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Are Dentists Qualified to identify & Treat Obstructive Sleep Apnea? Daniel Smith, DDS, FAGD


Obstructive Sleep Apnea (OSA) is a condition in which a person has episodes of stopped breathing, usually occurring at night, due to upper airway obstruction. According to the American Academy of Sleep Medicine, in 2008 more than 100-200 million people suffered from OSA. Persons suffering from OSA run the risk of increased heart attacks, high blood pressure, strokes and other co-morbidity problems that dentists and other medical professionals are just starting to understand. OSA affects people of all ages and body types, and is especially prevalent in men and post-menopausal women.

Unfortunately the majority of people suffering from OSA do not seek treatment, mainly because of lack of knowledge about the problem. This condition can have no outward recognizable signs or symptoms and most often is discovered by professionals during a routine examination. Although some symptoms are recognizable, such as chronic snoring or excessive daytime sleepiness (EDS), with or without these outward symptoms the goal of the medical professional is to discover, educate and treat their patients so that the quality of their lives is enhanced.

Although dentists have never been looked to for the diagnosis of OSA, as a result of increased studies on the disorder, dentists are discovering new techniques to properly diagnose the problem. Certain observances that are only made by one’s dentist, such as specific skeletal and morphological relationships, which are more prone to apnotic tendencies; large tongue size relative to arch; existing tonsils with high grading; narrow arch width and/or low hyoid bone are all contributing factors that could lead to OSA. Additionally, changes in dental structures such as an increase in bruxism can also play a role in the development of OSA. If a dentist receives proper training and is willing to work in collaboration with another medical professional, he/she can be instrumental in recognizing and delivering a solution for this severe medical problem.

Our primary goal as dentists should be to ask the correct questions during a recall or initial examination to help in the diagnosis of the disorder. At my practice, The Focus Center of Sleep Apnea and Snoring, located near Los Angeles, California, I begin examinations by asking questions such as “Do you snore?”, “Does your sleeping partner think you snore?”, “Do you easily fall asleep during the daytime?” and “Do you have a difficult time breathing through your nose during the day or night?” If one of my patients gives positive responses, I have the choice to either refer him/her to a sleep specialist or to be involved in the treatment. The uniqueness of our office is that we have a medical doctor on staff who does the medical workups for each patient to give us a medical perspective to help with diagnosis.

The first step in a patient’s treatment is to have him/her take home the Epworth and Berlin tests to answer personally as well as by their sleeping partner. These tests allow me to get more specific in questioning the patients on their condition. Our goal, at this point, is to quantify the subjective feelings of the patients into an objective value so the patient owns the problem. “Owning the problem” is one the most important aspects of the diagnosis and that is why the sleep partner’s evaluation is so important. I am always surprised at how the bed partners’ tests and patients’ tests differ! Patients need to first see how bad the problem is and then understand the consequences if they are not treated.

Once we have these results and scored the questionnaires, we again decide whether to refer the patient to a sleep specialist and/or treat the patient internally with additional sleep testing and a full medical work-up done by a qualified physician. When I elect to continue on with a patient’s treatment, I will administer an ambulatory take home sleep study, which has a very high degree of correlation with polysomnogram (PSG) tests at an overnight sleep center. The results of this test allow us to get an idea of the patient’s level of OSA. Even though dentists can be trained to read the take-home sleep study, a board certified sleep specialist is needed to accurately read and diagnose the problem. Remember though, the job of the sleep specialist is to simply diagnose the problem by reading the test results; sleep specialists do not dictate the treatment. I recommend working with an on-site sleep specialist who can easily offer a medical workup as well as read test results as in our office. Once determining the diagnosis, if severe OSA, at this time you must refer your patients to a sleep lab so an advanced overnight sleep study can be conducted and CPAP therapy prescribed if necessary. Should the patient then refuse the CPAP, then an alternative is an oral appliance for the severe OSA. In addition, if we have determined that tonsils are a huge contributing factor, we will refer to an ENT for removal and then retest. Why? The results show that a majority of CPAP users stop using this method of treatment after the first year. Our goal is to help determine the problem and treat versus just treating a particular symptom.

For those people with mild or moderate OSA, dentists are able to use an appropriate Oral Appliance Therapy (OAT) device to reposition the mandible forward and open the airway. Not all devices reposition the mandible forward, as some move the tongue anteriorly by pushing from the base of the tongue forward or others actually pulling the tongue out. Through different in-office testing methods, like with a pharyngometer, you can determine if the airway is opened during simulated times of sleep, and therefore select the correct treatment option. After prescribing the proper device, patients use it for a few weeks and then undergo another at-home ambulatory sleep study to see if the results show a lowered OSA value. At this time, it is imperative to give a follow-up questionnaire to determine if the symptoms of the patients have decreased. Unfortunately, we do not have 100 percent success with appliance therapy, but our success determined by long-time comfort and usage is much higher than for traditional CPAP therapy.

There is a huge difference between the practices of medicine and dentistry; even though we have determined that an OAT should work effectively, it might not give us the required result. Dentists are used to their treatment plans working… if there is a broken cusp we place a crown. Medicine might need many solutions to get the desired result. Medical Doctors are used to treatment modalities requiring multiple answers. We need to think like they do; maybe use an OAT and a surgical procedure. For example, after OAT the patient might have a lowered snoring sound but still have a high OSA. Is the treatment a success? The answer is no for systemic health reasons but yes for treating a symptom (snoring). In our office we then decide if there are more contributing factors that are preventing a better outcome. This can occur when the patient did not follow the orders of the doctor such as: to lose weight. Other times we might involve a consult with an ENT to consider a surgical procedure involving the soft palate. The advantage of having a physician in the office is that we are able to deal with contributing factors more effectively to ultimately give the patient a higher chance of long term success. Our goal is to diagnose, treat, retest and make the patient healthier with all available options for treating OSA.

When looking to enhancing your involvement in Sleep Medicine and dentistry the two active organizations that are most important are the AADSM (American Academy of Dental Sleep Medicine and AASM (American Academy of Sleep Medicine). Dentists should join both and meet other specialists with whom they can refer back and forth patients.

If you are interested in expanding your practice by aiding your patients in their OSA diagnosis, you can begin by simply incorporating a few changes into your routine examination. Just a simple questionnaire can make your patients aware of their problem, and lead them down the road to a correct treatment plan.
Author's Bio
Daniel Smith, DDS, FAGD, graduated from the University of California, Los Angeles (UCLA) School of Dentistry in 1981 and began his professional career with the U.S. Public Health Service in Dallas, Texas, while simultaneously in Private Practice in Plano, Texas. Dr. Smith has a subspecialty in implant dentistry (Diplomate ICOI) and has lectured and developed products in that field. His active role in learning about sleep medicine occurred because of his own snoring problems and has accelerated his desire to become a Diplomate in the AADSM organization. Besides practicing dentistry, he is the active director of Focus Dental Institute for Implant Reconstruction (multi specialty group) as well as co-director with Kathleen Anderson, MD, and founder of Focus Center for Sleep Apnea and Snoring.
Dentaltown Magazine
September 2025
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