Springtime (2012) has seen further clarity develop around the provision of mandibular repositioning devices (oral appliances for snoring and sleep apnoea).
In the UK, the British Society of Dental Sleep Medicine’s (BSDSM) screening protocol [i] was elevated to ‘authoritative guidelines’ by the reviewer (Rob Jagger), of a paper by Jauhar et al examining the Kushida Index in the British Dental Journal[ii] .
The BSDSM protocol was then further endorsed by the Association of Respiratory Technology and Physiology in their recently published Standards of Care position statement [iii].
The Californian Dental Association [iv] determined 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. They 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 I believe 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 from effective treatment)
- How to discourage the medical profession from supplying or by lack of guidance endorsing use of ‘Boil & Bite’ devices.
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…!
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] California Dental Association (2012) http://www.cda.org/Portals/0/journal/journal_022012.pdf? [accessed 6th Mar 2013]