HOME SLEEP TESTING & DENTISTRY
What I expect to happen
is that some poor dentist
will be criminally charged
with practicing medicine
without a license and his
state medical board will try
to make an example out of
him. Ultimately, the case
may terminate at the State
Supreme Court. That case
will serve as a precedent and
give us some direction for the
future. However, you don’t
want to be the unfortunate
dentist who is charged and
pays to set that precedent.
Can a dentist utilize HSAT
or Pulse oximetry to titrate
mandibular advancement
appliances?
Here the question is easier
to answer. The ADA has now
published a policy statement
which specifically authorizes
the use of Type 3 and Type
4 testing for MAD titration
purposes.
ADA Policy Statement on
the Role of Dentistry in the
Treatment of Sleep-Related
Breathing Disorders
7. Dentists who provide
OAT to patients should
monitor and adjust the Oral
Appliance (OA) for treatment
efficacy as needed, or at least
annually. As titration of OAs
has been shown to affect
the final treatment outcome
and overall OA success,
the use of unattended
cardiorespiratory (Type 3) or
(Type 4) portable monitors
may be used by the dentist
to help define the optimal
target position of the
mandible. A dentist trained
in the use of these portable
monitoring devi ces may
assess the objective interim
results for the purposes of OA
titration. This is a much harder
question to answer.
This issue has not been
adjudicated. Three states
(Georgia, New Jersey and
North Carolina) have placed
dentists on notice that this
act may exceed the scope of
practice for a dentist. Both
the AASM and AADSM policy
statement condemn this
practice.
After the publication of
the ADA policy statement
last November, the AADSM
published: Dental Sleep
Medicine Standards for
Screening, Treating, and
Managing Adults with Sleep-
Related Breathing Disorders,
where, for the first time, the
AADSM authorized the usage
of HSATs for MAD titration.
With the current agreement of
the ADA and AADSM, in a court
of law, these policy statements
will be introduced as a
learned treatise and HSAT/
Pulse Ox usage, for titration,
would be found to be within
the scope of practice of a
dentist trained in the usage of
such devices. In response to the position of
the AASM, screening products
have been developed such
as the high-resolution pulse
oximetry (HRPO), which
are specifically designed to
utilize bruxism along with the
patient’s Oxygen Desaturation
Index (ODI) to screen patients
for SRDB.
If you currently live in a state
that limits the use of HSAT, I
would petition the board for
a review to allow appliance
titration in light of the ADA
and AADSM policy statements.
Can a dentist utilize HSAT
or Pulse Oximetry to
screen dental patients of
SRBD?
Here the argument is that
oximetry is not diagnostic
of OSA; therefore, these
screening tests do not rise
to the level of a “Sleep Test”
for the purpose of diagnosing
OSA.
The legality of these
screening devices has NOT
been tested in a court of
law, however, if you live
in North Carolina, Georgia
or New Jersey, I would
not utilize HRPO, HSAT, or
similar devices, for screening
patients for SRBD or MAD
titration until your dental
boards change their current
positions on the usage
of screening and testing
devices.