The AADSM is committed to supporting and advancing the dentist's role as part of the treatment team for those with sleep-disordered breathing diseases. This role has come under scrutiny because of recent events in Texas, where the Texas Medical Association has requested that the court void Rule 108.12 Dental Treatment of Sleep Disorders, which was adopted over the summer by the Texas State Board of Dental Examiners. It is essential for all members to understand the AADSM's position on this important issue.
As the leading professional society in dental sleep medicine, the AADSM is dedicated to the highest standards of patient care. It has been the longstanding position of the AADSM that obstructive sleep apnea (OSA) is a medical disease that must be diagnosed by a physician, which is consistent with all state medical practice acts. Furthermore, because snoring is a common symptom of OSA, a diagnosis of primary snoring can be made only by a physician who has ruled out OSA.
These professional boundaries are defined clearly in the AADSM Treatment Protocol, which specifically states that "the dentist shall refer the patient to the physician for a complete medical evaluation and diagnosis to determine the absence or presence, and severity, of sleep-disordered breathing (SDB), which may include snoring, upper airway resistance syndrome (UARS) or obstructive sleep apnea (OSA)." In contrast, language in Texas Rule 108.12 is inconsistent with this protocol and leaves it to the discretion of the treating dentist to determine which patients require physician assessment prior to the initiation of treatment. This allows the dentist to make a de facto diagnosis, which is outside the scope of the practice of dentistry.
It is the position of the AADSM that a qualified dentist may proceed with oral appliance therapy only after a diagnosis of OSA or primary snoring has been made by a physician. Although a prescription from a physician is required for the dentist to treat OSA, a prescription is not a requirement for the treatment of snoring once a diagnosis has been made. However, should a patient with primary snoring later develop signs or symptoms of OSA, then referral to a qualified physician for medical reassessment is required.
We consider it the standard of care that only a qualified physician should diagnose OSA, and only a qualified dentist should provide oral appliance therapy. Cooperation between dental sleep medicine practitioners and physician colleagues ensures the highest quality of care for those battling OSA and provides the best avenue for successful patient outcomes. Long-term treatment of OSA with oral appliance therapy requires ongoing follow-up and reassessment by both a qualified dentist and qualified physician.
Dentists who are trained in dental sleep medicine play a critical role in providing proven, effective and well-tolerated treatment for patients diagnosed with sleep disordered breathing by a qualified physician. The AADSM remains committed to its vision to lead and promote dentistry's role in collaboration with our physician colleagues in reducing the burden of snoring and OSA.
The links below provide additional information for your reference. If you have any questions or comments about this issue, please contact me at email@example.com.
Kathleen Bennett, DDS
AADSM Treatment Protocol: Oral Appliance Therapy for Sleep Disordered Breathing: An Update for 2013
Texas Administrative Code Rule 108.12 Dental Treatment of Sleep Disorders