Position Paper by Canadian Dental Sleep Medicine Professionals Regarding the Role of Different Health Care Professionals in Managing Obstructive Sleep Apnea and Snoring with Oral Appliances

Abstract

The present Canadian position paper contains recommendations for the management by dentists of sleep-disordered breathing in adults with the use of oral appliances (OAs) as a treatment option for snoring and obstructive sleep apnea (OSA). The recommendations are based on literature reviews and expert panel consensus. OAs offer an effective, first-line treatment option for patients with mild to moderate OSA who prefer an OA to continuous positive airway pressure (CPAP) therapy, or for severe OSA patients who cannot tolerate CPAP, are inappropriate candidates for CPAP or who have failed CPAP treatment attempts. The purpose of the present position paper is to guide interdisciplinary teamwork (sleep physicians and sleep dentists) and to clarify the role of each professional in the management of OA therapy. The diagnosis of OSA should always be made by a physician, and OAs should be fitted by a qualified dentist who is trained and experienced in dental sleep medicine. Follow-up assessment by the referring physician and polysomnography or sleep studies are required to verify treatment efficacy. The present article emphasizes the need for a team approach to OA therapy and provides treatment guidelines for dentists trained in dental sleep medicine. Many of the dentists and sleep physicians who contributed to the preparation of the present article are members of the Canadian Sleep Society and the authors reached a consensus based on the current literature.

Obstructive sleep apnoea and the need for its introduction into dental curricula

“…OAs are recommended for patients with: mild-to-moderate OSA, with severe OSA but intolerant of CPAP therapy, and who are not surgical candidates (14,62,(81)(82)(83)(84). These appliances are designed to enhance the patency of the posterior pharynx (11,18,85) and have been shown to decrease AHI and elevate oxygen saturation (84).…”

Place de l’orthèse d’avancée mandibulaire (OAM) dans le traitement du syndrome d’apnees hypopnées obstructives du sommeil de l’adulte (SAHOS). Juillet 2014

“…L'évaluation céphalomé-trique n'est pas systématique ; quand nécessaire, elle sera conduite par des professionnels confirmés [14]. Les données morphologiques linguales et palatines, le type d'occlusion (mesures du surplomb et recouvrement incisif), la présence de bruxisme, de dysfonctions de l'ATM sont analysés et rapportés dans le dossier du patient [69]. Dès 2005, l'AASM [14] recommandait que les OAM soient adaptées par un spécialiste de la cavité orale qualifié, formé et expérimenté dans les soins de la cavité orale, de l'ATM, de l'occlusion et des structures orales associées.…”

“…Ces auteurs estiment qu'il est de la responsabilité des praticiens d'acquérir une formation complémentaire afin de réaliser un examen de l'ATM et un diagnostic et ainsi améliorer le pronostic du traitement en réduisant la survenue d'effets indésirables. Comme des effets indésirables peuvent survenir, il est indispensable de conserver tous les documents initiaux radiographiques et les modèles d'étude [67,69]. Les candidats à l'OAM doivent avoir des dents saines sur lesquelles appuyer l'orthèse.…”

“…Les recommandations professionnelles [1,67] préconisent un suivi régulier, tous les 6 mois, par un spécialiste de la cavité orale formé au traitement par OAM. Ce suivi a pour objectifs d'évaluer l'observance, le bon état de l'orthèse, la survenue de troubles de l'occlusion et de l'ATM [14,69]. Chez les patients à risque (normoclusion, classe I d'Angle, surplomb incisif initial important, occlusion mésiale (classe III), une surveillance plus rapprochée peut être recommandée [67].…”

Current therapeutic options for Huntington's disease: Good clinical practice versus evidence‐based approaches?

“…23 Some argue that this undervalued resource 9,[24][25][26] should be used to fill the evidence gap in EBM, 27,28 or at least be incorporated into clinical practice guidelines to avoid skewed recommendations. 25 This practice is already in place for numerous clinical guidelines, [29][30][31][32][33][34][35][36][37][38][39] and is supported by the American Medical Association. 40 It is also endorsed by many researchers, including Sackett (a pioneer of EBM), who believe that it leads to the best clinical outcomes, but that either one alone is insufficient 4,9,41 and may even be harmful.…”