Dental Sleep Medicine Insider November DSM Insider | Page 8

TIPPING POINT
KEITH THORNTON, DDS
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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