Testing for airway problems in the dental office is becoming more frequent and is growing in its acceptance by the dental community everywhere. Because of the significant negative health impact on patients exhibiting the results of bruxism, snoring, and the debilitating effects of interrupted sleep, the importance of this discipline should not be overlooked. While most patients do not seek out their dentist for help with these problems, the symptoms can often be observed in the dental chair.
The presence of worn and ground dentition can be a telltale sign of airway interference for an astute practitioner. A few strategic questions can start the process of exploring potentially damaging sleep-related challenges, which can often be mitigated by the use of the proper protocol. This may include prescribing one of several effective monitors available for this purpose. These instruments can monitor masseter behavior, heart rate, oxygen desaturation, airflow, effort, pulse rate, bruxism, body position, and even audio for snoring - all to determine a medical diagnosis of sleep disorders, including sleep apnea.
Though it may seem obvious to some dentists that they should seize the opportunity of helping their patient base by examining their health beyond the oral cavity, it may play out differently depending on where you live and practice. I thought I would share some of what I have read from articles covering the subject. Some legal challenges have even sprung up between the dental and medical community around the country in the past few years.
One such dispute has erupted in Pennsylvania, where a dentist was following what he thought to be an acceptable home sleep test protocol for airway problems. The doctor was relatively new at treating sleep disordered breathing and had made only about 6 sleep appliances. A patient came to see him that he thought might have airway issues, and he asked her if she would take a home sleep test. He used the Ares home test, sent the data to a Board Certified Sleep Medicine specialist, and received back the medical results and a prescription from the PCP to make an appliance.
The patient happened to live next door to an oral surgeon. The patient told the wife of the oral surgeon about the results of her home sleep test, and the wife told her husband, the oral surgeon. The oral surgeon told his wife that the dentist was practicing medicine without a license. In the state of Pennsylvania, practicing medicine without a license is a criminal charge. The wife shared this with the patient, and the patient turned the dentist in to the State Board of Dentistry for practicing outside the scope of dentistry. For some, ordering a sleep study translates to giving a diagnosis.
Until this lawsuit, the dentist followed the home sleep test protocol. He sent the data to a sleep medicine specialist and received a medical prescription. Dr. Ken Berley, one of the most qualified lawyer/dentists in the country, seems confident that they will prevail.
The conflict between ADA and AASM policies, and the new legal battles, have some dentists reeling in confusion. What is validated to be within the dental scope of practice? What are dental practice parameters? What is the definition of screening for sleep disordered breathing? Right now dentists are in “No Man’s Land” when it comes to sleep medicine.
Dr. Berley uses home sleep tests regularly, and is confident that if you do not use one, you will not be getting accurate results with sleep appliances. He most often uses the Nox T3 and, for some titration, the Minolta.
Dr. Berley has presented a two-part webinar series which is available through this Blog link. In this series, he reviews why we are experiencing this conflict and how one can have a practical and legal referral-based sleep practice. He also covers which states regard dentists involved in sleep issues in violation of practicing medicine without a license. This is an important topic of interest in dentistry right now and the webinar is timely.