Kudos to Dr. Friedlander and his colleagues for their enlightening treatise on oral appliance therapy for the management of sleep disordered breathing ("Diagnosing and Comanaging Patients With Obstructive Sleep Apnea Syndrome," August JADA). This timely topic deserves widespread exposure in all our journals since sleep disordered breathing, or SDB, adversely affects the lives of millions of people worldwide. With fewer than 95 percent of these cases being diagnosed and treated, the need is clear.
Science has made the relationship between SDB and a host of medical conditions, in particular cardiovascular consequences. This provides an opportunity for dentists to impact not only the quality of patients’ lives, but, in some instances, the quantity. Dentistry is now evolving into a major component of the health care treatment team in the management of SDB.
This article creates an imperative awareness among dentists that SDB is a medical problem that can be life-threatening in severe cases. It also reinforces how important it is that dentists not act unilaterally in the treatment of these patients. As the title indicates, patients must be comanaged within the appropriate medical team. (In this arena, dentists are not medically or legally qualified to diagnose SDB, and physicians are not dentally qualified to manage oral appliances and their effect on the oral structures.)
The comprehensive nature of the article serves the reader well, as many topics germane to dentistry’s role in comanaging SDB are thoroughly presented.
Dental sleep medicine, as it is now known, is vastly complex, and much more needs to be said that is beyond the scope of Dr. Friedlander and colleagues’ article. For example, the dentist treating sleep disorders has numerous appliances and multiple surgical procedures available to manage upper-airway patency during sleep. Knowing how and when to use each appliance, or when to opt for surgery or a proper referral (pulmonary, sleep, oto-laryngological and so on) is both an art and a science.
Patient referral protocol, trouble-shooting and managing individual appliances, insurance reimbursement issues, pharmacology, coexisting dental and medical conditions, morbidity and peer-reviewed research are but a few of the important areas needing attention in this new arena where medicine and dentistry coexist. At first glance, it may appear that this treatment is simple and straightforward. It is neither. As with any new treatment modality, proper training and education are essential.
The increased awareness of sleep disorders by both physicians and the public is creating a demand for dentists who are proficient in dental sleep medicine.
