Dental Sleep Medicine Insider November DSM Insider - Page 8

TIPPING POINT KEITH THORNTON, DDS INTERESTED? JOIN ME AT THE NADSM SYMPOSIUM. REGISTER NOW DENTISTS TAKE THE BATON FROM MD’s AND CHARGE TO THE FRONT Almost 20 years ago, I wrote an article for the California Dental As- sociation titled “Should the Dentist Independently Assess and Treat Sleep Disordered Breathing?” The abstract is still cogent today. “…The standard of care for the diagnosis and treatment of sleep disordered breathing by sleep medicine has been the use of the polysomnogram and continuous positive airway pressure (CPAP), [respectively]. This approach is burdensome, cost- ly, and ineffective due to lack of compliance with or the rejection of treatment…. The dentist can and should manage these patients.” Fast forward twenty years, three separate developments have occurred to highlight the above comments: 1. The president of the Amer- ican College of Chest Physi- cians, Dr. Barbara Phillips’s video, 1 2. The American Dental Association (ADA) policy on sleep-related breathing dis- orders (SRBD), 2 and 3. The FDA ruling on over- the-counter oral appliances. 3 The first is Barbara Phillips’ scath- ing indictment of sleep physicians and the American Academy of Sleep Medicine (AASM). DR. KEITH THORNTON, DDS “The diagnosis and management of sleep apnea to this point, has been, in my view, too complicated, too time consuming, too expensive, too patient unfriendly, too test oriented and not nearly enough follow up chronic management oriented. That is changing, it has to change. There is a professional organization (aka AASM) that continues to insist that physicians who are board certified in sleep medicine be reimbursed for reading the sleep studies, which is where the money has traditionally been, and which, I can tell you, is not rocket science. The manage- ment, follow up and actual care of patients has been sort of willy-nilly, slip-shod, not necessarily done by people who even understand what a sleep study means. As a result, the vast majority of people with sleep apnea remain undiagnosed.” Also, Dr. Phillips in conjunction with Drs. David Gozal and Atul Malhotra, both past presidents of the Ameri- Keith Thornton was a gen- eral dentist for 37 years, he taught at the Pankey Insti- tute for 25 years, and holds 72 patents in sleep tech- nology. He has developed the TAP family of applianc- es, which included hybrid therapy. can Thoracic Society (ATS) wrote an editorial in the ATS journal, Ameri- can Journal of Respiratory Critical Care Medicine. 4 They documented not only the sleep apnea epidem- ic but also the pending crisis in sleep medicine due to the paucity of sleep specialists. One of their solutions was “increased training for generalist clinicians, including non-physicians (i.e. Dentists) in the diagnosis and chronic management of symptomatic, uncomplicated, high pretest probability OSA…. This approach has already begun to hap- pen in the diagnosis and treatment of OSA in children.” Additionally, a plethora of studies show CPAP’s lack of effectiveness at