Snoring and Obstructive Sleep Apnoea Syndrome (OSA)

The role of the clinician continues to evolve in the provision of appliances either for the treatment of snoring or to assist in the treatment of Obstructive Sleep Apnoea Syndrome (OSA). The most recent development is the inclusion of the role of the clinical dental technician (CDT) in the General Dental Council’s Scope of Practice document.

Dentists may be asked to fit anti-snoring appliances and Dental Protection has frequently been asked if the provision of such devices can be considered to be the practise of dentistry and therefore is within the scope of assistance normally provided to dental members.

Our view is that:

1. Dentists and CDTs are well placed to construct any oral appliance/device provided they have appropriate training to do so.
2. The diagnosis and treatment of OSA, other sleep disturbances or snoring conditions does not fall within the definition of the practise of dentistry and therefore falls outside the scope of assistance normally provided by Dental Protection. However, dentists can have an important role in the screening of patients for signs and symptoms which may predict the presence of OSA.

Obstructive Sleep Apnoea

This is a condition that can have serious consequences. It is important that all patients who exhibit signs and symptoms of sleep apnoea should have a proper medical assessment and, if necessary, be referred to an appropriate specialist for treatment.

An anti-snoring device, whilst reducing snoring, could be counter-productive in terms of masking symptoms of OSA, thereby resulting in late diagnosis of the condition.

It is vital that a proper assessment of the patient, to exclude signs and symptoms of OSA, is carried out prior to the provision of any anti-snoring device (mandibular advancement device). Such assessments should be in line with contemporary standards.

Dentists and anti-snoring devices

Patients may request that a dentist provide an anti-snoring device. A dental member will be entitled to apply for assistance in respect of the provision of such appliances provided the following conditions are met:

1. The dentist has undergone a documented training course in the provision of anti-snoring appliances which includes training in the appropriate screening for OSA.
2. The patient has been properly assessed for the signs and symptoms of OSA in accordance with contemporary standards and such assessment is documented.
3. If the patient exhibits signs or symptoms of OSA, there must be a referral for a medical assessment.
4. Patients should be advised if appropriate of the risks and benefits of anti-snoring appliances including any potential impact on the occlusion and the temporomandibular joints. Documentary evidence of the consent process must be kept.

Where OSA is present, any anti-snoring device should only be provided as part of an integrated treatment plan.

Dental Protection will not normally assist when the above conditions are not met in full.

Clinical Dental Technicians (CDTs)

The GDC’s Scope of Practice document (effective from 30 September 2013) states that as an additional skill, CDTs may 'provide anti-snoring devices on prescription of a dentist'. This statement has to be read in conjunction with the GDC’s other relevant guidance documents which among other things require that all registrants must ‘only carry out a task or a type of treatment if appropriately trained, competent, confident and indemnified’.

CDTs, unlike registered dentists, cannot be ‘appropriately trained, competent, confident and indemnified’ to diagnose medical conditions, as this would amount to the illegal practise of dentistry. Dental Protection will only consider assisting CDT members who have provided an anti-snoring device for a patient if the following conditions are met:

• An appropriately trained medical practitioner has assessed the patient and made the diagnosis
• They have undergone a documented training course in the provision of such appliances which includes training in the appropriate screening for OSA
• They are in possession of a prescription for that patient from a suitably trained dentist

• It is also incumbent on the CDT that they should ensure the four conditions, set out earlier, required of the dentist prescribing the anti-snoring device have been met in full, to ensure the appropriateness of the prescription they will be working to. Dental Protection will not normally assist when this requirement has not been met.

In summary:

• A proper medical assessment of patients who exhibit symptoms is essential.
• The diagnosis and treatment of OSA falls outside the definition of the practise of dentistry.
• Anti-snoring devices should only be provided as part of an integrated treatment plan.
• Clinical dental technicians can provide anti-snoring devices on a dentist's prescription.