Provide With A No First Line Of TX - PowerPoint Presentation

Slide1

Provide With A

No

First Line Of TX

Dentist Screen Their Patients

By

Screening

Children

No Problems

Monitor

Growth & Development

Problems Identified

Manage

Growth

& Development

Protocols Like

HealthyStart

With Orthodontics

As Needed

While Creating A Healthy Adult Airway

Screen The

Adult Population

Not At Risk

Follow Up At Recalls

PAP – Non- Compliant

We’ll Revisit These

PAP Compliant

Review The Compliance Reports & Consider ONO (HRPO)

At Risk

Yet Undiagnosed

AHI > 30

Consider Spo2, HR Variability, Comorbidities

AHI < 30

Consider Spo2, HR Variability, Comorbidities

Order or Dispense a Multiple Night HST With An MD Interp.

LOMN / RX For PAP MD Refer For Therapy

Fails PAP Request Medical Collaboration

These Two

Processes Need To Be Better Monitored

Then

Reevaluate

On Recall

PAP Compliant Monitor Compliance Reports & ONO (HRPO)

& If Determined To Be A Candidate Request LOMN / RX For A Mandibular Advancement Device

An Initial Draft

Referral To The Patient’s MD For Medical Collaboration

Creating Healthy Airways

Maintaining Airways

An Alternative To CPAP

An Oral Appliance

ENT Referral

HGN Implant

Before A Dentist Orders An OA An MD LOMN/RX Should First Be Obtained And In Records

Perform A Consultation Discussing OSA & All Options Especially PAP

At The Same Visit Evaluate Candidacy For OAT

Gather All Clinical Notes & The Study Results

Deliver Custom Fabricated Appliance & Titrate To Efficacy & Administer HST

Diagnostic Testing Allowed

If Indicated

By MD

A Consideration Regarding Testing Guidelines(Alberta )

At all levels a determination needs to be made as to who needs to be tested and how, and who performs the follow up. I think we can all agree that the process must also include an initial screening, a comprehensive assessment to determine who needs to be tested and how, the testing itself however that is determined to be done, then treatment considerations and follow up monitoring and care.Initial Screening: this can include but is not limited to issues such as loud snoring, witnessed apneas and daytime sleepiness.Comprehensive Assessment: this can include but is not limited to age, history of hypertension, controlled or uncontrolled, cardiac issues, congestive heart failure, pulmonary disease, smoking, COPD, tonsillectomy, family history of sleep apnea, medications, previous sleep testing or treatments, Stop Bang / ESS, BMI, suspected hypoventilation syndrome, UARS, dental conditions such as retrognathia, edentulism, periodontal health and compliance expectations.

After the Initial Screening and Comprehensive Assessment, based on the above it will need to be determined if an In or Out of lab study is indicated according to established guidelines.After Testing and the Interpretation by a BoardCertified Sleep Physician a determination will be made for:A Referral back to a medical provider, PCP or Sleep Physician for a determination of care.

Rx for a Self titrating AutoPap.Rx for a PAP Titration Study.Rx for a Mandibular Advancement Device.Other more definitive care such as a Cardiac, Pulmonary or other Medical Evaluation.Care Follow up and monitoring should be a shared collaborative responsibility between the patient’s medical team and their dental team:The Dental Teams Responsibility is to fabricate, adjust and care for oral appliances if ordered by the physician.

The Medical Teams Responsibility is to reach out to and utilize a dentist qualified in treating sleep for evaluations and requests for collaborative care by Rx.Both Medical and Dental providers need to proactively share records and information that is deemed to be in the patient’s best interest.As many, if not all, of these considerations will have to be determined and negotiated within Standard of Care Guidelines, first between the representative organizations and then on a case by case basis between providers on the ground – I have provided below two links – one to Alberta’s 2016 Draft Proposal and two to the adopted 2019 version. These can be viewed as a great starting point from which to build a program here in the states even though we have very different healthcare models.

Standard Of Care Guidelines

Alberta Draft 2016Alberta Adopted 2019

No

First Line Of TX

Dentist Screen Their Patients

By

Screening

Children

No Problems

Monitor

Growth & Development

Problems Identified

Manage

Growth & Development

Protocols Like

HealthyStart

With

Orthodontics

As Needed

While Creating A Healthy Adult Airway

Screen The

Adult Population

Not At Risk

Follow Up At Recalls

PAP – Non- Compliant

We’ll Revisit These

PAP Compliant

Review The Compliance Reports & Consider ONO (HRPO)

At Risk

Yet Undiagnosed

AHI > 30

Consider Spo2, HR Variability, Comorbidities

AHI < 30

Consider Spo2, HR Variability, Comorbidities

3 Night

Self Reporting HST

Like The NightOwl

LOMN / RX For PAP MD Refer For Therapy

Referral For OAT Or Fails PAP Request Medical Collaboration

Now Three Processes Need To Be Better Monitored

Then

Reevaluate On Recall

PAP Compliant Monitor Compliance Reports & HRPO

LOMN / RX For A Mandibular Advancement Device

An Initial Draft

Referral To MD For Definitive Testing HST or PSG

Creating Healthy Airways

Maintaining Airways

An Alternative To CPAP

An Oral Appliance

ENT ReferralHGN ImplantBefore A Dentist Orders An OA An MD LOMN/RX Should First Be Obtained And In Records

Return To MD

If There Is Going To Be a Significant Delay In Obtaining A Diagnosis Or Getting Treatment, As Determined & Ordered By A Medical Provider, A Protective Temp Appliance Could Be Fabricated For Safety.

No Diagnostic Testing Allowed

If Indicated

By MD

MyTap – Optional Based On Need, MD Referral

And Patient Risk

If There Is Going To Be a Significant Delay In Obtaining A Diagnosis Or Getting Treatment, As Determined & Ordered By A Medical Provider, A Protective Temp Appliance Could Be Fabricated For Safety.

No

First Line Of TX

Dentist Screen Their Patients

By

Screening

Children

No Problems

Monitor

Growth & Development

Problems Identified

Manage

Growth & Development

Protocols Like

HealthyStart

With

Orthodontics

As Needed

While Creating A Healthy Adult Airway

Screen The

Adult Population

Not At Risk

Follow Up At Recalls

PAP – Non- Compliant

We’ll Revisit These

PAP Compliant

Review The Compliance Reports & Consider ONO (HRPO)

At Risk

Yet Undiagnosed

NightOwl Like Device

Titrate To Efficacy

Titrate To Subjective Symptoms

Delay In Treatment Or A Perceived Risk Deliver myTap

AHI > 30

Consider Spo2, HR Variability, Comorbidities

AHI < 30

Consider Spo2, HR Variability, Comorbidities

3 Night

Self Reporting HST

Like The NightOwl

LOMN / RX For PAP MD Refer For Therapy

Fails PAP Request Medical Collaboration

Now Three Processes Need To Be Better Monitored

Then

Reevaluate On Recall

PAP Compliant Monitor Compliance Reports & HRPO

LOMN / RX For A Mandibular Advancement Device

Whether AResponder or Non Responder

An Initial Draft

The Need For The Delivery Of A Trial Appliance

Should Be Dependent On A Balance Between The Severity Of The Patient’s Disease, The Comorbidities And The Expected Delay In Delivering A Diagnosis And Initiating The Treatment As Determined By An MD

Referral To MD For Definitive Testing HST or PSG

Creating Healthy Airways

Maintaining Airways

An Alternative To CPAP

An Oral Appliance

ENT Referral

HGN Implant

Before A Dentist Orders An OA An MD LOMN/RX Should First Be Obtained And In Records

Return To MD

No Diagnostic Testing Allowed

– A Protective

Protocol -

If Indicated

By MD