In: Sleep Apnea30 Dec 2013
Three-hundred fifty-five surveys were mailed, of which 124 (35%) were returned. One hundred ten of these respondents were dentists (87%), 10 were orthodontists (9%), and 4 were maxillofacial surgeons (3%). All respondents were SDDS members. Since most respondents were dentists, all practitioners are referred to as dentists for the purpose of this study. Over the preceding year, these dentists evaluated or treated 5% of their total patients (range, 1 to 90%) for either snoring or OS A. These dentists treated a median of 27 patients (range, 2 to 260) with snoring or OSA with OAs over the preceding year. A total number of 3,421 patients were treated with OAs during the study period. Twenty-five different OAs were used and are listed by the number of dentists using a specific device (from highest to lowest).
A device is listed only if it is used by more than one dentist: Tongue-Retaining Device, (Professional Positions, Inc; Racine, Wis), Klearway (Great Lakes Othodontics; Tonawanda, NY); Nocturnal Airway Patency Appliance (Great Lakes Orthodontics); Herbst Appliance (Great Lakes Orthodontics); PM Positioner (Dental Services Group; Minneapolis); Snore Guard (Hays and Meade, Inc; Albuquerque, NM); Tongue Anterior Positioner (Oral Appliance Therapeutics; Dallas); Therasnore (Distar, Inc; Albuquerque, NM); Elas-tometric (Great Lakes Orthodontics); Mandibular Repositioning Device (Todd Morgan, MD; Escondido, Calif); Silent Night (Lion’s Bay, British Columbia, Canada); SNOAR Positioner (Micro Labs, Inc; Dublin, Calif); and Snor-no-mor Of the 25 OAs used, only 11 (42%) have been evaluated with studies that include pretreatment and posttreatment NPSG data. The individual efficacy rates for these appliances are cited in a number of review articles. These OAs are classified as one of the following four design types and the percentages for each type are weighted according to the number of patients seen annually by each dentist to provide a total for all four device types of 100% (Fig 1).
Dentists adjust an individual appliance 2.5 (range, 0 to 6) times, which is consistent with the frequent use of custom-fit and serially adjustable devices, although the survey did not distinguish the adjustment rates for individual OAs. Dentists observe that 10% (range, 0 to 37%) of patients are unable to tolerate long-term (>6 months) use of an OA. The total cost to the patient for treatment with an appliance excluding any reimbursement is $933 (range, $400 to $2,450).
Only 7% of dentists believed that subjective patient reports alone are an adequate substitute for NPSG. Nocturnal pulse oximetry was perceived to be an adequate substitute for NPSG by 37%. Dentists who believe nocturnal pulse oximetry to be an adequate substitute for posttreatment polysomnography are less likely to obtain pretreatment or posttreatment NPSG (Mann-Whitney U test, two-tailed; p=0.001, p=0.02). Pretreatment NPSG was performed in 95% (range, 0 to 100%) of patients referred for snoring or OSA and posttreatment NPSG was performed in 18% (range, 0 to 100%) of known OSA patients. Dentists believe that 70% (range, 12 to 100%) of patients are successfully treated for OSA with OAs, despite the low percentage of posttreatment studies performed. Dentists also believe that 95% (range, 45 to 100%) of patients are successfully treated for snoring with OAs.
Figure 1. Oral appliance types used by dentists to treat patients who have OSA. TRD—Tongue Retaining Device.
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