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Controversies in Dentistry

17 Oct 2016

There are probably more controversial areas in dental sleep medicine than any other field of dentistry, with dentists using methods and techniques which are not regarded as standard practice in the field.

While these dentists might say they are backed by scientific evidence, it is not the type of evidence that is accepted when the protocols were devised by the peak bodies in the field, such as the American Sleep Association and the American Academy of Dental Sleep Medicine.

The controversial areas include various investigations, types of appliances, taking a registration, and methods of predicting success. These methods generally add to the complexity and expense of treatment, often without providing any benefit, and have the potential to cause problems.

These controversial methods can be very confusing for a dentist new to the field and wanting to establish their protocols of practice. So what should a dentist do?

My recommendation is to first become familiar with the seminal articles that have been published in the established journals. Another step is to find out what experts in the area are doing. And I would be very discriminating in who I considered an expert. Fortunately in the area of dental sleep medicine there is a group called the ORANGE network (Oral Appliance Network on Global Effectiveness). 

They are comprised of 15 heads of departments, associated with sleep units in some of the most prestigious universities in the world. They have published widely and many have written textbooks or chapters. This group are practising within defined guidelines.

My recommendation is to look at their published material and find out how they, and their clinics operate. I have been in contact with some members of this group and they are very happy to share their protocols. 

It is these protocols that have provided the published evidence that place oral appliances at the forefront of the established treatment options.

Other areas of controversy involve treatments based on the assumption there is a proven, causative relationship between sleep disordered breathing, bruxism and temporomandibular disorders.  Associate Professor Ramesh Balasubramaniam, chair of the dental orofacial group of the Australian Sleep Association, and a foremost authority in the field, has published an excellent overview article on the state of knowledge in this area.

I would also recommend attending training programs such as at the annual me


etings of the Australian Sleep Association and their oral sleep medicine course, and the American Academy of Dental Sleep Medicine and their three day program. The controversial methods have never been presented at these meetings.

I would make the point that if you are going to deviate from the established protocols, you should have a very good reason for doing so, and as part of informed consent you should let your patient patient know that this is what you are doing.

In conclusion, I would like to recommend that dentists make the effort to do their own investigation and develop a sound basis for their way of practice.

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