Dentist Physician Relationship Flashcards
AASM Standards of Diagnosis (2005)
Dx of OSA prior to starting treatment to establish a baseline
Dx criteria include clinical signs, symptoms, and PSG findings
Severity of SDB must be established in order to make appropriate Tx decision (Standard)
AASM standards for fitting of oral appliances
Must be qualified dental personnel who are trained and experienced in the overall care of oral health, TMJ, dental occlusion and associate oral structures (i.e. dentist, not physician)
AASM guideline for dental management of patients with oral appliances
Management of OA patients should be overseen by practitioners who have undertaken serious training in sleep medicine and/or sleep disorders with focused emphasis on the proper protocol for diagnosis, treatment, and follow up (option, but may impact insurance payments).
What is the AASM parameter on cephalometric records?
Optional - they should be done when necessary.
AASM parameter on OA for snoring
OAs are appropriate for primary snoring when behavioral therapy (weight loss, position) don’t work
AASM parameter on OA for OSA
Not as efficacious as CPAP, but indicated for mild to moderate OSA in those who prefer it to CPAP and in patients who don’t respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment measures with CPAP or behavioral measures
AASM parameters for severe sleep apnea
CPAP (unless patient refuses) because CPAP has been shown to be more efficacious. More literature is showing better efficacy of OA, though – he encourages us to publish our results.
In cases of severe craniofacial abnormality, etc., where it is obvious that surgery is better option, then surgery would be recommended
AASM parameters for sleep study follow up with appliance therapy
Treatment of primary snoring: no follow up indicated (besides subjective)
OSA: PSG or Type III study are recommended with appliance in place after final adjustments/titration to confirm resolution of AHI and low SpO2
AASM parameters for continuing care/follow up in OAT patients
Follow up with dentist every 6 months for first year, at least annually thereafter
Periodic followup office visits with referring clinician
PURPOSE: to assess for signs and symptoms of worsening OSA.
Objective reevaluation (HST/PSG) if subjective symptoms reappear
How do most sleep physicians treat OSA?
Go straight to CPAP first, regardless of severity; poor compliance is rarely handled by physician, but by staff; POORLY ADDRESSED Weight loss, avoid alcohol and drugs Occasional use of Modafanil Then surgery is recommended Then OAT is recommended
Why is OAT generally not considered, even though the authorities have recommended it as a firstline treatment for mild/moderate OSA?
Ignorance as to the effectiveness of OAT and of the guideline
Not aware of the availability of a dental sleep specialist in their practice area
No relationship with dental sleep specialist
Not comfortable with credentials, potential of poor results
Referring position is liable for outcome - concern about losing control of patient care
Concern about losing patient to the dentist
How can I overcome the physician’s concerns that prevent them from considering OAT?
When I become credentialed, make sure they know it and understand what it is
Assure them that I will only treat the OSA and encourage the patient to continue to see the physician regularly for followup and continued care of other problems
Find out the individual physician’s preference regarding communications
What should I communicate to the physician (PCP and sleep MD)?
Accurate sleep specific assessment (including signs/symptoms, POX, TMJ, etc.)
Clear recommendations and statement of my followup plans (remember, I am the expert and need to communicate)
Regular followup updates (they are responsible for outcome and should be informed of what the outcomes are)
What does he recommend be put in a physician binder?
Research Articles Credentials Bibliography Customized referral forms
