Dentists, Myofunctional Therapists, and Sleep Apnea – Part 1

CPAP is currently the gold standard for managing obstructive sleep apnea
There are many effective approaches to treating obstructive sleep apnea (OSA) used in the field of sleep medicine. These therapies are provided by sleep physicians, pulmonologists, otolaryngologists, and other physicians with advanced training in treating sleep apnea. In 2024, CPAP remains the "gold standard" for achieving predictable improvements in patients with OSA.

Intraoral dental appliances and oral surgery are also effective OSA treatments
There are also procedures provided by dentists, orthodontists, and oral surgeons that have been clinically proven to help OSA. Intraoral appliances hold the lower jaw forward, pulling the tongue away from the back of the throat, which may help some patients who can't wear a CPAP. Oral surgeons, teamed up with orthodontists who provide the necessary braces, provide a surgery called maxillomandibular advancement (MMA) that moves the entire face forward, carrying the front wall of the airway with it.

Dentists are not the best qualified to treat breathing problems
Dental professionals providing these services may participate as "subcontractors" to medical physicians specifically trained to diagnose and treat OSA. While dentists can take continuing education courses that help them to better understand and recognize the symptoms of OSA, they are not trained to prevent, manage, or cure this condition on their own. Oral surgeons and orthodontists receive sufficient training in their residencies to provide the MMA surgeries prescribed by sleep physicians. While dentists may be exposed to making and adjusting intraoral appliances in dental school, advanced training in dental sleep medicine is required to work most effectively with medical doctors who have diagnosed OSA in their patients. Simply stated, dentists are not the most qualified to diagnose or treat breathing problems.

There is nothing wrong with dentists receiving compensation for necessary procedures
Dentists are (or should be) motivated to provide procedures that make their patients more comfortable, healthier, and attractive. It is no secret that they are also paid to provide these services. So, a mutually beneficial relationship exists if a dentist can offer services that benefit their patients and provide themselves with income. There is nothing unethical or dishonest about making a profit by delivering necessary, effective care.

New technologies have led to an increase in procedures dentists provide
As science and technology progress, it is plausible that the number and types of procedures available to dentists may also increase. However, before a procedure is provided, it is essential to know that it is safe, effective, and necessary. This is why doctors, universities, and other scientists are required to test drugs or other therapies before they are approved for use.

Evidence-based treatment has been proven to be effective
Scientific research allows doctors to be sure that the therapies they provide are safe and effective. Appropriately conducted research also determines if the treatment is necessary by comparing the effects of the therapy with patients who receive either a placebo or no treatment at all. Treatment techniques tested using the scientific method are known as "evidence-based."

Research that doesn't include a control group can't demonstrate cause and effect
Three other justifications used by doctors and companies to promote their services do not meet the standards required by evidence-based research. The first is research that does not include a "control group." Control groups are important because they answer the question, "What happens to similar patients who receive no treatment?" This is critical so that patients do not receive unnecessary treatment.

For example, suppose a group of eight-year-old children are all given an experimental diet supplement to help them grow taller and are then measured a year later. All of them would grow taller with or without the supplement. The only way to know If the supplement makes any difference is to compare those who take it with those who don't. If a sleep study shows improvement in OSA scores without including a control group, the inferences that can be drawn are inconclusive.

(NOTE: This is the first of three articles on dentists, myofunctional therapy, and sleep apnea. Click HERE for Part 2)

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho and Albuquerque, New Mexico. He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen's 30+ years of specialty practice and 10,000+ finished cases qualify him as an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. Copyright laws protect the opinions expressed here and can only be used with the author's permission.