Sleep | COVID-19 Recovery

Incorporating Dental Sleep Medicine Into Your Practice

Snoring and obstructive sleep apnea (OSA) are common conditions that dentists can screen for and effectively treat with a custom-made mandibular advancement device (MAD). As dentists look to expand the services offered by their practice and contribute to their patients’ overall health, dental sleep medicine has emerged as one of the fastest-growing areas of dentistry.

However, the traditional medical model of treatment and reimbursement for snoring and OSA can be complex and time-intensive. Dentists consistently cite these challenges as a key limiting factor to the introduction of sleep therapy to their practice.
For 25 years, Glidewell has provided dentists with oral appliances for the treatment of snoring and OSA. More recently, we’ve initiated the provisional mandibular advancement device (PMAD) therapy protocol, in which dentists can easily identify patients who complain of daytime sleepiness or bed partner disturbance due to untreated snoring. Dentists can then offer single-visit sleep treatment using a provisional diagnosis along with our proprietary informed consent form, seeing to the patient’s primary complaint before referral to a physician for follow-up and medical management.
This streamlined approach offers dentists a simple way to serve their existing patient population and increase practice revenue without the complexity and uncertainty of traditional sleep treatment services.

Dental Sleep Treatment Requires a Medical Diagnosis. Or Does It?

The provisional mandibular advancement device (PMAD) protocol offers dentists a means to simply and reliably treat a vast patient population suffering from snoring and obstructive sleep apnea.

PMAD Protocol: Sleep Therapy in 3 Easy Steps

One in four patients in the dental practice suffers from sleep-disordered breathing (SDB), which includes snoring and obstructive sleep apnea.1 The resulting medical conditions can include daytime sleepiness, diabetes, heart disease and stroke. For dentists starting out in sleep therapy, these are not new patients that have to be recruited, but existing patients who are easily identified if you ask the right questions.

The PMAD protocol is designed to help dentists successfully incorporate sleep treatment into their practice so that it helps to grow the practice without disruption.
Step 1: Identify and Qualify Patientsfor PMAD Therapy

Step 1: Identify and Qualify Patients for PMAD Therapy

A simple two-part question used to identify patients with sleep-disordered breathing would be: “Do you snore?” If the answer is yes: “Would you like to stop?” This can easily become part of the everyday patient screening process, undertaken at routine checkups and hygiene appointments.
The American Dental Association encourages dentists to screen for sleep-disordered breathing as part of a comprehensive medical history. The PMAD protocol offers a next step for positive screens with the STOP-BANG Questionnaire, which may be provided to patients as an easy and reliable tool for predicting risk for obstructive sleep apnea.
Patients are accustomed to receiving oral appliances like nightguards in the dental office. If they are a candidate for sleep treatment, explain that a sleep appliance is essentially an upper and lower nightguard joined by hinges, straps, or other connectors that help to gently reposition the mandible forward to help open up the airway. It’s a subtle change that can have significant systemic health benefits.

Step 2: Informed Consent

OSA is a medical diagnosis that must be made by a physician or other suitably trained individual. From a medicolegal perspective, an informed consent document is required to confirm that patients are aware they are being treated provisionally, with the understanding that their condition entails medical risks for which they should consult with a physician.
Step 2: InformedConsent
Step 3: Provide ProvisionalTreatment

Step 3: Provide Provisional Treatment

With the signed consent form, dentists can proceed with selecting an appliance. All mandibular advancement devices employ essentially the same mechanism of action:
  • Move the jaw forward to activate muscles and ligaments of the oropharynx
  • Provide more room for the tongue by separating the teeth and allowing the tongue to naturally posture forward
  • Maintain an advanced jaw position during sleep to hold the tongue out of the airway
Final appliance selection often comes down to clinician or patient preference, connector style, and price.
Silent Nite Sleep Appliance

Silent Nite®

Helping patients achieve a deeper, more satisfying night’s sleep, the Silent Nite® Sleep Appliance treats snoring and mild to moderate sleep apnea quickly and effectively.

EMA

EMA®

The EMA® appliance is designed to promote a deeper, more restful sleep by preventing snoring and relieving the symptoms of obstructive sleep apnea.

OASYS Hinge Appliance Image

OASYS Hinge Appliance

Designed to gently shift the lower jaw forward during sleep, the OASYS Hinge Appliance treats patients suffering from snoring and mild to moderate obstructive sleep apnea.

dreamTAP

dreamTAP

Developed with advanced technology, the dreamTAP™ appliance is designed to treat snoring and obstructive sleep apnea.

For any of the above oral appliances, take a bite registration with upper and lower impressions. Submit these with your Rx form to Glidewell.

Payment for PMAD Therapy

Dental insurance does not pay for sleep appliances. Medical insurance can be complex and time-intensive, and will not pay unless a physician provides the definitive diagnosis. Therefore, the patient is charged directly for the provisional appliance and related chairside services. With affordability in mind, Glidewell offers sleep apnea treatments at the lower end of the cost spectrum. The popular Silent Nite Sleep Appliance is a treatment that can be fabricated for $157. Special pricing enables a backup appliance to be prescribed at the same time for just $60 more.

Resources

1. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015 Apr;3(4):310-8.

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