Discussing Oral Appliances vs. CPAP with Physicians

Every professional who treats sleep apnea wants to recommend the most effective therapy for each individual patient.  If only we had a tool to predict such a positive match!

Study after study shows that CPAP, applied effectively, will resolve all forms of sleep disordered breathing.  Unfortunately many studies also show that CPAP is not well accepted by patients, thus alternative therapies have been pursued almost since obstructive sleep apnea was described.

As dentists seek to form collaborative care relationships with diagnosing physicians, it is necessary to back up claims of effectiveness of the dental appliance therapy we provide.

Two recent articles can help support dental interventions:

Efficacy of An Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome
Aaron B. Holley, Christopher J. Lettieri and Anita A. Shah
Chest; June 2, 2011; DOI 10.1378/chest.10-2851

Full Article Available Here

The comparison of CPAP and OA in treatment of patients with OSA: A systematic review and 
Wenyang Li1, MD, Lin Xiao2, PHD, Jing Hu1*, PHD
RESPIRATORY CARE . Published on January, 2013  DOI: 10.4187/respcare.02245

Full Article Available Here

Each of these well written papers show that many measurements of sleep-related diagnostics such as Epworth, SQALI, and oximetry are equally treated with either CPAP or OAT.  Patient preference continues to be for OAT while AHI reduction is best accomplished by CPAP, especially as the diagnosed AHI rises above 30. This was summarized well recently:

Eur Respir J. 2012 May;39(5):1241-7. doi: 10.1183/09031936.00144711. Epub 2011 Nov 10.

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy.
Marklund M, Verbraecken J, Randerath W 

Read Abstract

How can the interested dentist use this information?  Your sleep physicians may understand that dentists have something to offer their patients, but are not as sure about effectiveness.

Dentists mostly treat disease with procedures:  we surgically remove decay and restore the void with various materials. We mechanically reduce infection and rely on the body to heal tissue lesions. We can do this for years without much concern for scientific basis of why we do what we do.

Physicians tend to pay much more attention to research and publications than dentists do. This fact means that as dentists seek to gain a legitimate role in the treatment of medical patients, we must provide properly researched data to support our therapeutic option.

Of course, there are research savvy dentists and CPAP-blinded physicians. Focusing on improving the health of our community depends -on all parties growing together.

Steve Carstensen, DDS
Bellevue, WA

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