“The evidence is limited compared to CPAP” - Really!
In a recent episode of “The Social”, CTV Program, a physician discussed “Everything you need to know about Sleep Disorders”. When a caller explained that they were having difficulty with CPAP, the physician recommended that she persevere, that she have her CPAP checked out or perhaps that she try a new mask. Then she went on to say, in a very dismissive tone of voice, “Some people try dental appliances that help, but the evidence is limited compared to CPAP”.
WRONG SHEILA! According to the American Academy of Sleep Medicine, an Oral Appliance is considered a “Standard of Care” for All Severities of Sleep Apnea when the patient cannot tolerate CPAP or simply prefers an Oral Appliance. These are evidence based guidelines. Notwithstanding these guidelines, in North America, this is typical of what patients’ experience when they are having difficulties with CPAP. Many physicians dismiss the Oral Appliance option leaving the patient frustrated and with little in the way of alternatives. Unfortunately, by dismissing Oral Appliances, physicians may be steering patients away from a therapy that can help them become healthy again, and leaving them unmanaged for their life threatening disorder.
So why does this happen? A couple of years ago I attended a Medical conference hosted by a local university, entitled “Current Management of Sleep Disorders: A Comprehensive Update”. You can read an article I wrote on that experience here, the title of my article, “It’s Time Dentists are Invited to the Front of the Room”. The title says it all.
This problem of physician ignorance regarding Oral Appliances to manage Sleep Apnea does not exist in other developed countries. In the chart below you can see how often the Oral Appliance alternative, referred to as COAT (Continuous Open Airway Therapy) is used in North America in comparison to other countries. Although Canada is not listed, the number is even lower than in the USA.
There is probably more than one reason for this misleading bias, but based on the fact that the only things physicians at the Continuing Education program I attended heard was, “I don’t know if they work”, and “they lead to tooth movement”. I would say, they just don’t know any better.
Oral Appliance technology has come a long way, in a recent article, I wrote about the MATRx Plus, a tool that allows a dentist to test whether an appliance will work prior to making a custom Oral Appliance. You can read about that here. Of course, the MATRx Plus has been validated in the literature, you can read about that here. There really is no reason to shy away from considering an Oral Appliance if you are having issues with CPAP, or simply prefer an Oral Appliance. May I suggest that physicians should be more Patient Centric, rather than Treatment Centric. Trying to fix everyone with one tool simply does not work! The fact that only about 1/3 of patients happily wear their CPAP all night long is proof of that. More Collaboration between the various clinicians involved with the care of Sleep Apnea Patients is what's needed. You can read about that here.
Maybe the Social CTV program should invite a dentist to discuss the Oral Appliance option, because they are certainly not going to hear about it from a physician. Just Sayn’.
John Viviano DDS D ABDSM