With changes in healthcare delivery and access in the United States, dentistry is moving towards a more comprehensive total health model. A shift from focusing on oral health alone to the combination of oral and systemic wellness has occurred. Dentists are now, more than ever, on the front lines of the healthcare delivery system, and possess the unique opportunity to make a significant impact in the early detection and treatment of many life-threatening systemic conditions that are easily recognizable during a comprehensive, semi-annual dental wellness visit. A well-trained dental team can detect signs of a variety of these conditions, such as obesity, hypertension, diabetes, and heart disease.

Sleep apnea is a commonly occurring condition that can be life-threatening if left untreated. There are three types of sleep apnea — obstructive, central, and complex. Obstructive sleep apnea is the most common. It results when the airway is blocked by the tongue and soft palate during sleep. As the brain detects a drop in oxygen, it sends a signal to arouse an individual enough to regain the airway. The loss of oxygen in the blood, as well as the constant interruption of sleep, can contribute to hypertension, atrial fibrillation, heart disease, obesity, and overall alertness. Ample research indicates that sleep apnea has a significant impact on traffic- and work-related accidents due to increased levels of drowsiness for inadequate sleep.

Mild, moderate and severe apnea can be detected with a properly coordinated sleep study. The frequency of apneic events determines the severity of the disease. Moderate to severe apnea is most commonly and most effectively treated with Continuous Positive Airway Pressure (CPAP), while mild and borderline moderate cases can be very well treated with oral appliances.

Oral appliance therapy allows for improved airflow by repositioning the mandible in a downward and anterior direction. Oral appliances can be easily fabricated in a dental office through the coordinated efforts of a well-trained dentist and qualified lab.

Million Dollar PPO Coaching and Consulting suggests including questions regarding not only systemic health but sleep as well. Your dental history should be designed to facilitate discussions about wellness, including sleep apnea. If you recognize an at-risk patient, a sleep study should be recommended for accurate diagnosis and treatment recommendation.

While there is no specific code for Oral Appliance therapy, the D5999 code can be used. However, medical cross coding should be utilized, as Oral Appliance Therapy is a recognized treatment modality and can be covered by medical insurance. We suggest establishing a relationship with a local sleep center to facilitate communication after referral, as well as in the coordination of diagnosis and treatment.

There are a number of organizations dedicated to the education and training of dentists in the diagnosis and treatment of apnea including the American Academy of Dental Sleep Medicine (AADSM).

Dr. Matthew Krieger is CEO and founder of Million Dollar PPO, a dental practice consulting and coaching company serving dentists across the United States. Its core philosophy is increasing profitability through increasing efficiency. It works with its clients through various programs to ensure that they have the understanding and the tools to create the practice that they’ve always dreamed of.