If you have patients with untreated Sleep Apnea because of PAP non compliance we maybe able to help you. As you know untreated Sleep Apnea can have profound effects on your patients health and make your treatment plans more difficult to meet. An oral Appliance will not resolve all sleep issues, but a great many patients have tried PAP and were not able to continue. We are a Medicare Approved DME practice, so patients can be reimbursed for the covered portion of their appliance.
Who to refer
We are focused on treating those patients who are unable to utilize PAP, or those who need both PAP and OAT. As you know PAP is the gold standard in SA treatment as such we advise patients who are successfully using PAP to continue with PAP. Our best candidates are those who are unable to utilize PAP.
How to refer
The easiest way to refer is to fax us. Please include the patients Name, Birth Date, contact information and reason for the referral. Send the fax to (352) 753-7340.
Richard W. Rozensky DDS, D.ABDSM
Richard W. Rozensky DDS, D.ABDSM is a graduate of the University of Buffalo, School of Dental Medicine where he minored in periodontology. After graduation he served in the USAF treating thousands of active duty members at multiple locations. The USAF enabled him to participate in many advanced courses in dentistry. Upon leaving the USAF he settled in Ocala and has been practicing in The Villages since December 2002. A devoted believer in continuing education he has attended the two year Comprehensive Dentistry Course An Advanced Program at the University of Florida, College of Dentistry. Additionally he was one of the first to complete the Executive Dental Management Program at the University of Florida, College of Dentistry.
His experience in Sleep Dentistry has grown over the years. His first Sleep Apnea Appliance was over 10 years ago. Recognizing patients were underserved and untreated in in sleep he committed to educating himself in multiple aspects of Sleep Medicine. Over time he was able to obtain status as a Diplomate of the American Board of Dental Sleep Medicine. This is recognized by the American Academy of Sleep Medicine as making him qualified to treat Obstructive Sleep Apnea with oral appliances.
What we do for you and your patient
- We rely on Physicians to recognize their patients as having untreated sleep apnea.
- Approximately 50% of all patients with OSA have tried PAP and were unable to continue treatment. There are a variety of reasons for this but untreated OSA has proven to have negative effects on a patients health. This can affect your patient management and success of your treatment plan.
- Upon receiving a referral we contact the patient and proceed to gather relevant records. We appoint the patient for a consultation/ screening appointment. At this time we have the patient complete a comprehensive medical history as well as multiple sleep based questionnaires (ESS, Stop-Bang, etc)
- We complete a dental exam focused on sleep. We look at the structure of the overall oral cavity, not just the teeth. If we discover any dental needs we refer them to their dentist to have those needs addressed.
- OSA is a medical condition we do not fabricate an appliance or proceed with any treatment except upon receipt of a prescription from a Board Certified Sleep MD. We work with several and try to be as efficient with time as possible in obtaining a prescription.
- If the patient is a candidate for treatment and we have the prescription we will schedule the patient for a digital scan. We are a completely digital office. We use 3D scanners to record the patients teeth and jaw. The digital file is then sent to an FDA Medicare approved lab for fabrication of an FDA Medicare approved appliance.
- Once we have the custom Oral Appliance we fit it to the patient and follow their treatment. We adjust the appliance and then when it is set properly either refer the patient back to you, a Sleep Physician the patient or have HST completed and reviewed by a Board Certified Sleep Physician. Since this a medical condition you select the overall work flow for the patient.
- Copies of any HST's are sent to your office. We continuously update you and your staff as to your patients progress, we copy you on any correspondence to other offices so you will always know what is transpiring with your patient. Upon completion of treatment we refer the patient back to you.
- Sleep Apnea is a managed condition so every few years the patient will need to have a sleep test completed. This can be performed at a local Sleep Clinic with either a PSG or a HST.
- Once a year we need to see the patient for a follow up to ensure the appliance is being properly maintained and the settings are correct as well as ensuring no dental issues are presenting. This is usually a 20 minute appointment.
- If you have questions we can help you. Please call us at (352)-430-1710
Evidence Based Treatment
Evidence based treatment is critical in the success of treating OSA. We follow AASM and AADSM protocols in the treatment of OSA. Our treatments are based on accepted research.
Oral appliance therapy clinical guideline published jointly by AASM and AADSM
The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) have published a new clinical practice guideline for oral appliance therapy, which updates the practice parameters that the AASM published in 2006. The guideline recommends that sleep physicians consider prescription of oral appliances for adult patients with obstructive sleep apnea (OSA) who are intolerant of CPAP therapy or prefer alternate therapy, and it suggests that oral appliance therapy be provided by a qualified dentist using a custom, titratable appliance.
The guideline notes that CPAP therapy should still generally be the first-line option for treating OSA because it is superior in improving oxygen saturation and reducing the apnea-hypopnea index (AHI) and arousal index. The guideline also recommends that sleep physicians prescribe oral appliances for adult patients who request treatment of primary snoring, emphasizing that diagnosis of primary snoring should be rendered by a sleep physician and not a dentist since snoring is a cardinal symptom of OSA.
To learn more click on the links below.
Journal of Clinical Sleep Medicine (2021)
Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data
Cureus Journal of Medical Science (2021)
Efficacy and Effectiveness of the ProSomnus® [IA] Sleep Device for the Treatment of Obstructive Sleep Apnea: EFFECTS Study
Journal of Applied Physiology (2020)
CPAP combined with oral appliance therapy reduces CPAP requirements and pharyngeal pressure swings in obstructive sleep apnea (2020)
Amercian Academy of Sleep Medicine and American Academy of Dental Sleep Medicine Joint Position Paper (2017)
Journal of Clinical Sleep Medicine (2015)
Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015
Journal of Clinical Sleep Medicine (2014)
Oral appliance treatment for obstructive sleep apnea: an update