Snoring and Obstructive Sleep Apnoea Syndrome

There has been considerable interest in recent years as to the role of dentists in the provision of appliances either for the treatment of snoring or to assist in the treatment of obstructive sleep apnoea. Dentists may be asked to place anti-snoring appliances and a number of requests have been made with regard to whether the provision of anti-snoring devices falls within the practise of dentistry and therefore within the scope of assistance normally provided to members.

Dental Protection's view is that:

1. Dentists are well placed to construct any oral appliance / device provided they have appropriate training to do so.
2. The treatment of obstructive sleep apnoea or other sleep disturbances or snoring conditions does not fall within the definition of the practise of dentistry and therefore would normally fall outside the scope of assistance normally provided by Dental Protection, however dentists can have an important role in the screening of patients for signs and symptoms which may predict the presence of obstructive sleep apnoea syndrome.

Obstructive Sleep Apnoea

Obstructive sleep apnoea is a condition that can have serious consequences. It is important that all patients who exhibit signs and symptoms of sleep apnoea should have a proper medical assessment and, if necessary, be referred to an appropriate specialist trained in the diagnosis and treatment of OSA.

An anti-snoring device, whilst reducing snoring, could be counter-productive in terms of masking symptoms of OSA thereby resulting in late diagnosis of the condition.

It is vital that a proper assessment of the patient, to exclude signs and symptoms of OSA, is carried out prior to the provision of any anti-snoring device (mandibular advancement device). Such assessments should be in line with contemporary standards.

Dentists and Anti-Snoring Devices

Patients may request that a dentist provide an anti-snoring device. A dental member will be entitled to apply for assistance in respect of the provision of such appliances provided the following conditions are met.

1. The dentist has undergone a documented training course in the provision of anti-snoring appliances which includes training in the appropriate screening for OSA.
2. The patient has been properly assessed for the signs and symptoms of OSA in accordance with contemporary standards and such assessment is documented.
3. If the patient exhibits signs or symptoms of OSA then there must be a referral for a medical assessment.
4. Patients should be advised if appropriate of the risks and benefits of anti-snoring appliances including any potential impact on the occlusion and the temporo-mandibular joints. Documentary evidence of the consent process must be kept.

Where obstructive sleep apnoea is present any anti-snoring device should only be provided as part of an integrated treatment plan.

Dental Protection will not normally assist when the above conditions are not met in full.

Issued: Dec 2005