When Airway’s Involved, You Should Be Too
As the practice of integrative dental medicine becomes more prominent, dentists are increasingly seen as the frontline caregivers of the oral cavity and expected to screen for conditions that affect overall health, such as compromised airway function, and collaborate with physicians and other healthcare providers to provide treatments ranging from oral appliance therapy to orthognathic surgery. This month's cover story examines dentistry's ever-growing role in screening for and treating airway conditions that can result in sleep-related breathing disorders and contribute to other manifestations of oral disease.
As guardians of the oropharyngeal vault, dentists should be performing a basic evaluation of the airway in all cases, especially ones involving children with abnormal craniofacial development. This is our duty to our patients. However, when indicated, whether you choose to personally manage further screening with at-home sleep tests or refer to a physician and whether or not you will be providing oral appliances to treat these patients are other questions entirely.
In order to avoid potentially contributing to malocclusion, you need to acquire the requisite education before pursuing sleep dentistry treatment with oral appliances. Partnering with a certified sleep physician to handle the sleep studies, make diagnoses, and provide you with a prescription prior to fabricating appliances is highly recommended. To further enhance collaboration, one contributor to the article suggests holding an annual sleep medicine conference for both physicians and dentists. This is an excellent idea.
It is important to ensure that our patients receive the care that they need, but adding sleep dentistry treatment as a service line is a decision that will impact a practice's efficiency, and it can be difficult to pursue it in a way that is profitable. The screening takes time, and you need to be compensated for that time; however, many dental insurers do not offer reimbursement for airway screening or the fabrication/titration of appliances when they are for conditions such as obstructive sleep apnea. Oftentimes, the patient's medical insurance can be billed for these services, but many dentists are unfamiliar with this process.
Therefore, although dentists may be the "agents of change" in the future of sleep medicine, change is going to have to come from the dental insurance payors as well. Demonstrating the importance of these interventions by agreeing to reimburse for them is a necessary step to secure the buy-in of more oral healthcare providers and truly reduce the morbidity associated with airway conditions and sleep-disordered breathing.
Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa