicates that physicians may refer patients to an experienced sleep disorders dentist for oral appliance therapy as first-line treatment for primary snoring and for mild and moderate OSA.
The ideal patients include those that are:
- Less obese
- Primary snoring
- Mild and moderate OSA
- Adequate dentition
- Asymptomatic TMJ
- Failures of CPAP or surgery at any OSA severity
However, even obese patients with sleep apnea have been shown to benefit significantly from oral appliance therapy. In addition, oral appliances can be utilized in tandem with CPAP for a "combination" approach.