The great irony about the emergence of dental sleep medicine is that generations of dentists have looked in the mouth of countless individuals with sleep disordered breathing without knowing of the disorder. Given that the Dentist is often the first healthcare provider to look in the oral cavity, a good knowledge of sleep apnea should be a part of precession knowledge base and be a multidisciplinary approach.
The treating dentist should have a good understanding of the signs and symptoms of OSA. He/she should understand a sleep study report and be aware of any other sleep issues which may impact resolution of symptoms with the DNA Appliance. The dentist should not take it upon himself to diagnose OSA. Diagnosis for OSA can only be done by a licensed medical provider.
A comprehensive evaluation should be completed prior to DNA Appliance fabrication. The patient should have a clear understanding of the various options of treatments available for OSA, be aware of the possible side effects that oral appliance such as DNA Appliance may cause and know that the American Academy of Sleep Medicine considers CPAP the treatment of choice in all instances of obstructive sleep apnea. The patient should be reappointed for appliance fabrication to allow proper ‘comprehension’ of all the information given at the initial visit.
All custom fitted DNA Appliances for the treatment of OSA require that the dentist make molds of the patient’s mouth and, often provide a “bite registration” using a George Gauge™, gothic arch tracer or one of the other devices that will tell the dental laboratory how to orient the upper and lower casts in both horizontal and vertical planes. Only licensed laboratories such as Arrowhead Dental Laboratory are allowed to fabricate the DNA Appliances for the treatment of OSA.
Placement of the DNA Appliance can require from 20-60 minutes of time with the dentist. Some dentists allow ancillary staff to do many of the procedures involved in appliance fabrication and placement. If so, the staff should be exceptionally well trained (EFDA or hygienist) and the dentist should provide constant oversight of care given to the patient. Follow up appointments are required every 4 weeks after placement of the DNA Appliance. This allows for adjustment of the appliance to improve fit, patient comfort and compliance along with follow up sleep studies.
The American Academy of Dental Sleep Medicine recommends that patients be seen every 6 months for 2 years after placement of an orthotic. After that time, the patient should be seen annually for as long as the patient wears the orthotic.