The role of the clinician continues to evolve in the provision of appliances either for the treatment of snoring or to assist in the treatment of Obstructive Sleep Apnoea Syndrome (OSA). Dentists may be asked to fit anti-snoring appliances and Dental Protection has frequently been asked if the provision of such devices can be considered to be the practise of dentistry and therefore is within the scope of assistance normally provided to dental members.

Our view is that:

1. Dentists are well placed to construct any oral appliance/device provided they have appropriate training to do so.
2. The diagnosis and treatment of OSA, other sleep disturbances or snoring conditions does not fall within the definition of the practise of dentistry and therefore falls outside the scope of assistance normally provided by Dental Protection. However, dentists can have an important role in the screening of patients for signs and symptoms which may predict the presence of OSA.

Obstructive Sleep Apnoea

This is a condition that can have serious consequences. It is important that all patients who exhibit signs and symptoms of sleep apnoea should have a proper medical assessment and, if necessary, be referred to an appropriate specialist for treatment.

An anti-snoring device, whilst reducing snoring, could be counter-productive in terms of masking symptoms of OSA, thereby resulting in late diagnosis of the condition.

It is vital that a proper assessment of the patient, to exclude signs and symptoms of OSA, is carried out prior to the provision of any anti-snoring device (mandibular advancement device). Such assessments should be in line with contemporary standards.

Dentists and anti-snoring devices

Patients may request that a dentist provide an anti-snoring device. A dental member will be entitled to apply for assistance in respect of the provision of such appliances provided the following conditions are met:

1. The dentist has undergone a documented training course in the provision of anti-snoring appliances which includes training in the appropriate screening for OSA.
2. The patient has been properly assessed for the signs and symptoms of OSA in accordance with contemporary standards and such assessment is documented.
3. If the patient exhibits signs or symptoms of OSA, there must be a referral for a medical assessment.
4. Patients should be advised if appropriate of the risks and benefits of anti-snoring appliances including any potential impact on the occlusion and the temporomandibular joints. Documentary evidence of the consent process must be kept.

Where OSA is present, any anti-snoring device should only be provided as part of an integrated treatment plan.

Dental Protection will not normally assist when the above conditions are not met in full.

In summary:

• A proper medical assessment of patients who exhibit symptoms is essential.
• The diagnosis and treatment of OSA falls outside the definition of the practise of dentistry.
• Anti-snoring devices should only be provided as part of an integrated treatment plan.