A dental sleep medicine practitioner explains why the AASM and AMA’s actions only reinforce what dentists already know.
By now you have likely heard that the American Academy of Sleep Medicine (AASM) and American Medical Association (AMA) are advocating to block dentists from diagnosing obstructive sleep apnea (OSA). The AASM has launched a nationwide initiative that aims to defend the scope of practice of physicians and advanced care providers who manage patients with OSA from dentists and other practitioners who are not trained or qualified to diagnose a medical disease.
Every state medical board received a copy of the AMA resolution, Appropriate Use of Objective Tests for Obstructive Sleep Apnea H-35.963. The resolution was introduced in November 2017 at the AMA Interim Meeting and was adopted by the House of Delegates. Because of this new policy, the AASM released a position statement on the clinical use of a home sleep apnea test.
The statement stated that the diagnosis and effective treatment of OSA in adults is an urgent health priority. However, according to the AASM, only a physician can diagnose medical conditions such as OSA and primary snoring.
While it is understandable that some dentists are upset over this new ruling, let’s not create any bad blood. This new statement does not mean the end for us dentists providing treatment for OSA. It simply goes back to what we’ve always known: we need to continue to build a working relationship with physicians.
Build a Working Relationship with Physicians
Sleep medicine in the dental office provides knowledge and understanding of sleep physiology and the life-threatening consequences of sleep-disordered breathing. Many at-risk patients are candidates for oral appliance therapy, and many patients who are suffering from sleep apnea can be treated by your dental practice working in an interdisciplinary relationship with a sleep physician.
While you can provide your patients with oral appliance therapy, it is important to be aware that the first step in treatment is a proper diagnosis. To properly diagnose your patients, a sleep physician or other medical professional is needed—they are available to provide proper diagnosis of sleep apnea in patients, as well as other sleep issues that may be identified by their examination, such as restless leg syndrome, periodic limb movement, and insomnia.
For this reason, it is important to establish a relationship with your local physician. With each patient that displays signs of a sleep-breathing disorder, send them to your local sleep physician for referral. By visiting the sleep physician, your patient will be monitored, tested, and diagnosed. From there you can treat your patient with oral appliance therapy when appropriate.
This is where the creation of a working relationships with physicians in your community comes into play. First, introduce your dental sleep medicine practice to your local physicians. This will allow physicians to be aware of the services you provide, which helps to build a relationship for diagnosis and treatment planning. Give physicians and their staff confidence that your practice will provide exceptional care for their patients by speaking their language and sending standard medical SOAP [subjective, objective, assessment, and plan] format narratives that document your patients’ treatment.
By doing this you are also establishing a solid relationship with your local physician because you are informing them that you are screening your dental patients for sleep apnea and will be referring to them for proper evaluation and diagnosis. The physician will also play a large role in a follow-up sleep study after the patient has begun oral appliance therapy. They will make sure the treatment is working or provide treatment adjustments as needed.
As a dentist, you can still screen for potential patients that might be suffering from an undiagnosed sleep-breathing disorder. However, a referral should be made to a sleep physician for diagnosis. Diagnosis should be in the hands of the physicians, but we need to learn to work with each other rather than against each other.
Sleep medicine does not just constitute sleep-breathing disorders, but other disorders as well. As dentists, we are not well versed in it; hence why we need to depend on our physician colleagues.
Mayoor Patel, DDS, MS, is the owner of Atlanta’s Craniofacial Pain and Dental Sleep Center of Georgia.