Although many treatments, including surgery and CPAP, currently already fall under the auspices of otolaryngology, fitting and managing patients with oral appliances typically is done by a dental specialist, as recommended by the revised 2006 American Academy of Sleep Medicine (AASM) guidelines, despite the fact that most dentists are not trained in sleep issues and are not familiar with more than one appliance.
Explore This IssueNovember 2009
With sufficient training and education about oral appliances, however, otolaryngologists should be able to provide this treatment as well, according to Dr. Jacobowitz, and echoed by Drs. Mickelson and Huntley, who added that providers need to be aware of their potential dental side effects and how to deal with them.
Sleep apnea is a medical problem, with serious health consequences such as cardiovascular disease, emphasized Dr. Huntley. Otolaryngologists don’t have to relegate the need to take a larger role in the entire care of the sleep apnea patient. We know the medicine, we know the disease process, and we know the upper airway anatomy better than anyone else.
As this is management of a medical problem, Dr. Huntley also emphasized that treatment with oral appliances, similar to surgery and CPAP, is covered by insurance. Under the auspices of many dentists, he said, this is often not the case, because they might not bill insurance for these appliances. Instead, patients are required to pay out of pocket, sometimes up to $3000 to $5000. This is not right, said Dr. Huntley, noting that if otolaryngologists would provide these oral appliances, they would be billed to insurance, eliminating out-of-pocket expenses for the patient.
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