Dentists’ Treatment of Sleep Disorders: An Awakening Market
Have you ever been told that you snore?" "Are you tired when you wake up?" "Do you fall asleep easily when you read or watch TV?" "Are you drowsy or sleepy during the day?" "Have you noticed a decrease in your energy levels?"
Any of these simple questions asked of the patient or added to an existing medical history form may help the dentist uncover a major health issue and possibly save a patient's life. The National Institutes of Health estimates that between 50 million and 70 million Americans suffer from chronic sleep disorders,1 and that most of them remain undiagnosed. It's been estimated that 93% of women and 82% of men with moderate to severe sleep apnea syndrome have not been clinically diagnosed.2 Moreover, in a study of 1,500 respondents, 26% met the Berlin questionnaire criteria indicating a high risk of obstructive sleep apnea (OSA) meaning that one in four dental practice patients are at high risk.3
When normal breathing is disrupted during sleep, such anticipated conditions as poor sleep quality or daytime fatigue may occur, but other more serious consequences may also result, such as cardiovascular conditions, kidney disease, type 2 diabetes, or other issues that affect overall health. With the patient base so vast and the risks so high, dentists should recognize the expanded role they stand to play in offering patients a better quality of life or even helping save lives through early recognition of potential health risks.
Assuming a patient is seen at least twice a year, dentists are uniquely positioned to respond to sleep disorders because of their interaction with patients on a regular basis. On average, dental visits last longer than primary care physician visits and afford patients more one-on-one time with the dentist, hygienist, or other dental team member. While having more time to spend with the patient is important, focusing on the mouth is imperative. Enlarged tonsils, a long soft palate and uvula, or an enlarged tongue-all of which contribute to a blocked airway-are some of the visual symptoms with which patients who snore and/or have sleep apnea usually present. These are symptoms dentists can readily identify because they focus on the oral cavity at every appointment.
The dentist has the opportunity to recognize potential issues, but the physician must also be an integral part of the protocol. Dentists are not allowed to make a formal diagnosis of sleep apnea due to it being a medical condition; therefore, they must partner with physicians and communicate accordingly. Dentists need to know the proper terminology, understand the diagnosis and treatment options, and-perhaps most importantly-know their limitations. In embracing dental sleep medicine, dental professionals are entering the physician's world and must be open to the forthcoming interaction.
The most common treatment for these conditions has been continuous positive airway pressure (CPAP); however, compliance levels are low because patients do not tolerate the device well. Since 2006, when the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine established guidelines for the use of oral appliance therapy in treating OSA, this market has continued to grow. In October 2017, the American Dental Association (ADA) adopted a policy stating, "dentists are the only healthcare provider with the knowledge and expertise to provide oral appliance therapy," according to Resolution 17H-2017 passed by the ADA House of Delegates.
Entering the realm of dental sleep medicine can be confusing and sometimes misleading. Professional educational programs, such as two-day programs from Tucker Educational Excellence (tuckereducationalexcellence.com), can provide a baseline for a dental practice moving forward. Nonetheless, obstacles still remain. Training the dental team, obtaining a diagnosis, and procuring payment through the patient's medical insurance are three major hurdles dentists face in successfully implementing dental sleep medicine. Online training programs, such as OSA University (osauniversity.org), are ideal resources for training the members of the dental team at their own pace while ensuring that everyone on the team is delivering the same message. Third-party providers of home sleep tests, such as SleepTest.com (sleeptest.com), have simplified the process of obtaining a diagnosis of OSA from a board-certified sleep physician. Medical billing also has been simplified through the introduction of reputable third-party billers, such as Pristine Medical Billing (pristinemedicalbilling.com).
A simple update to the health history form, the right question chairside, the willingness to look for key symptoms-these are easily implemented strategies for dentists to re-invent themselves and their practice. Dental sleep medicine, with its various additional responsibilities, research, protocols, products, and new relationships, can be intimidating but also gratifying and economically worthwhile.
About the Author
Director of Strategic Planning, Tucker Educational Excellence, LLC, Erie, Pennsylvania; With more than 46 years' experience in the dental industry, Mr. Simon has worked in such specialty areas as early oral cancer detection, salivary diagnostics, and dental sleep medicine.
1. National Center on Sleep Disorders Research. National Institutes of Health Sleep Disorders Research Plan. 2011. Bethesda, MD: National Institutes of Health; 2011.
2. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-706.
3. Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: results from the National Sleep Foundation Sleep in America 2005 Poll. Chest. 2006;130(3):780-786.