In October 2017, the American Dental Association (ADA) adopted a policy on dentistry’s role in treating sleep-breathing disorders including obstructive sleep apnea (OSA). It emphasizes that all dentists should screen for sleep-breathing disorders and that dentists should be the professionals who fabricate oral appliances (with a physician’s prescription).

Sleep-breathing disorders are “recognized as potentially serious medical conditions caused by anatomical airway collapse and altered respiratory control mechanisms,” the ADA said in a written statement to Sleep Review. “As experts in the oral cavity, dentists are able to question patients about pertinent symptoms during routine dental evaluations, and refer patients to physicians for diagnosis. The policy was adopted to address dentistry’s growing role in the multidisciplinary care of patients with [sleep-breathing disorders].”

In a news release from October, the ADA lists key takeaways that describe the role dentists should play:

• assess patient risk for sleep-breathing disorders as part of a comprehensive medical and dental history and refer affected patients to appropriate physicians
• evaluate the use of oral appliance therapy and provide it for mild and moderate OSA when CPAP fails
• identify and address the side effects of oral appliance therapy
• communicate patients’ treatment progress with referring physician and other healthcare providers.

Another point made in the policy is dentists treating sleep-related breathing disorders should stay up-to-date on the disorders and training in dental sleep medicine with continuing education. When asked what education the ADA will be providing dentists about how to screen for sleep-breathing disorders, the ADA advised that is currently under consideration.

The policy, written by the ADA Council on Dental Practice, is a result of an evidence brief on the use of oral appliances for sleep-breathing disorders, which was developed by the ADA Council on Scientific Affairs. The ADA’s governing body, the House of Delegates, reviewed and made comments for the policy, which were incorporated into the final draft before the association finally adopted it this past fall.

The evidence brief that inspired the policy shows there is a large portion of people who could have undiagnosed sleep-breathing disorders that could potentially be identified and treated by dentists who abide by these policy guidelines. It states that the prevalence of OSA is “estimated to be 3% to 7% in men and 2% to 5% in women. Prevalence is higher (greater than 50%) in patients with cardiac or metabolic disorders, relative to the general population.”

The ADA does not yet have data on any recent increase in sleep-disordered breathing screenings at dental offices or how quickly the policy is being rolled out.

Posted by Dillon Stickle, an associate editor for Sleep Review.

<style=”text-align: center;”>

Sleep Apnea Screening
-Patients are realizing how a blockage of oxygen to the brain, caused by 
nocturnal apnoeic events, can influence systemic damage. 
-Sleep Apnea is connected to strokes, cardiac arrest, diabetes and dementia. 
-The public asks their dentists for help- most dentists are unprepared. 
-Less than 1% of practicing dentists are trained and qualified to screen and treat 
the over 40 million victims of Sleep Apnea.
-One of the next three patients that walk thru your doors is a Sleep Apnea victim. 
    
  -Are you prepared to help them? 


Diabetes Mellitus 
The oral manifestations of diabetes include:  
-Periodontal Disease, Xerostomia, tenderness, pain and burning sensation 
of tongue, secondary enlargement of parotid glands with sialosis. 
-Increased caries prevalence in adults. 
-Increased risk of infection- reasons unknown, but macrophage metabolism 
altered with inhibition of phagocytosis. 
-Peripheral neuropathy and poor peripheral circulation, 
-Oral mucosal diseases including Candidal infections, lichen planus and 
recurrent aphthous stomatitis. 
-Delayed healing of wounds due to microangiopathy and ultilization of protein 
for energy may retard the repair of tissues. 
-Increased prevalence of dry sockets. 
-Immunological deficiency: -A high sugar medium decreases 
production of antibodies.

 Blood pressure and other "vitals" 
Imagine administering a mandibular block, having your patient go into 
cardiac arrest, and realizing that no one in your office has taken that patient's 
blood pressure today.
 Enough said about that!

Are you providing a Comprehensive Exam?