The Role of Dentists in the Diagnosis and Treatment of Obstructive Sleep Apnea: Consensus and Controversy

Journal of Clinical Sleep Medicine, Vol. 13, No. 10, 2017 Obstructive sleep apnea (OSA) is recognized by the medical community and the general public as an important chronic medical condition that can have serious medical consequences, reduce lifespans and impair quality of life.1 Positive airway pressure (PAP) is the most efficacious therapy, but not all patients are able to tolerate PAP or are willing to use it on a long-term basis.2 For many patients, oral appliance therapy (OAT) can be an effective alternative.3 Fabrication of an OAT device and its implementation are specialized skills that should be done by a qualified dentist, as advocated by the professional societies of both sleep medicine and dental sleep practitioners.4 Dentists have been involved in the collaborative evaluation and treatment of patients with OSA using oral appliances since initial descriptions of their effectiveness in the 1980s with the first practice parameters for their use published in 1995.5,6 Controversy regarding the role of the dentist in the care of patients with OSA came soon after. Initially, it centered on whether the practice of dentistry included independent treatment of patients who snore as well as whether physicians could employ OAT without an input from a dentist.7 Although these issues have been generally resolved, some conflict between the disciplines remains. Recently the role of a dentist in the evaluation and treatment of a potential patient with OSA has been delineated by joint policy and practice guidelines published by the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) as well as by a treatment protocol published by the AADSM.4,8,9 These state that patients with symptoms of OSA must have a face-to-face evaluation by a sleep medicine physician to diagnose OSA,4,8 and that dentists—even those certified by the American Board of Dental Sleep Medicine (ABDSM)—are not qualified to diagnose OSA.8,10 Furthermore, they explicitly indicate that interpretation of polysomnograms or home sleep studies is not in the purview of dentists.10 Dentists have an important role in identifying patients with OSA. As part of routine dental examinations, dentists can recognize a small upper airway and other anatomic risk factors for OSA, and use the opportunity to identify potential patients through use of simple screening questions EDITORIALS