diagnose and treat sleep apnea indepen- dently, this would be a violation of the Texas Medical Practice Act. This would include a dentist ordering a sleep study.” According to dental board meeting minutes, W. Keith Thornton, DDS, a Dal- las dentist who invented the Thornton Adjustable Positioner (TAP), a mouth- piece designed to replace CPAP, sub- mitted written comments in favor of the rule, as did the Texas Academy of General Dentistry and Plano dentist Bill Gerlach, DDS.
“I think it’s a travesty,” said Houston
neurologist Bob Fayle, MD, a member of TMA and TNS who testified before the dental board against the rule change. Dr. Fayle says CPAP is the most effec- tive form of treatment for OSA. Mouth- pieces like TAP can help mild cases of sleep apnea but are not enough to treat severe cases of OSA, he says.
“Sleep apnea can be potentially fatal,” he said. “I’m not tied to any one treat- ment, but 95 percent of the time, CPAP is the most effective treatment.” Dr. Fayle says it is common for un-
treated OSA patients to have cardiac ar- rhythmias and heart block.
“Some of those can be lethal,” he said.
“All that goes away when you put them on CPAP.” Dr. Fayle says a small, vocal group of dentists pushed for the rule. He worries dentists will use mouthpieces to treat severe cases of sleep apnea, “which ba- sically means those cases are not being treated,” he said. “We all feel that sleep apnea is a medi- cal illness. For the dentists to be doing this is exceeding their scope of practice. It’s going to lead to a big fight, I think, between the medical board and the den- tal board,” he said. “I’m afraid all that is going to get very contentious.” That contention could ruin the col-
legial relationship between many physi- cians and dentists, he says, negatively affecting patient care. Attempts to expand NPP scope of practice have caused TMA to take up arms in the past and defend certain pro- cedures that should be performed only by trained physicians, such as TMA’s suit in 2006 to invalidate the Texas Board of
Chiropractic Examiners’ (TBCE’s) rule permitting chiropractors to diagnose and test for neuromuscular diseases. Dr. Fayle worries the dental board’s decision also could lead to a lawsuit. Dr. Monday says she fears the new rule will mean patients with moderate to severe OSA will be underdiagnosed, leading to complications, including an
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September 2014 TEXAS MEDICINE 29
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