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09 October 2019

The role of the orthodontists in OSA

Davide Elsido

There is increasing interest in the role of the orthodontist both in screening for obstructive sleep apnea (OSA) and as a practitioner who may be valuable in the multidisciplinary management of OSA in both children and adults. Although OSA can be definitively diagnosed only by a physician, the orthodontist may be called on to screen for OSA, contribute to the identification of underlying dentofacial components, and assist the physician in managing the disease. In the July 2019 issue of the journal The American Journal of Orthodontics and Dentofacial Orthopedics an article was published by a board of experts in sleep to address the management of obstructive sleep apnea. You can easily read the full article in the AJODO website.

The conclusions that they made are very important for the everyday dental practice. Here is an excerpt with the recommendations that the authors want to convey to the reader. Obstructive sleep apnea is a medical disorder that can have many serious consequences if left untreated. OSA can affect adults and children and can present at any point in the lifespan. All orthodontists should consider incorporating OSA screening into their history-taking and examination of patients. When an orthodontist has a clinical suspicion that a patient may have OSA, it is strongly recommended that referral to a physician be made; a sleep medicine physician is preferred. The definitive diagnosis of OSA should be made by a physician. Individual orthodontists may elect to participate in the treatment and monitoring of OSA patients as appropriate and permissible under applicable laws, standards of care, and insurance coverages.

1. It is strongly recommended that orthodontists be familiar with the signs and symptoms of OSA.
2. It is strongly recommended that orthodontists screen patients with regard to the signs and symptoms of OSA. A thorough history and clinical examination are critically important in that they establish the presence of preexisting conditions, a basis for diagnosis, the need for referral, and a baseline for evaluating the effects of treatment.
3. It is strongly recommended that the orthodontist refer patients with risk factors for OSA to a physician for further evaluation and a definitive diagnosis. A sleep medicine physician is preferred.
4. It is recommended that the orthodontist refer pediatric patients with nasal obstruction or adenotonsillar hypertrophy to an otolaryngologist.
5. It is recommended that the orthodontist refer adult patients to an otolaryngologist when nasal obstruction or adenotonsillar hypertrophy is present.
6. The decision for an orthodontist to participate in the treatment of OSA is a choice that should be made based on interest as well as training, skills, experience, laws, standards of care, and insurance coverage applicable to the orthodontist.
7. If involved in the treatment of OSA, an orthodontist should monitor OA (Oral Appliance) treatment efficacy.
8. An orthodontist may elect to manage adverse side effects of OA therapy.
9. No orthodontic treatments have been shown to cause or increase the likelihood of OSA. Rather, some forms of orthodontic treatment have been shown to be important in the treatment of OSA.
10. Interdisciplinary treatment of OSA helps to serve the best interests of patients with OSA.

In the picture, an oral appliance suited for this kind of condition. We will discuss more about these appliances in the soon future.

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