North Texas Dentistry Convention Issue 2014 | Page 20
The inquiry set off a firestorm. It didn’t take
long for the TSBDE to consult the American
Academy of Dental Sleep Medicine and the
American Association of Sleep Medicine
for their constituents’ opinions. In the 18
months since, a rollercoaster of hearings
and proposed rulings has ensued, and at
times throughout this dialogue, the right of
dentists to independently treat and sleepdisordered breathing has hung in the balance. At the core of the issue is a dentist’s
right to order a sleep study or diagnostic
home sleep test in order to rule out
obstructive sleep apnea. Such studies are
interpreted by a licensed Texas physician,
and until recently, ordering these tests for
patients was something dentists could do
without question.
According to an April AASM member
e-newsletter, the academy’s official stance is
that dentists should not be able to order
either test. This would mean that even for
issues unrelated to obstructive sleep apnea,
such as snoring, dentists would need to refer
patients to physicians before providing treatment.
“If you just say you’re snoring, and you tell
your patients to go to a sleep physician before
you will help them, they will likely not go,”
says TAMBCD alum Dr. David McCarley,
president-elect of the Texas Dental
Association. “That would shut down a lot of
patients.”
Perhaps no one is more passionate about this
issue than Thornton who, in addition to creating custom sleep masks for patients, has a
patented oral appliance known as the
Thornton Adjustable Positioner. Thornton
describes this “TAP” device as a tent pole that
works by propping the mouth open, preventing the tongue and soft tissue of the throat
from collapsing into the airway. It’s become
a popular alternative to continuous positive
airway pressure — or CPAP — machines,
which keep the airway open during sleep
through increasing air pressure in the throat.
“My device has been FDA-approved for any
physician or dentist to purchase and fit,”
Thornton says. While he isn’t pushing to treat
obstructive sleep apnea patients independently of physicians, Thornton’s concern is
that if dentists must refer patients to a physician before using his oral appliance for any
breathing problem, dentists could be cut out
of the process entirely.
“Treating sleep-disordered breathing with a
dental device to position the jaw is a dental
problem with a dental solution,” says
Thornton, who, along with several TAMBCD
alumni, formed the nonprofit Clinicians for
Healthful Sleep to advocate their viewpoint
to the state dental board. “That is why I have
fought so hard for dentists to do it.”
McCarley adds that some appliances can
cause temporomandibular joint problems if
incorrectly made or adjusted.
“The sleep physicians really are not trained to
diagnose occlusal problems,” says McCarley.
“Sometimes these occlusal problems will lead
you to a better diagnosis of what patients are
doing in their sleep.
“You need both sides. Our intent at the TDA
is to work with physicians on something. We
don’t want to set up these barriers.”
Dentists won’t have to wait long. According
to a Sept. 13 proposal issued from the TSBDE,
dentists would still be able to order sleep
studies as a screening tool for sleep disorders
as well as diagnose and treat any dental
comorbidity related to snoring and upper airway resistance syndrome. Diagnosis and
treatment of obstructive sleep apnea would
continue to require collaboration with a
licensed Texas physician.
If the meeting concludes without the opposition that occurred at an August open session,
those recommendations could become the
official state rule.
If not, and dentists are eventually deprived of
their right to independently diagnose and
treat non-sleep apnea breathing disorders, it
could create a domino effect nationwide, says
neurologist Dr. Richard Dasheiff, a former
director of the Sleep Medicine Program at the
Dallas VA Medical Center.
“If Texas goes through with this, all the other
states could follow suit,” says Dasheiff, who
is a member of the AASM but has supported
the cause of dentists throughout this debate
and even testified on behalf of Clinicians for
Healthful Sleep.
During Dasheiff’s time at the VA, his team
relied on a variety of treatment options, ranging from the use of CPAP machines and oral
appliances to prescription medications and —
in severe cases of sleep-disordered breathing — surgical intervention through tracheostomies.
“We always tried to educate patients on what
their options were,” says Dasheiff. “Having
this restricted would ultimately reduce the
number of patients who get adequate care.”
Founded in 1905, Texas A&M University Baylor College
of Dentistry in Dallas is a college of the Texas A&M
Health Science Center. TAMBCD is a nationally recognized center for oral health sciences education,
research, specialized patient care and continuing dental
education.
Jennifer Eure Fuentes is a communications specialist
at Texas A&M Health Science Center Baylor College of
Dentistry. A 2006 graduate of Texas Christian University,
she has worked in the communications and editorial
field for five years.
20 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com