Dr Aditi Desai
President, British Society, Dental Sleep Medicine
One billion people are thought to suffer with sleep apnoea, yet many do not know they have it. Dentists could play an important role in the prevention, screening and treatment of sleep apnoea.
There are thought to be over a billion people worldwide who suffer with obstructive sleep apnoea (OSA). A large percentage of these are either not aware of, or not diagnosed with, a sleep related breathing disorder (SRBD).
Dentists can be crucial in identifying patients at risk of sleep apnoea
Dentistry’s role in the management of SRBD, of which snoring, daytime tiredness and obstructive sleep apnoea (OSA) are the most common, is an important one.
Patients visit their dentist and hygienist more regularly than their primary care doctor, which places them in an important position to screen, assess and identify those at risk of this debilitating disease.
Although formal diagnosis of this disease can only be carried out by a physician, once diagnosis is confirmed, dentists are best qualified to provide oral appliance therapy to treat these patients.
A multi-disciplinary approach
In 2017, The American Dental Association adopted a policy that states that dentists can and should play an essential role in the multidisciplinary management of patients with certain sleep related breathing disorders.
The underlying cause of SRBD is multifactorial, which is best treated through a multidisciplinary team approach with collaboration between the patient’s dentist and physician.
Most snorers and mild apnoeacs can be successfully treated with an oral appliance.
Appropriately trained dentists are well placed with their education and hands-on experience that is necessary to provide such therapy, which enhances the patient’s experience and treatment outcome.
It is the vast knowledge of the oral environment that further endorses the trained dentist’s role in delivering suitable appliance selection thus minimising complications.
In children, the dentist’s knowledge of anatomical deficiency, craniofacial growth and development or other risk factors should lead to medical referral or orthodontic intervention to treat and/or prevent SRBD.
All patients should be entitled to treatment
Surgical methods and positive airway pressure (PAP) devices are used by physicians. Combination treatment using PAP therapy with oral devices is recommended for those who are intolerant of PAP pressure but in whom oral appliance therapy alone may not be adequate to effect treatment success.
While continuous positive airway pressure (CPAP) remains ‘gold standard’ treatment for the moderate to severe OSA, the compliance rate is low.
As a result, the joint statement from the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine in 2015, recommends that all patients are entitled to some treatment as opposed to none.
Patients need to be involved in their treatment decisions
Most snorers and mild apnoeacs can be successfully treated with an oral appliance, and the noncompliant CPAP users should receive alternative treatment options of which a bespoke oral appliance is recommended.
It further recommends that patients be part of the decision-making process as to which treatment option is recommended versus which treatment option the patient is able to tolerate or is willing to accept.
Compliance rate of a bespoke Mandibular Advancement Device (MAD) is higher than CPAP, which makes the overall effectiveness of treatment benefit similar.
Bespoke Dental Devices manufactured with absolute precision minimise the risk of complicating side effects and enhance the patient experience, which further improves compliance and treatment effectiveness.