Letter 2, Issue 10.4

Recent AADSM Protocol Update: A Step Forward, or Backward?


John S. Viviano, DDS, DABDSM
Sleep Disorders Dentistry Research and Learning Centre, Mississauga, Ontario CANADA

Recently, the American Academy of Dental Sleep Medicine (AADSM) provided an update to Dental Sleep Medicine Standards of Practice; are they a step forward, or a step backward?1 The abstract states, “…this article provides best practices for dental sleep medicine as it currently exists…”; yet the concept of a mandatory physician prescription does not appear even once throughout the entire article. Instead of the term physician prescription, this update uses the term physician referral, pointing out that “bidirectional referral patterns should be recognized, with the Qualified Dentist (QD) referring to the medical provider and the medical provider referring to the QD.”

Setting aside the requirement of a physician prescription is problematic in many ways, it further strains physician-dentist relations, complicates insurance reimbursement that requires a physician prescription, allows a dentist to initiate the management of a medical disorder without a physician’s oversight, and opens the door to abuse by both unscrupulous providers of oral appliance therapy and sleep testing.

The AADSM worked very hard to earn the respect and trust of physicians. To date, the AADSM has remained solidly committed to both evidence-based guidance and working collaboratively and under the direction of a physician to manage obstructive sleep apnea. Near the end of a recent webinar entitled Non-PAP Treatment Alternatives for OSA, hosted by the Sleep Research Society (August 19, 2021),2 Denis Hwang, a prominent researcher and sleep specialist at Kaiser Permanente, stated the following: “One thing that we haven’t discussed that’s probably the elephant in the room that probably needs to be put out there, which is, there is a lot of distrust between the sleep physicians and the dentist, the dentists feel like the sleep physicians don’t believe in their product and are just trying to make a lot of money and are trying to do things that are outside their scope, and that’s how many sleep physicians feel. So, you know, for oral appliances to become successful, we are going to have to bridge that gap some way.”

I understand that the status quo has failed us dentists, and that this AADSM Guidance has been written with the best of intentions. However, in contrast to setting aside the requirement of a physician prescription to facilitate access to care, perhaps the collaborative and multidisciplinary patient-centric model so eloquently discussed by Dr. Olivier Vanderveken is a better approach.3 Considering the acknowledged lack of trust physicians have for dentists, in my humble opinion, setting aside the mandatory physician prescription cannot possibly be viewed as a step forward in efforts to bridge the gap Dr. Hwang mentions.


Viviano JS. Recent AADSM protocol update: A step forward, or backward?. J Dent Sleep Med. 2023;10(4).


  1. Levine M, Cantwell MK, Postol K, Schwartz DB. Dental sleep medicine standards for screening, treating, and management of sleep-related breathing disorders in adults using oral appliance therapy: an update. J Dent Sleep Med. 2022;9(4).
  2. Watch: Non-PAP treatment alternatives for obstructive sleep apnea. American Academy of Sleep Apnea. Accessed September 13, 2023. https://sleepresearchsociety.org/watch-non-pap-treatment-alternatives-for-obstructive-sleep-apnea/
  3. Vanderveeken O. Patient-centric personalized approach in sleep medicine – From theory to practice. J Dent Sleep Med. 2022;9(4).


Submitted for publication December 13, 2022
Accepted for publication June 25, 2023
Address correspondence to: John S. Viviano, DDS; Email: john@drviviano.com


The author has no relevant conflicts of interest to disclose.