The Dental Sleep Medicine Revolution: Expanding Your Practice with Oral Appliance Therapy

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Oral appliances are now established by research, and experts in the field, as the best treatment for chronic snoring, and along with the CPAP machine, one of only 2 frontline treatments for sleep apnoea. The most recent Guidelines of the American Academy of Sleep Medicine¹, the world peak body,  have greatly elevated the status of oral appliances.

The Guidelines state that oral appliances should be offered as an alternative to the CPAP machine to all patients with sleep apnoea, irrespective of the severity.  There are many patients in a dental  practice that snore, and have sleep apnoea and would benefit greatly from an oral appliance.² There are also now many medical practitioners, seeking out dentists trained in the field of dental sleep medicine. And there are more and more dentists making this a valuable and rewarding part of their practice. 

Should I get involved in providing oral appliances for snoring and sleep apnoea?

Benefits of Providing Oral Appliance Therapy

There are many benefits in providing oral appliance therapy:

You will:

• Provide a valuable, often life-changing, service and have satisfied, grateful patients.
•  Significantly add to practice revenue.
• Retain patients who may have gone elsewhere for this treatment.
• Attract new patients, interested in treatment, who, together with their family and friends, can become long term patients of the practice.
• Find it ergonomically comfortable and not stressful on the body.
• Identify and treat many patients who have a significant medical disorder which would be impacting their health and quality of life.

What makes this the best time to get involved in dental sleep medicine?

• Credibility of oral appliances. Multiple studies³ demonstrate that mandibular advancement splints are a highly effective treatment for snoring and sleep apnoea.
• Breakthroughs in technology have included digital design, 3D printed Nylon and intra oral scanning. This has resulted in appliances of unprecedented comfort, accuracy of fit and strength.
• Sleep studies and diagnosis can now be done at home using accurate, miniaturised, comfortable monitors, with diagnosis and directions for treatment from a sleep physician.

What’s the first step?

I recommend first doing a training program to develop knowledge and skills in dental sleep medicine. 

In choosing a program it is important to be very selective. Be cautious of courses put on by distributors of specific appliances and groups selling equipment, most of which is unnecessary. 

There are courses in which the main focus is based on theory. However it is important that the program is evidence based, as well as practical, with all the clinical steps demonstrated on patients. This will give you the skills and the confidence  to commence practicing in the field. An experienced mentor to support you after the training is essential. 

What’s Next?

You’ve done a course and now want to make a start. What’s next?

1. Establish a method for screening and diagnosing your patients, with recommendations of treatment and support from the sleep physician.

2. Choose a specialised dental laboratory that provides well fitting, high quality, long lasting oral appliances. This will make your life easier by minimising the clinical time in fitting, as well as reducing side effects and extra visits.

3. Develop a relationship with an experienced mentor. 

4. Train your staff, as they are the first point of contact on the phone, or in the waiting room, and have an important role to play in enabling the patient to proceed with treatment.  

 5.  Let your patient database know that dentists have the best treatment for snoring, and a frontline treatment for sleep apnoea.

You will already have many patients in your practice who would be good candidates, and benefit greatly from this treatment. 

Marketing activities such, newsletters and regular mail-outs to patients and GPs, as well as posters in the waiting room, are  proven to be very effective,

In conclusion I recommend taking a medium-term approach, and develop the knowledge, systems and experience.

You may be a little out of your comfort zone at the start, however once you’ve completed around 3-4 cases the process will flow smoothly, and you’ll find it an extremely enjoyable and rewarding part of your practice.

References

1. “Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015.“ Katz et al. J Clin Sleep Med. 2015 Jul 15;11(7):773-827.
2. “Prevalence of probable obstructive sleep apnea risk and severity in a population of dental patients” Daniel J. Levendowski et al. Sleep Breath (2008) 12:303–309
3. “Health outcomes of continuous positive airway pressure versus mandibular advancement device for the treatment of severe obstructive sleep apnea: an individual participant data meta-analysis” Cistulli, P Sutherland, K et al. Sleep, 2021 Ju 9;44(7)