In Your Own Words

The American Academy of Dental Sleep Medicine (AADSM) drastically changed their stance on dentists’ involvement with home sleep testing (HST). This landmark position paper boosts dentists’ prestige in the field of sleep medicine and removes obstacles that have impeded patient care.

The AADSM’s position has changed, but how will this affect your patients and your practices? We asked a few of your colleagues 3 questions, and here are the answers In Your Own Words.

1. How do you manage sleep testing in your practice?
2. What do you think of the AADSM’s recent position statement?
3. How will this change the way you practice DSM?

Carrie Magnuson, DDS, D.ABDSM • Premier Sleep Associates • Bellevue, WA

1. When a patient presents with no diagnosis, I review the patient’s health history, symptoms, and perform a physical exam. I determine whether HSAT is appropriate versus a PSG or direct oversight from a sleep physician is recommended. If an HSAT is appropriate, I refer to an online sleep testing company with telemedicine capability to prescribe, administer, and interpret the HSAT results with a board-certified sleep physician.
    The majority of our patients are referred from a sleep physician with diagnostic testing already completed. The local sleep physicians prefer we do not do any follow-up titration evaluation with an HSAT. Instead, we use HRPO testing to evaluate the oxygen levels for advancement recommendations before sending the patient back to the sleep physician for HSAT with their device.
2. I applaud the AADSM Board Members for addressing the nebulous interpretation of dentist’s ability to order a sleep test. With the extraordinary percentage of the population having undiagnosed or untreated SBDs, we can help a sick population get treated in a timely manner. With appropriate training, dentists are certainly qualified to evaluate the symptoms and anatomy of sleep breathing disorders. This will allow the sleep physicians to focus on the more complex patients with sleep Hopefully, the medical insurance companies will acknowledge our qualifications. I look forward to the day when a dentist can prescribe a mandibular advancement device after evaluation and testing.
3. When a patient presents without a diagnosis and is determined appropriate for HST versus a PSG, I give the patient the option of testing from a local sleep physician or an online platform for testing and interpretation. I prefer referring to an online company with telemedicine services as an option and PAP therapy distribution and oversight if needed.

Jeff Rodgers, DMD, D.ABDSM • Sleep Better Georgia • Dunwoody, GA

1. In Georgia, we are not allowed to order diagnostic sleep tests. However, I do use WatchPat HSTs to help with calibration of patients’ devices on a very limited
2. I think it is fantastic and long overdue.  I love what is happening at the AADSM under Dr. David Schwartz’s leadership.  Access to this care is severely restricted and bringing dentists in at some level could help improve that situation.
3. Unfortunately, not much until the rules are changed in the state of Georgia.

Max Kerr, DDS, D.ABDSM • Sleep Better Austin • Austin, TX

1. 90% of our patients come from physician referrals and have a HST or PSG and diagnosis. In collaboration with the referring physician, we may use HST for titration purposes only and will ultimately refer the patient back for their final study.  For the remaining 10%, we either refer them to one of our referring physicians for an HST or we use SleepTest.com
2. This is great and a step in the right direction. I would like HST to be as ubiquitous and routine as blood pressure monitoring and blood panels. It’s crazy to me to think that something as fundamental as sleep rarely gets attention from healthcare professionals. Hopefully this creates more awareness around sleep dysfunction amongst the patient population.
3. It won’t really alter how we do things. We need our medical colleagues and their governing bodies to be on board with dentists prescribing sleep tests before it will impact our practice. I think we still have a long climb in front of us in that regard.

Erin Elliott, DDS • Sleep Better Northwest • Post Falls, ID

1. We have a hybrid in our practice. Most of the patients are referred to us by physicians, but we also use telemedicine and testing through SleepTest.com. On rare occasions, we dispense our own HST unit and get the diagnosis online. That’s only when absolutely necessary though.
2. I AM IN LOVE!! And so grateful for leadership that ultimately has the patients’ best interest at heart so we can get help to the people that otherwise wouldn’t seek The “traditional” way is cumbersome, slow, and patients give up (if they even start to begin with).
    We HAVE to make it easier for patients to get help. Patients have been overlooked and over-medicated for years. Dentists are in the trenches with those suffering. Sleep physicians are crying out about a shortage in their field. They are saying they have a goal of increasing awareness and diagnosis and then tying the hands of the very people that can help them manage the mild to moderate patients so they can focus on the complex and severe cases.
3. It will open the floodgates of PATIENTS.

Tarun Agarwal, DDS • Raleigh Dental Arts • Raleigh, NC

1. I am a firm believer that dentists can and should play a vital role in assisting patients in the diagnosis of sleep apnea and the education of the adverse health effects related to it. My practice encourages all patients with symptoms or ’telltale’ signs to strongly consider a sleep test to ‘rule out’ the presence of sleep apnea.
    We offer to refer them to a local sleep physician, work with a telemedicine sleep physician, or the convenience of taking a home sleep test through our office. Our office has 5 HST devices for patient convenience. Each test is scored by a sleep tech and officially read by a board-certified sleep physician.
   We have found that by making it convenient for patients, we help more patients get therapy – CPAP and/or Oral Appliance.
2. While I do feel it should have come much earlier, it’s a welcomed message from the AADSM. Unfortunately, since the AADSM wasn’t proactive, in several states we are now faced with reactively fighting state dental boards to regain the ability to provide HST from dental offices. Worse yet, the lack of guidance has created confusion and fear amongst many dentists to enter the world of dental sleep medicine. It’s my belief that this will take years to overcome.
3. It won’t really change much for me since we’ve been utilizing HST within our practice for years. We’ve developed trusted relationships with sleep physicians and medical professionals within our community.
   I must admit that there is a ‘sigh of relief’ that encourages me to continue with dental sleep medicine knowing that our most recognized dental sleep medicine organization is standing by us.

John Bouzis, DDS • Restful Sleep Wyoming • Casper, WY

1. I own several testing devices one of which, the NoxT3, provides the availability of the raw data, but I still prefer using outside testing services such as SleepTest.com & DocViaWeb due to their telemedicine services before and after testing, and their ability to provide insurance coverage as we recently lost our community’s sleep physician.
2. If OSA prevalence stats are remotely accurate, it demonstrates a tremendous lack of diagnosis, patient awareness and shows how poorly our present system addresses the disease. Read Jason Tierney’s’ introduction to the winter issue of DSP and I’ll wager most could fill in a name of someone they know – the AADSM position paper is good start to address this!
3. The AADSM position paper will not change a whole lot with how I practice DSM as I am no longer practicing dentistry. Patients usually find me through a medical referral with a request to be tested or as a result of being previously diagnosed and in need of treatment whether it be with PAP or OAT.