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A Dental Alternative to CPAP

By Ira L. Shapira, D.D.S., F.I.C.C.M.O.
Reprinted from Sleep & Health - May/June 2004

Many patients who snore and have sleep apnea report positive results from CPAP treatment to their doctors. However, less than 50 percent tolerate it on a long-term basis and even regular CPAP users experience problems when they travel away from home. Fortunately, good news does exist for patients who are unresponsive to or frustrated with CPAP treatment. The alternative is called the intraoral dental appliance.

A little more about the device: patients can wear it comfortably without noisy compressors, bulky tubes, masks or straps. Most people who have tried the appliance prefer it to CPAP. (Of course, most patients use it after an unsuccessful bout with CPAP.) Though it is not flawless, it fits relatively comfortably in the mouth and keeps the airway open.

CPAP or BiPAP, typically doctors' first treatment option, may be losing its rank as the gold standard of sleep medicine. Intraoral devices' classification is at Class 2 (special controls), effective by the FDA December 12, 2002, which means that insurance reimbursement is now higher than it used to be for patients who choose this comfortable alternative.

Universal acceptance of intraoral appliances is a first line of treatment for snoring, mild to moderate apnea, as well as severe apnea, is one step closer with this ruling. To clarify, these appliances must be used in a similar manner to CPAP. Efficacy of treatment and appropriate titration must be confirmed by an overnight polysomnography test. Further, while a dentist may manufacture and deliver the appliance and deal with dental issues, it is always the sleep physician that makes the diagnosis and determines the efficacy of treatment.

Where can a patient find a dentist that understands the complexities of oral appliance therapy? The group to contact is The Academy of Dental Sleep Medicine (ADSM). I say this as a charter member of the Sleep Disorder Dental Society and a credentialed member of the Academy of Dental Sleep Medicine. It is the only national dental group dedicated exclusively to dental sleep medicine. The academy's web site, www.dentalsleepmed.org, helps patients find a trained or credentialed member who will treat their sleep disordered breathing problems. It is an excellent resource for anyone who is interested in oral appliances or looking for a qualified dentist to provide complete dental makeovers.

The ADSM's annual three-day meeting will take place in Salt Lake City on June 15-17, 2006 where all medical and dental practitioners, as well as sleep technicians, are welcome. If your dentist is not yet a member of the academy, encourage her/him to attend. The academy credentials members that have acceptable knowledge in the field of sleep medicine, including oral appliance therapy, and have presented extensive, complete and documented cases. There is a certification exam supervised by the Certification Board of the Academy of Dental Sleep Medicine. Doctors who have met the requirements may take the exam at the Salt Lake City meeting.

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