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