The Dentists’ Role in Diagnosing Sleep Disorders

Advice for Working with Your Patient’s Physician When Developing Treatment

 Sleep disorders affect millions of patients worldwide, many of whom seek treatment in dental offices every day. These disorders can affect the patient’s mood, psychological status, cognitive abilities, and physical reflexes, and are directly related to bruxism, temporomandibular joint (TMJ) disorder, and orofacial pain issues.

 The most common type of sleep disorder is obstructive sleep apnea (OSA). It is important to note that all sleep disorders are medical conditions that require a diagnosis by a physician or nurse practitioner. So, why should dentists care about OSA when it is something that they cannot directly treat or even diagnose without a physician?

 Let’s explore the dental connection to sleep medicine and why every dentist should integrate bruxism, TMJ, and orofacial pain treatment with dental sleep medicine into their practice.

 Dental Sleep Challenges

One method of helping our patients who have sleep disorders is through technology such as oral appliances that can move the jaw forward, thus alleviating the obstructed airway. This will also will reduce or eliminate bruxism, which is one of the most common dental diseases affecting one out of three patients.

 Herein lies the major frustration that dentists keep running into: Dentists cannot legally make an oral appliance for OSA unless the patient has a medical diagnosis; otherwise, they are practicing outside the scope of dental practice. If a dentist administers a home sleep test that only tests for sleep disorders and then sends the patient to his or her physician, the physician does not send this patient back to a dentist because that is not the accepted medical protocol. Instead, the physician will send the patient to a pulmonologist or medical sleep professional. Most physicians simply do not see or understand how a dentist can help this patient who has a medical condition. Most physicians rightfully have a good question: Why is a dentist administering a home sleep test to a patient for a condition the dentist cannot even diagnose?

 The key to a dentist being involved and integrating dental sleep medicine is diagnosing co-morbid bruxism and TMJ issues that are present in most OSA patients.

AAFE Dental Sleep Protocol

One way that dentists can be involved with dental sleep medicine is through the use of home bruxism and sleep monitors that will objectively test the patient for both bruxism and sleep disorders. First, this keeps the dentist within the scope of dental practice with diagnosing a condition that they can legally diagnose. Second, the conversation with the patient’s physician now can go like this: “Dr. Physician, we have a mutual patient whom I have tested and diagnosed with a dental condition (bruxism) of which I am the primary provider. These test results state the patient has OSA of which you their physician is the primary provider. With your permission, I can make them one dental appliance that is considered primary therapy for both bruxism and OSA.” Every physician we have dealt with has agreed to prescribe an oral appliance under those circumstances. Here is why: I have properly tested the patient, stayed within my scope of practice; showed the physician proper documentation; followed a defined, medically acceptable protocol; and have a clear treatment plan that includes follow-up efficacy testing.

 A Call for Treatment Integration

It is time for all dentists to offer appliance treatment, as well as the use of Botox, for bruxism, orofacial pain, and dental sleep medicine in their practices. The method of treatment described above keeps dentists in their scope of practice while directing and ensuring the physician that the patient has been properly diagnosed and treated. General dentists should be integrating bruxism treatment and dental sleep medicine into his or her practice so dentists collectively can start improving patients’ lives while giving them better dental treatment outcomes.

Louis Malcmacher DDS MAGD is a practicing general dentist and an internationally known lecturer and author.  Dr. Malcmacher is president of the American Academy of Facial Esthetics (AAFE).  You can contact him at 800 952-0521 or email drlouis@FacialEsthetics.org   Go to  www.FacialEsthetics.org where you can find information about live patient Frontline TMJ/Orofacial Pain, Botox and dermal fillers training, Dental Implant Training, Frontline Bruxism Therapy / Dental Sleep Medicine, Medical Insurance, download his resource list, and sign up for a free monthly e-newsletter.