Plus advice for dental sleep medicine practitioners who have not experienced a bump in patients seeking oral appliance therapy.

By Lisa Spear

When one of the largest manufacturers of CPAP machines, Philips Respironics, issued a recall a year and a half ago affecting millions of patients, sleep physicians and patients alike scrambled to identify alternative treatments for sleep apnea. Many of them found a solution in oral appliance therapy, a device-based obstructive sleep apnea treatment prescribed by a physician but typically ordered and fitted by a dentist.

Sleep physicians in search of a way to treat their patients flooded dental offices with calls, and those calls are still trickling in, several dentists throughout the country told Sleep Review recently.

“The only thing I can say about the CPAP recall is that we were inundated with patients,” says Robert B. Garelick, DDS, a dentist who treats sleep apnea patients at Chase Dental SleepCare in the New York Metropolitan area. Normally, the office distributes about 100 oral appliances for sleep apnea every month. Last month, they hit roughly 160. In the beginning of the recall, the practice’s multiple locations struggled to keep up with the demand.

“We did our best to accommodate them, but for a few weeks it was pretty hairy,” says Garelick. Already having established relationships with a network of physicians in the area, most of the new patients came to him from physician referrals.

Garelick isn’t alone. Most of the dentists who have seen the greatest increase in patients are those who already have very active dental sleep practices and have established relationships with referring sleep physicians, says Jamison R. Spencer, DMD, MS, who runs The Spencer Study Club, a professional organization for dentists who treat sleep apnea.

“Across the board, almost universally, people have said they have seen an influx of more patients. They have had more medical doctors reach out to them about cases and to ask them if they can handle increased volume,” Spencer says.

At The Center for Sleep Apnea and TMJ in Boise Idaho, and Salt Lake City, where Spencer serves as director of dental sleep medicine, he and his colleagues have seen between a 20% and 30% increase in patient volume, he estimates.

Oral appliance manufacturers are also reporting that high-volume dentists have seen an increase in patient interest in oral appliance therapy. ProSomnus Sleep Technologies and Airway Management Inc report that some dentists they work with have seen their businesses grow exponentially due to the Philips CPAP recall.

“I’ve seen an uptick, no doubt about it,” says Mark T. Murphy, DDS, D-ABDSM, who sees sleep patients and works as lead faculty for clinical education at ProSomnus.

He says he saw a 10% to 15% uptick in patient referrals from sleep physicians.

For some, the Philips recall became a blessing when they found that an oral appliance could treat their apnea without the help of a machine. It’s a silver lining, says Spencer.

“In some of the cases, too, there’s been sleep doctors who maybe didn’t have that much experience with oral appliance therapy or maybe they just didn’t have a great opinion of oral appliance therapy overall, but because they, to a degree, had no choice, it had allowed those physicians to see that those oral appliances work better than they thought they would,” says Spencer.

“This CPAP recall, at the very least, has opened up awareness to physicians as well as patients. Overall, I think it will have a long-term positive effect on oral appliance therapy as well.”

Still, obstacles remain to getting oral appliance therapy into the hands of sleep apnea patients and there are many dentists who did not see such inflows.

“Initially, our dental clients believed this would cause a groundswell of CPAP to oral appliance therapy converts. We have definitely seen an increase in both custom TAP and non-custom myTAP devices. Many of our high-volume dentists reported an increased patient interest in [oral appliance therapy], but we are still hearing that the progress is slow. As an industry, we have to be persistent in reaching the tremendous patient population that is still affected by the recall, no matter how long it takes,” says Charles Collins, CEO of Airway Management.

“My advice to dentists on trying to grow their practice during the recall is to keep working on building relationships with local sleep doctors. The dental practices we work with that have an established network are by far the busiest. We also work with several high-volume practices that market directly to the patient population. With endless online resources and communication, patients are becoming more health-educated and therefore seeking alternative treatments on their own.”

Lisa Spear is associate editor of Sleep Review.

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