OSA is effectively treated by two therapies – Positive Airway Pressure (PAP) therapy, and Oral Appliances (OA) – with neither being a panacea and each having its benefits and pitfalls. The choice of which therapy is used should be predicated on what is best for the individual sufferer in terms of handling the severity of the condition and their tolerance for each modality. With physicians favoring PAP therapy and established by the AASM as the “Gold Standard” in treating OSA, dentists have the task of educating their fellow physician practitioners on the role that Oral Appliances can play in the effective management of OSA.
Studies show that more than 30% of patients prescribed PAP therapy never initiate treatment and further, 15% of those that do start treatment, abandon therapy after 10 – 15 months. The reasons for this are complex and require their own research and correction, but suffice to say, patients are reluctant to wear the PAP machine paraphernalia and may have difficulty adapting to forced airflow. Conversely, studies show 75 – 100% compliance with oral appliances for up to 2 years and 75 – 90% up to 5 years.
However, prior to Home Sleep Testing, with the only path to OSA diagnosis through physician-centric sleep laboratories, unfamiliar with OA therapy and the role they can play in OSA management, many dentists found the patients they referred to a sleep lab ending up on PAP therapy without an objective discussion on the relative merits of each therapy.
There is probably little disagreement amongst physicians and dentists that instruction and training in each other’s proficiencies are limited and a greater understanding of each therapy and an inter-disciplinary approach to managing a patient’s condition might lead to better outcomes.