When it comes to representing dentists to government, the ADA is used to talking about private health insurance, practitioner regulation, red tape and dental funding for disadvantaged Australians but it’s not very often that we get to talk about sleeping.
But that’s exactly what we have been doing recently and to the Australian Parliament Health, Aged Care and Sport Committee who are conducting an inquiry into sleep health awareness in Australia.
The Committee Chair, Mr Trent Zimmerman MP, stated that “the Committee will examine the causes, economic and social costs, and treatment of inadequate sleep and sleep disorders. In addition to education and training available to medical (and allied health) professionals regarding sleep health issues, and current research into sleep health.”
Some of you may be thinking this is a strange topic for the ADA to be involved in and most likely, the Committee probably thought the same until they read . They obviously thought we had a lot to add to the discussion because they invited us to present to them in person.
Dr Andrew Gikas, Past President of the ADA Victorian branch and recently appointed Dental Board of Australia member and Conference Chair of the Australasian Sleep Association and Eithne Irving our Deputy CEO/General Manager of Policy represented the ADA at the hearing and spent almost 45 minutes with the Committee reinforcing some of the issues related to oral health and sleep.
Our discussions with the Committee focused on a couple of key matters.
First, explaining to them the role dentists play in managing snoring and obstructive sleep apnoea and bruxism and our affiliation with the Australian Sleep Association.
As many of you would know bruxism is divided into awake bruxism (AB) and sleep bruxism (SB) with SB classified as a sleep disorder, it is reported that up to 20% of children will brux their teeth while they sleep. Studies show this incidence decreases as they get to teenage years with approximately 3% of the adult population still affected by SB and 4.6% by AB, with up to 40% of the population occasionally clenching during the day.
Many dentists are concerned about regularly seeing tooth wear, tooth loss and significant damage to teeth in bruxing patients. Rehabilitating and reconstructing bites is both costly and complex so having the opportunity to pick the destructive bruxism habit early is facilitated by regular dental care and continuity of care with the same dentist.
A lot of the discussion in both our submission and at the hearing related to the second important issue, Obstructive Sleep Apnoea (OSA). However, as we pointed out to the Committee, we are concerned about the increasing commercialisation in the provision ADA addresses inquiry into sleep health awareness of oral appliances for snoring and obstructive sleep apnoea by nondentists and believe that this is something of significant concern that the Senate should consider in detail.
We made it clear to the Committee that we believed that over-the-counter self-prescribed and self-fitted devices be subject to the same regulations as medically prescribed and dentist fitted devices.
OSA is increasingly recognised as an important public health concern. Large studies estimate that as many as 23% of women and 50% of men have OSA and up to 13% of men and 6% of women have moderate-severe OSA. It is thought that up to 75% of people are undiagnosed.
So, it was important to make the Committee understand that dentists are in a perfect position to ask their patients about their sleep as 55.5% of the population has seen a dentist in the last 12 months. Dentists have the opportunity to screen patients with either validated questionnaires or targeted questions that tease out who may have sleep disorders. We acknowledged that to obtain a diagnosis it is necessary to involve the patient’s medical practitioner and a qualified sleep medicine practitioner, who can interpret a sleep study.
The problem is that the Medicare system does not support the referrals required to support best clinical practice as there is no rebate payable to a patient if they are referred to a sleep physician by a dentist. To get a rebate, the patient has to go back through their GP.
The ADA argued that this is not good medicine and indeed it is common to see patients who have failed one therapy, show up with a prescription for another when it may have been better to do it the other way around. Savings can be made, and better treatment outcomes will result in a truly multidisciplinary approach to OSA.
Our recommendation therefore was that a referral by a dentist to a sleep physician should attract a Medicare rebate for patients.
We look forward to seeing the Committee’s recommendations which should be available in the next month or two.
