Dental Tribune U.S. Edition

HYGIENE TRIBUNE | July 2011 Clinical 3D About the author Ashley Truitt, RDA, BBA, has been in the dental industry for the past 25 years. She is the director of Dental Sleep Medicine USA and owner/director of Dental Sleep Medicine Worldwide, an education and consulting orga- nization dedicated to the advancement and awareness of sleep apnea in the dental office. For additional information on how to imple- ment dental sleep medicine into your practice, please contact Truitt about dental sleep medi- cine team training and office implementation at atruitt@dsmworldwide.com or (940) 395-4555. on the treatment recommendation) and the main function in the dental office where it is used to check the effectiveness of the oral appliance therapy and ongoing efficacy. Once you have a diagnosed patient who is dentally appropri- ate for oral appliance therapy, you are ready to do a full patient examination, evaluation and work up, including impressions and a bite registration incorporating pro- trusive and vertical dimension. It would be at this stage that you check their medical insurance and benefits to see if they are covered for this type of treatment. There are numerous custom fit- ted oral appliances available on the market, all with varying degrees of efficacy, patient comfort and cost. Consider fabricating and dispens- ing only FDA-cleared devices when treating OSA in order to secure insurance reimbursement because oral appliance therapy is covered by medical insurance not dental insurance. Medical billing is becoming a more common necessity in the dental practice for a variety of treatments and procedures. The learning curve and process of med- ical billing and cross coding can be somewhat consuming, however, there are software solutions avail- able and also companies that will handle the entire process for you which is very helpful, especially for those just getting started. Once a patient is fitted with an oral appliance, a follow-up proto- col is essential in order to ensure that the appliance is adjusted to the optimum position whereby snoring is eliminated and the apnea is reduced significantly. Initially this is done with an HST device and ultimately, when efficacy has been achieved, refer the patient back to the sleep laboratory for a sleep study (PSG). The HST and PSG results should correlate well, which gives the sleep physician confidence that oral appliances are proving effec- tive, and in some cases a good alternative, to CPAP. Oral appliance therapy can be truly life changing for these patients and being able to change the quality of someone’s life is extremely powerful and reward- ing. I have seen many tears and hugs from grateful patients who didn’t even realize how bad they felt until they started to feel the benefits of their treatment. In summary, a large part of this treatment can be performed by the hygienist working closely with the dentist and incorporating a multi- disciplinary approach. Dental sleep medicine is a substantially reward- ing practice and our country is in desperate need of more awareness and treatment options. HT References 1. National Sleep Foundation, 2005 Poll. 2. U.S. National Department of Health and National Services. 3. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in adults. J Clin Sleep Med 2009;5(3):263–276; page 2, Journal of Clinical Sleep Medicine, Vol.5, No. 3, 2009. 4. The Epworth Sleepiness Scale,Key 1997 ESS Dr. Murray Johns. 5. American Academy of Sleep Medicine Practice Parameters — Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliance Therapy with Oral Appliances: Kushida C, Morgenthaler T, Littner M, Alessi C, Bailey D, Coleman J, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee- AD Chiong T, Owens J, Pancer J; American Academy of Sleep Medicine. SLEEP, 2006 Feb. 1; 29(2):240–243. 6. The American Academy of Dental Sleep Medicine, The Ins and Outs of Oral Appliance Therapy.