By Anthony T. Dioguardi, DMD, DABDSM, and Sree Roy
From April 28 through May 19, 2016, Sleep Review conducted an online survey to find out how home sleep testing (HST) is currently being used in the dental setting. More than half of the dentists who took the survey (57%) self-identified as general dentists; 34% identified themselves as dentists who spend more than half of their time on dental sleep medicine; 9% said they spend more than half of their time on an area of dentistry that is not general dentistry or dental sleep medicine.
Because a main avenue for survey distribution was via Sleep Review subscriber lists and social media channels, it is important to note that the dentists who took this survey were more likely to have an interest in dental sleep medicine than a random sampling of dentists in the general population. Seventy dentists completed the survey.
The survey was 11 questions in length (a 12th question allowed respondents to enter to win a gift card) and was developed by an editorial advisory board member and Sleep Review‘s chief editor.
The Sleep Review survey found:
- When asked about how the dental practice has facilitated the use of HST for patients who do not currently have a diagnosis of obstructive sleep apnea (OSA) in the past 12 months, dentists replied as follows:
o 53% facilitate and follow up on referrals to local physicians who are likely to write HST prescriptions
o 40% directly connect the patient to an HST device, both with and without in-person physician visits
o 6% will make a physician referral but do not typically follow up
o 1% do not offer OSA screening or referrals for their patients
- Regarding patients who already have an OSA diagnosis, respondents indicated that their practice has facilitated HST with these patients in the following ways:
o 53% directly employ HST as a tool to help find the ideal oral appliance position before sending the patient back to a sleep physician
o 37% will make a physician referral or work in-person with a physician for titration follow-up via likely HST
o 9% do not typically facilitate any post-diagnosis HST
o 1% do not treat OSA patients
- Dentists indicated they use the following HST device supply model:
o 59% own the HST devices themselves
o 22% do not directly facilitate or employ HST
o 10% rent devices per month
o 9% outsource to a dental HST provider
o 0% rent devices per use
- The number of HSTs leased or owned per practice:
o 0 devices: 30% currently (33% one year ago; 44% two years ago)
o 1 device: 26% currently (28% one year ago; 26% two years ago)
o 2 devices: 25% currently (22% one year ago; 18% two years ago)
o 3 or more devices: 19% currently (17% one year ago; 12% two years ago)
- Type of HST device currently leased/owned:
o Type III: 45%
o Do not own/lease HST devices: 30%
o Both Type III and Type IV: 18%
o Type IV: 7%
- How HSTs are scored:
o 43% via outsourced service (by physician who dentist does not personally know or automated)
o 34% automated (by computer)
o 23% manually by local physician
- Do you or your office share the HST results with the patient?
o Yes: 80%
o No: 20%
Anthony T. Dioguardi, DMD, DABDSM, developed this survey in conjunction with his article “Incorporating Home Sleep Testing into Oral Appliance Therapy.” Sree Roy is editor of Sleep Review.
So this survey just drives home the division between Sleep labs/MD and Dentists.
If 59% of respondents own, 10% rent and perform their own HSAT how does that encourage a referral pattern from the sleep clinic to a dentist for an oral device?
If the sleep MD and DDS have a great relationship focused on outcome, the dentists can use HST to accomplish what the referral was for – an open airway. Using HST to check effectiveness prior to returning the patient to the sleep MD for evaluation is a very efficient, cost effective use of medical time and financial resources. The patient feels well cared-for and likes the docs working together.
What doesn’t seem right are the dentists who do not involve the MDs in the process out of fear of not being able to do appliances. The problem isn’t in the HST, it lies elsewhere.