© December 2009, American Academy of Dental Sleep Medicine
AADSM Treatment Protocol:
Oral Appliance Therapy for Sleep Disordered Breathing
1. Medical Assessment 1, 2, 3, 11
Either;
- In order to practice within the limits of their license as designated by their
state the dentist refers the patient to the physician for diagnosis of SDB – be it
snoring, UARS or Obstructive Sleep Apnea. Following diagnosis, the
physician sends the patient back to the dentist for OAT as appropriate.
Or;
- Referral by Physician for oral appliance therapy if appropriate.
2. A copy of the diagnostic sleep study is forwarded to the dentist.
3. The dentist is to assess the patient through a complete clinical examination,
including determining the current health and prognosis of oral tissues that might
be affected by the use of a mandibular advancement appliance. Evaluation of a
recent radiographic survey when indicated is important to a complete
examination. The dentist is to recommend the choice of appliance 4,5,6,7,8,9,10 and
disclose relevant fees. Rationale for appliance therapy should be explained to the
patient and documented.
4. Communicate your proposed treatment plan, progress and follow up notes, as well
as other pertinent information, with the patient’s physician and appropriate
healthcare providers on a regular basis.
5. Informed consent must be obtained prior to appliance delivery.
6. Dentist to initiate therapy and titrate 9, 11 the OA to achieve optimum results based on resolution of patient symptoms and / or obtaining objective data during titration with the use of portable monitors.
7. Following optimal titration9, 11, the dentist refers the patient back to the physician for assessment of OA treatment of SDB. If the OA treatment is sub-therapeutic, the dentist consults with the physician to discuss further treatment options.
8. Patients diagnosed with primary snoring may be treated without follow-up objective data.
9. Follow-up protocol should include a patient evaluation at six months after
successful titration and at least annually thereafter. The annual recall exam should
evaluate efficacy, patient compliance, side effects, symptoms as well as the
structural integrity of the oral appliance and the need for possible additional
titration. Continual annual assessment and the need for possible additional
titration is communicated with the patient’s physician.
10. Knowledge of various appliances is strongly recommended, as no one appliance is
effective for treatment of all patients. Dentists who treat SDB are encouraged and
have a responsibility to pursue additional education in the field.
© December 2009, American Academy of Dental Sleep Medicine
Bibliography:
1. American Sleep Disorders Association, Standards of Practice Committee. Practice
parameters for the treatment of snoring and obstructive sleep apnea with oral
appliances. Sleep 1995; 18:511-513.
2. Schmidt-Nowara WW, Lowe A, Wiegand L, et al. Oral appliances of the
treatment of snoring and obstructive sleep apnea: a review.Sleep 1995; 18:501-
510.
3. Loube DI, Strauss AM. Survey of oral appliance practice among dentists treating
obstructive sleep apnea patients. Chest 1997; 111:382-6.
4. Cartwright R, Samelson C: The effects of a non-surgical treatment for obstructive
sleep apnea – the tongue retaining device. JAMA 248:705, 1982.
5. Loube DI, Andrada T, Shanmagum N, Singer M. Successful treatment of upper
airway resistance syndrome with an oral appliance. Sleep and Breathing, October,
1997.
6. Menn SJ, Loube DI, Morgan TD, et al. The mandibular repositioning device: Role
in the treatment of obstructive sleep apnea. Sleep 1996; 19:794-800.
7. Ferguson KA, Ono T, Lowe AA, et al. A short-term controlled trial of an
adjustable oral appliance for the treatment of mild-moderate OSA. Thorax 1997;
52:362-368.
8. Clark GT, Blumenfeld I, Yoffe N, et al. A cross-over study comparing the
efficacy of CPAP with anteriorly mandibular positioning devices on patients with
OSA. Chest 1996; 109:1477-1483.
9. Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of variable mandibular
advancement appliance for treatment of snoring and sleep apnea. Chest 1999;
116:1511-1518.
10. Alan A. Lowe, Titratable Oral Appliances for the Treatment of Snoring and
Obstructive Sleep Apnea, J Can Dent Assoc 1999; 65:571-4.
11. R. R., Oral Appliance Therapy for the Management of Sleep Disordered
Breathing: An Overview. Sleep and Breathing 2000; Vol. 4, No. 2: 79-83.
AADSM Treatment Protocol:
Oral Appliance Therapy for Sleep Disordered Breathing
1. Medical Assessment 1, 2, 3, 11
Either;
- In order to practice within the limits of their license as designated by their
state the dentist refers the patient to the physician for diagnosis of SDB – be it
snoring, UARS or Obstructive Sleep Apnea. Following diagnosis, the
physician sends the patient back to the dentist for OAT as appropriate.
Or;
- Referral by Physician for oral appliance therapy if appropriate.
2. A copy of the diagnostic sleep study is forwarded to the dentist.
3. The dentist is to assess the patient through a complete clinical examination,
including determining the current health and prognosis of oral tissues that might
be affected by the use of a mandibular advancement appliance. Evaluation of a
recent radiographic survey when indicated is important to a complete
examination. The dentist is to recommend the choice of appliance 4,5,6,7,8,9,10 and
disclose relevant fees. Rationale for appliance therapy should be explained to the
patient and documented.
4. Communicate your proposed treatment plan, progress and follow up notes, as well
as other pertinent information, with the patient’s physician and appropriate
healthcare providers on a regular basis.
5. Informed consent must be obtained prior to appliance delivery.
6. Dentist to initiate therapy and titrate 9, 11 the OA to achieve optimum results based on resolution of patient symptoms and / or obtaining objective data during titration with the use of portable monitors.
7. Following optimal titration9, 11, the dentist refers the patient back to the physician for assessment of OA treatment of SDB. If the OA treatment is sub-therapeutic, the dentist consults with the physician to discuss further treatment options.
8. Patients diagnosed with primary snoring may be treated without follow-up objective data.
9. Follow-up protocol should include a patient evaluation at six months after
successful titration and at least annually thereafter. The annual recall exam should
evaluate efficacy, patient compliance, side effects, symptoms as well as the
structural integrity of the oral appliance and the need for possible additional
titration. Continual annual assessment and the need for possible additional
titration is communicated with the patient’s physician.
10. Knowledge of various appliances is strongly recommended, as no one appliance is
effective for treatment of all patients. Dentists who treat SDB are encouraged and
have a responsibility to pursue additional education in the field.
© December 2009, American Academy of Dental Sleep Medicine
Bibliography:
1. American Sleep Disorders Association, Standards of Practice Committee. Practice
parameters for the treatment of snoring and obstructive sleep apnea with oral
appliances. Sleep 1995; 18:511-513.
2. Schmidt-Nowara WW, Lowe A, Wiegand L, et al. Oral appliances of the
treatment of snoring and obstructive sleep apnea: a review.Sleep 1995; 18:501-
510.
3. Loube DI, Strauss AM. Survey of oral appliance practice among dentists treating
obstructive sleep apnea patients. Chest 1997; 111:382-6.
4. Cartwright R, Samelson C: The effects of a non-surgical treatment for obstructive
sleep apnea – the tongue retaining device. JAMA 248:705, 1982.
5. Loube DI, Andrada T, Shanmagum N, Singer M. Successful treatment of upper
airway resistance syndrome with an oral appliance. Sleep and Breathing, October,
1997.
6. Menn SJ, Loube DI, Morgan TD, et al. The mandibular repositioning device: Role
in the treatment of obstructive sleep apnea. Sleep 1996; 19:794-800.
7. Ferguson KA, Ono T, Lowe AA, et al. A short-term controlled trial of an
adjustable oral appliance for the treatment of mild-moderate OSA. Thorax 1997;
52:362-368.
8. Clark GT, Blumenfeld I, Yoffe N, et al. A cross-over study comparing the
efficacy of CPAP with anteriorly mandibular positioning devices on patients with
OSA. Chest 1996; 109:1477-1483.
9. Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of variable mandibular
advancement appliance for treatment of snoring and sleep apnea. Chest 1999;
116:1511-1518.
10. Alan A. Lowe, Titratable Oral Appliances for the Treatment of Snoring and
Obstructive Sleep Apnea, J Can Dent Assoc 1999; 65:571-4.
11. R. R., Oral Appliance Therapy for the Management of Sleep Disordered
Breathing: An Overview. Sleep and Breathing 2000; Vol. 4, No. 2: 79-83.