Oral Appliance Therapy for OSA: Are you qualified to own the Risk?

Every so often I hear about yet another professional aside from a Dentist providing Sleep Apnea Appliances: Denture Therapists, ENT’s, Sleep Physicians, Chiropractors etc. This begs the question; who is actually “Qualified” to own the risk of providing this therapy.

This week, a local “Sleep Experienced” Dentist complained to his lab when the Dorsal appliance he just inserted extracted 3 teeth on removal. Of course, these periodontally compromised teeth should have been considered in the treatment planning stage, an omission that was clearly, his and only his responsibility. I am not criticizing this Dentist’s efforts, unfortunately, errors happen. But tell me, when a Denturist, ENT or Chiropractor makes a Sleep Apnea Oral appliance, whom is expected to take on this responsibility? Only adding to the significance of this issue, keep in mind that this responsibility does not end, ever! As long as a patient is wearing an oral appliance, the professional that placed it has taken on an obligation to monitor not only the continued effectiveness of the appliance but also the continued health of the dentition, supporting structures and TMJ. So, unless a professional is accepting of this responsibility it would be medico-legally and ethically prudent for them to leave this area of practice to those qualified practitioners that are able and willing to do so; within their licensure. For those remaining unconcerned about this caution. Consider this, often liability insurance does not cover issues that arise from venturing outside of licensure, but don’t sweat it. A very good friend once pointed out to me that there is no such thing as “No Insurance”. Everyone is insured, even if it is with their “Beach House”.

Do you think this is a case for a Boil and Bite?

This may leave some wondering if their “Scope of Practice” includes the management of Sleep Apnea with an Oral Appliance. The American Academy of Dental Sleep Medicine (AADSM) provides readily available guidance in this regard. Look up “Standards for Dental Sleep Medicine Facility Accreditation”, if what they are mandating is outside of your scope of practice (ie. you are not licensed to perform those requirements) and you continue practicing Sleep Disorders Dentistry I suggest that you make sure your liability insurance is paid up. It’s not a matter of “if” this will catch up with you it’s a matter of “when”.