The Difference Between a Crown and an OSA Appliance…

When the typical dentist first hears about Oral Appliance Therapy (OAT) to manage Obstructing Sleep Apnea (OSA), the thought process goes something like this, “Wow, a couple of impressions and you advance the jaw a bit and you’re done! Hmmm… Another profit centre to add to my practice. Let’s get started!”

Well, providing OAT for OSA is very different than anything else a general dentist is accustomed to doing. It holds a very different level of responsibility and obligation. To better explain this, let’s compare what happens when a dentist provides a crown to when he provides an Oral Appliance…

Placing a crown involves evaluating the dentition and periodontium both clinically and radiographically. Once adequate health is established, the crown is prepared, impressed and delivered, in most cases providing many years of problem free service. Barring complications, the dentist is done regarding this procedure and typically considers the tooth optimally restored for many years to come.

Let’s contrast this to placing an OA to manage OSA. The same due diligence is conducted to ensure adequate health of the dentition and periodontium. However, that is where the similarity ends. To begin with, since the OA will likely maintain the jaw in a posture other than the one it has been accustomed to, the TMJ is also assessed for health. The next major difference is that a dentist requires a written prescription (direction) from a physician before proceeding. Also, unlike a crown that is usually delivered in one appointment and then forgotten for many years, once an OA is delivered, the dentist’s obligations continue and don’t stop unless the patient stops wearing their appliance. First, there is the obligation to optimally titrate the appliance, all the while helping the patient deal with any untoward side effects that may initially discourage them from continuing with therapy. Then, regular (yearly) follow up is required to ensure the appliance remains optimally titrated. This obligation continues for as long as the patient is wearing their appliance, and the dentist is also obligated to report their findings from each follow-up appointment to the prescribing physician and other care givers such as their family physician and dentist (if they are working with another dentist’s patient). This obligation to follow-up and report yearly does not stop unless the patient actually stops wearing their appliance, which initiates the need for one final letter informing the caregivers that the patient has dropped out of treatment.

These protocols are unlike anything else a general dentist does in their practice, so if you want to add this procedure to your office, ensure that you establish systems that prevent these patients from falling through the cracks. After all, OSA is a life threatening disorder and these evidence based protocols have been established to best serve and protect our patients. Failing to competently fulfill these requirements could result in compromising both your patient’s lifespan and overall quality of life!

To learn more about the management of Snoring and Sleep Apnea as per the American Academy of Dental Sleep Medicine protocols, consider taking a Sleep Disorders Dentistry CE program. We are holding our Inaugural event at our new Sleep Disorders Dentistry Research and Learning Centre with Dr. John Remmers on the evening of Thursday October 12, 2017. The topic, “Proof of Concept”: Learn how to establish that an appliance will actually work prior to fabricating a custom appliance. Tuition is FREE but space is limited by room capacity. Call Callie to reserve your seat today 905 607 3777.

NOTE: Dr. Barry Glassman will be joining us for a 2-Day TMD and Occlusion program September 15-16. Consider joining us for a very unique and informative program that will literally change the way you manage your patients. Check out the flyers for these two programs below, or for more information on our various other CE programs CLICK HERE.

Cheers,

John

John Viviano DDS D ABDSM

SleepDisordersDentistry.com

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