Dental sleep medicine a new certification

Obstructive sleep apnoea (OSA) is a sleep disorder whereby an individual has repeated partial or complete airway obstructions due to intermittent narrowing or collapsing of their airway. This is a serious and potentially life-threatening condition that affects up to 30% of the population with a higher prevalence in men and in an ageing population.

While the interest in OSA and the scientific basis for oral appliances therapy (OAT) may seem relatively new in dentistry, oral appliances have been used for almost 200 years and OAT for the treatment of OSA for half a century. In 1934, French stomatologist Pierre Robin was the first to use a monobloc mandibular advancement appliance for the purpose of treating OSA and had previously used oral appliances in the 1900s for glossoptosis.

OAT works by advancing and stabilising the mandible thereby improving upper airway patency. The knowledge of its mechanism of action and use came to the forefront of medicine with the advent of general anaesthesia in the 1840s. Close to 100 years later, in 1973, OSA syndrome was first characterised in the medical literature. Subsequently, the more than a century old knowledge on the effective use of mandibular advancement to physically improve airway patency came to the forefront. The first oral appliances were tongue retaining devices and fixed mono-block devices. Subsequent research and development led to the adjustable devices, similar to what are in routine use today.

Since the early days of OAT in the 1980s, there has been substantial research into the mechanisms of action and efficacy of these appliances for snoring and OSA. As such, by the early 2000s, the field of Dental Sleep Medicine (DSM) was well established in most countries and OAT emerged as a viable alternative to continuous positive airway pressure (CPAP) for the treatment of OSA.

The diagnosis of OSA must be established by a medical doctor, based on the results of an overnight polysomnography (either at a laboratory or at home) under the management of a sleep physician. Typically, the polysomnography report will outline the diagnosis and treatment recommendation. For OSA, treatment recommendations may include sleep hygiene instructions and behavioural modifications such as weight loss, postural modification, CPAP, upper airway surgery and, in appropriate cases, OAT. As such, patients may be referred by their medical general practitioner, ENT surgeon, sleep physician, cardiologist, or occupational physician to a dentist for OAT. 

To date, there is no standardised training in the field of DSM at Dental Schools in Australia, which makes it difficult for referring medical practitioners to identify dentists trained and competent in the field. Often referral to dentists for OAT is based on self-proclaimed experts forging a relationship with medical practitioners with an interest in Sleep Medicine.

Given the risk for morbidity and mortality with untreated (or mismanagement of) OSA and its cardiovascular, metabolic, and cognitive comorbidities, dentists with an interest in DSM
must be both trained and competent in aspects of sleep medicine beyond the basic mechanics of constructing mandibular advancement appliances. A rigorous understanding of the sleep disorder being treated and associated comorbidities is necessary so the best possible outcome for the patient may be achieved.

To address these issues, the Australasian Sleep Association, the peak body in Sleep Medicine in Australia and New Zealand established assessment objectives (Table 1) and launched a certification in DSM in 2022 which aims to recognise dentists who have achieved minimum clinical competencies in DSM in Australia. The current Fellowship
of Dental Sleep Medicine (FDSM) committee include a number of experts in the field of Sleep Medicine (Table 2).

Eligible dentists who complete the certification requirements will be afforded the postnominals ‘Fellowship of Dental Sleep Medicine’ or ‘FDSM’. All FDSM fellows will be listed on the Australasian Sleep Association’s public website. As this certification program was established by a multidisciplinary team of sleep medicine experts, dentists who complete the FDSM will be recognised by our medical colleagues and patients as qualified in the field.

The criteria to complete the FDSM include a three-hour multiple-choice examination, a logbook of 15 cases, three case reports, attendance at a sleep laboratory placement overnight, and two references from sleep physicians with whom you have worked.

For further details regarding the FDSM, visit sleep.org.au or contact Dr Dinukshi Daniels
via email at fdsm@sleep.org.au

From the professionals who’ve qualified

“It’s good to have a formal qualification. The Fellowship of Dental Sleep Medicine is an excellent initiative by the ASA that gives dentists the opportunity to advance their skills in dental sleep medicine, show a commitment to the field with evidence-based knowledge, enhance collaboration between the dental and medical communities, and be recognised for their efforts and dedication. It blends together clinical and academic experience to give sleep professionals confidence in referring patients for oral appliance therapy, and patients the reassurance that they are receiving quality care with the prime goal being optimal patient management outcomes.” (Dr Adam Teo, Queensland)

“The Dental Sleep Medicine Fellowship covers a wide range of knowledge and experience required to practice in the field. The exam requires a thorough understanding of respiratory and sleep medicine, dental sleep medicine and long-term management of the patients. The case portfolios require a demonstration of your knowledge in a practical manner. The sleep lab observation requirement allows understanding of the procedures involved in diagnosis and management of a wide range of sleep disorders. I chose to complete the Dental Sleep Medicine Fellowship to add credibility to my practice and advance my knowledge to treat patients with evidence-based professional knowledge and provide them with the quality of care.” (Dr Anam Khan, Western Australia)