Guidelines for the Medical Profession? Oral Appliances for Snoring/OSA
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UK Guideline development
This past decade has seen further clarity develop around the provision of mandibular repositioning devices (oral appliances for snoring and sleep apnoea).
In 2012, the British Society of Dental Sleep Medicine’s (BSDSM) screening protocol (first published in 2009) [i] was elevated to ‘authoritative guidelines’ by Dr Rob Jagger when reviewing a paper by Jauhar et al examining the Kushida Index in the British Dental Journal [ii]
The same year saw the BSDSM protocol further endorsed by the Association of Respiratory Technology and Physiology in their Standards of Care position statement [iii]. This was updated in 2018 to version 4. [iv].
Californian Dental Association
The Californian Dental Association (CDA) [v] determined in 2012 that it is appropriate for dentists to screen patients for the signs and symptoms of sleep disordered breathing (SDB) and work with physicians to diagnose and treat SDB.
The CDA also stated that SDB is a medical condition and its diagnosis is outside the scope of the practice of dentistry.
This is all excellent progress towards appropriate patient assessment, screening and where appropriate provision of an MRD by a dentist.
However, two further issues remain:
Self diagnosis and fitting of Over-The-Counter ‘Boil & Bite’ devices (people need help and a proper assessment for OSA to determine the most appropriate therapy – not exploiting and delaying patients from effective treatment)
How to discourage the medical profession from supplying or by lack of guidance endorsing, use of ‘Boil & Bite’ devices.
Summary
A multi-disciplinary, holistic view of the patient that breaks down the current silo approach to patient care surely makes ethical and financial sense.
Perhaps raising awareness that effective treatment options for OSA exist and consensus development of guidelines that dentistry is not within the purview of a physician is required?
Let’s not even talk about professional indemnity…!
References and related Guidelines
Professor Stradling and Mr Grant Bates proposed GP Guidelines ‘Management of sleep apnoea and snoring, suggested guidelines for General Practitioners and other interested medical professionals’. I would note that this document was created prior to the BSDSM Pre-treatment Screening Protocol.
[i] British Society of Dental Sleep Medicine, Pre-treatment screening protocol. British Dental Journal, 2009 http://www.nature.com/bdj/journal/v206/n6/abs/sj.bdj.2009.214.html [accessed 1 February 2012]
[ii] Jauhar et al (2012) The Kushida Index as a screening tool for obstructive sleep apnoea-hypopnoea syndrome, http://www.nature.com/bdj/journal/v212/n1/full/sj.bdj.2012.2.html [accessed 1 February 2012].
[iii] Association of Respiratory Technology and Physiology (2012) ARTP Standards of Care for Sleep Apnoea Services (Mandibular Repositioning Devices) http://www.artp.org.uk/en/sleep/sleep-standards/index.cfm [accessed 1 February 2012]
[iv] ARTP standards of care for mandibular repositioning devices http://www.artp.org.uk/en/sleep/sleep-standards/sleep-documents.cfm/sleep-standards-iods [accessed 23 Oct 2018]
[v] California Dental Association (2012) http://www.cda.org/Portals/0/journal/journal_022012.pdf? [accessed 6th Mar 2013]
Created by Adrian Zacher. Last updated 21st May 2019.
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