Reba Matthews – Africa (Botswana)
How do you work with sleep doctors?
As far as I know, currently, there are no sleep doctors in Botswana. I often refer my patients to one of the local hospitals for overnight PSG assessments. An ENT specialist can give some advice regarding outcomes. I am not aware that he suggests sleep tests other than when I send my patients to him.
Are the dental sleep needs of your community being met? How or why not?
Dental sleep needs are not met in Botswana because most dentists are not aware. Questions about snoring and sleep apnea are not addressed. When patients go to the dentist, only basic dental care is addressed: general checkups, cleanings, and extractions.
Some dentists might see the need to refer for orthodontics, but this usually happens once all primary teeth are lost. If a primary tooth is decayed the dentist may extract it without taking into consideration the need for space maintenance. Many people may be on medical insurance that doesn’t cover sleep medicine and patients are not willing to pay out of their pockets for it. Medical doctors and specialists use medication and expensive surgical procedures to mask the cause of patients’ symptoms.
What would you like your patients to know about dental sleep health?
Many signs can be seen in the mouth that indicate a lack of quality sleep. I would like the community to be aware of the importance of getting regular dental checkups. Dental checkups should address the accumulation of plaque and calculus, dental decay, and the likelihood of impacted molars, AND make sure that all aspects of sleep health are noticed, noted, and treated.
Andrew Gikas – Oceania (Australia)
How do you work with sleep doctors?
The field of Dental Sleep Medicine has been in Australia since the late 1990s. Much of the research around oral appliance therapy originated from Australia and our Scientific Sleep community.
As such we have good access to sleep studies and sleep doctors that understand oral appliance therapy. All the patients I see in clinical practice have been diagnosed and specifically referred for an oral appliance. This makes my job easier. The patient is already looking for a solution and as a dentist, I just need to make sure they are dentally suitable. Getting them back to the sleep doctor can be a challenge but we try and get all our patients reviewed to make sure therapy is effective.
Are the dental sleep needs of your community being met? How or why not?
The issue is always who will fund the therapy. Dentistry and Dental Sleep Medicine in Australia is largely privately funded by the patients themselves. Insurance is available, but it only pays a small portion of the costs for oral appliance therapy. There is now a push to incorporate Dental Sleep Medicine within public hospital clinics. This provides a low-cost option for patients who are on low incomes and unable to afford private practice fees.
What would you like your patients to know about dental sleep health?
First, there is an option for them. Second, not all devices fit the same for each person. And third, one needs to see a professional to get the best advice and fitting.
Steve Carstensen – North America (United States)
How do you work with a sleep doctor?
Once we have a diagnosis from the sleep doctor, we provide oral devices to support the airway. These are monitored and adjusted until symptoms are relieved. The sleep doctor then tests again to check effectiveness. This partnership provides the best care available today. However, it restricts the number of people who can be identified and treated.
Are the dental sleep needs of your community being met? How or why not?
Many thousands of people breathe poorly during sleep. With diagnosis in the hands of only a tiny number of specially trained physicians, the unmet needs of our community will never be adequately addressed. We need more healthcare providers who can use today’s technology to identify people who are suffering and open treatment possibilities. Poor sleep breathing means shorter lives with more health problems.
What would you like your patients to know about dental sleep health?
Many people have false beliefs that poor sleep breathing is only a social problem, does not represent a true threat to their health, testing is a terrible experience, and the only treatment is a CPAP mask. Each of these myths must be addressed to improve health. Testing is easy, and there are many ways to treat precise problems when they are carefully identified. Dentists are critical members of any healthcare team and can spread this health message to large numbers of people worldwide.