Sleep Physicians Uneducated About Mandibular Advancement Appliances

Q: Hey, been playing some golf with my neighbor, R*** G***, who is an internist and sleep physician, and he doesn’t think much of oral appliance therapy. Can you give me some information that will help him understand what we can do as dentists?

Dr. Smith: I have Dr. ***’s wife in a SomnoDent, if that helps. Is he aware of the protocol from the AASM that was issued 5 years ago?

“Although not as efficacious as CPAP, oral appliances are indicated for use in patients with mild to moderate OSA who prefer OAs to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or positional change.”

That’s from HIS organization!
Ask what his issues are.

If bite changes are his worry, tell them they change with CPAP also, and I can send you photos if needed. There is also a study from 2010 that shows craniofacial changes that occur after 2 years with CPAP. Very convincing.

If TMD is his worry, tell him you are well versed in handling these issues, and you have far fewer issues with the Somnodent, since it has more vertical freedom and you can dial the patient in carefully with .1mm adjustments

If he says they don’t work, see above protocol. There are numerous studies that prove otherwise.

If he says they can’t be titrated in a lab like PAP, that’s true, but we have portable monitoring to assess effectiveness as the appliance is being titrated.

If he says they cost too much, ask him why he doesn’t allow the patient to make that decision. Just send them over and let you handle that.

Follow up everything with “so, what do you do with your patients who do not tolerate CPAP? Most studies show these numbers run close to 50%, with the numbers being higher with mild to moderate patients, which, BTW, is what our appliances are really good at fixing. Do you just tell them to lose weight?” Dr. G: “Yes” You: “Really? How often do you follow them up to make sure they’re losing weight, and what success % are you seeing?”

If he says he sends them for surgery, say “Were you aware that your organization (AASM) says that’s backwards? In October of last year, they said that surgery is to be considered on patients “in whom oral appliances have been considered and found ineffective or undesirable”

One physician at a time, Dr. C. One at a time.