Knowledge, Opinions, and Clinical Experience of General Practice Dentists toward Obstructive Sleep Apnea and Oral Appliances

 

 Buy Article Permissions and Reprints

Undiagnosed obstructive sleep apnea (OSA) can contribute to hypertension, cardiovascular disease, stroke, and detract from overall quality of life. Dentists can play an important role in detecting, making recommendations for, and treating OSA with oral appliances (OAs). A survey of 18 questions of knowledge and opinion of, educational background for, and clinical experience with OSA and OAs was mailed to 500 general practice dentists in Indiana, United States. Two hundred survey returns produced 192 valid responses. Responders reported strong positive opinions toward OSA and OAs. However, 58% of dentists could not identify common signs and symptoms of OSA, and 55% of dentists did not know the mechanism for mandibular advance devices. Only 39% of dentists could identify snoring, mild OSA, and intolerance to continuous positive airway pressure as possible indications for OA treatment. Respondents reported a general lack of education about both OSA and OAs. Only 31 (16%) were taught about this issue in dental school; 77 (40%) knew little or nothing about OA treatment for OSA patients; 57 (30%) learned from postgraduate training. Cooperation and referrals between dentists and physicians were rated as “poor.” Of the responders, 54% never consulted with physicians for a suspected OSA patient in their practice; 75% of dentists reported they have never been referred patients by physicians; and 80% of dentists never or less than five times prescribed OAs to OSA patients. Results suggest a need for increased education and training regarding OSA and OAs in dental school, as well as increased cooperation between dentists and physicians for better patient care.

REFERENCES

• 1 Phillipson E A. Sleep apnea: a major public health problem.  N Engl J Med. 1993;  328 1271-1273
  CrossrefPubMedGoogle Scholar
• 2 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med. 1993;  328 1230-1235
  CrossrefPubMedGoogle Scholar
• 3 Hossain J L, Shapiro C M. The prevalence, cost implications, and management of sleep disorders: an overview.  Sleep Breath. 2002;  6 85-102
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Carroll J L. Sleep-disordered breathing in children. In: Lee-Chlong TL, Sateia MJ, Carsjadon MA Sleep Medicine. Philadelphia, PA; Hanley & Belfus Inc 2002: 265-287
  Google Scholar
• 5 Young T, Peppard P E, Gottlieb D J. Epidemiology of obstructive sleep apnea.  Am J Respir Crit Care Med. 2002;  165 1217-1239
  CrossrefPubMedGoogle Scholar
• 6 Gami A S, Caples S M, Somers V K. Obesity and obstructive sleep apnea.  Endocrinol Metab Clin North Am. 2003;  32 869-894
  CrossrefPubMedGoogle Scholar
• 7 Wolk R, Shamsuzzaman A S, Somers V K. Obesity, sleep apnea, and hypertension.  Hypertension. 2003;  42 1067-1074
  CrossrefPubMedGoogle Scholar
• 8 Kapur V, Bough D K, Sandblom R E et al.. The medical cost of undiagnosed sleep apnea.  Sleep. 1999;  22 749-755
  PubMedGoogle Scholar
• 9 Strollo P J, Rogers R M. Obstructive sleep apnea.  N Engl J Med. 1996;  334 99-104
  Google Scholar
• 10 Friedlander A H, Walker L A, Friedlander A L, Felsenfeld A L. Diagnosis and comanaging patients with obstructive sleep apnea syndrome.  J Am Dent Assoc. 2000;  131 1178-1184
  PubMedGoogle Scholar
• 11 Bailey D R, Attanasio R. Dentistry's role in the management of sleep disorders.  Dent Clin North Am. 2001;  45 619-630
  PubMedGoogle Scholar
• 12 Bailey D R. Snoring and sleep apnea: the dentist's role in treatment.  Dent Today. 2000;  19 52-55
  PubMedGoogle Scholar
• 13 Schmidt-Nowara W, Lowe A, Wiegand L, Perez-Guerra F, Mena S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.  Sleep. 1995;  18 501-510
  CrossrefPubMedGoogle Scholar
• 14 Gotsopoulos H, Chen C, Cistulli P A. Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized, controlled trial.  Am J Respir Crit Care Med. 2002;  166 743-748
  CrossrefPubMedGoogle Scholar
• 15 Rose E C, Barthlen G M, Staats R, Jonas I E. Therapeutic efficacy of an oral appliance in the treatment of obstructive sleep apnea: a 2-year follow-up.  Am J Orthod Dentofacial Orthop. 2002;  121 273-279
  CrossrefPubMedGoogle Scholar
• 16 Schoem S R. Oral appliances for the treatment of snoring and obstructive sleep apnea.  Otolaryngol Head Neck Surg. 2000;  122 259-262
  PubMedGoogle Scholar
• 17 Schmidt-Nowara W. A review of sleep disorders. The history and diagnosis of sleep disorders related to the dentists.  Dent Clin North Am. 2001;  45 631-642
  PubMedGoogle Scholar
• 18 Rogers R R. Dental sleep medicine: coming of age.  Gen Dent. 2001;  49 398-400
  PubMedGoogle Scholar
• 19 Barsh L I, Schmidt-Nowara W. Collaborative care.  Sleep Breath. 2000;  4 51-52
  Article in Thieme ConnectPubMedGoogle Scholar
• 20 Barsh L I. Dentistry's role in the recognition and treatment of sleep-breathing disorders: the need for cooperation with the medical community.  J Calif Dent Assoc. 1998;  26 591-598
  PubMedGoogle Scholar
• 21 Veis R W. Snoring and obstructive sleep apnea from a dental perspective.  J Calif Dent Assoc. 1998;  26 557-565
  PubMedGoogle Scholar
• 22 L'Estrange P R, Battagel J M, Nolan P J, Harkness B, Jorgenson G I. The importance of a multidisciplinary approach to the assessment of patients with obstructive sleep apnea.  J Oral Rehabil. 1996;  23 72-77
  PubMedGoogle Scholar
• 23 Phillips B, Collop N, Goldberg R. Sleep medicine practices, training, and attitude: a wake-up call for pulmonologists.  Chest. 2000;  117 1603-1607
  CrossrefPubMedGoogle Scholar
• 24 Bahammam A S. Knowledge and attitude of primary health care physicians towards sleep disorders.  Saudi Med J. 2000;  21 1164-1167
  PubMedGoogle Scholar
• 25 Kramer N R, Cook T E, Carlisle C C, Corwin R W, Millman P P. The role of the primary care physician in recognizing obstructive sleep apnea.  Arch Intern Med. 1999;  159 965-968
  CrossrefPubMedGoogle Scholar
• 26 Crisostomo I, Merritt S, Roe B et al.. Knowledge and attitudes regarding sleep medicine among first-year medical students, nursing students, and residents.  Sleep. 1999;  22(suppl 1) S235-S236
  PubMedGoogle Scholar
• 27 Kovacic Z, Marendic M, Soljic M, Pecotic R, Kardum G, Dogas Z. Knowledge and attitude regarding sleep medicine of medical students and physicians in Split, Croatia.  Croat Med J. 2002;  43 71-74
  PubMedGoogle Scholar
• 28 Papp K K, Penrod C E, Strohl K P. Knowledge and attitude of primary care physicians toward sleep and sleep disorders.  Sleep Breath. 2002;  6 103-109
  Article in Thieme ConnectPubMedGoogle Scholar
• 29 Rosen R C, Rosekind M, Rosevear C, Cole W E, Dement W C. Physician education in sleep and sleep disorders: a national survey of U.S. medical schools.  Sleep. 1993;  16 249-254
  PubMedGoogle Scholar
• 30 Rosen R C, Mahowald M, Chesson A et al.. The Taskforce 2000 survey on medical education in sleep and sleep disorders.  Sleep. 1998;  21 235-238
  PubMedGoogle Scholar
• 31 Ivanhoe J R, Frazier K B, Parr G R, Haywood V B. The teaching and treatment of upper airway sleep disorders in North American dental schools.  J Prosthet Dent. 2003;  89 292-296
  PubMedGoogle Scholar
• 32 Loube M DI, Strauss A M. Survey of oral appliance practice among dentists treating obstructive sleep apnea patients.  Chest. 1997;  111 382-386
  PubMedGoogle Scholar

Hui BianM.A. C.H.E.S. 

Department of Health Education and Behavior

FLG. Room 5, Stadium Road, University of Florida

Gainesville, FL 32611-8210

Email: bianhui@ufl.edu