I am responding to your post "Outrageous claims by dentists". You mention an unfortunate situation where a dentist placed an oral appliance in a patient's mouth without any diagnostic basis for doing so. There can be no justification for this behavior and no dentist who is trained in sleep medicine would do such a thing. It takes very little training and no understanding of sleep medicine to learn how to make a "snore appliance". It takes a great deal of training and a significant amount of time to help someone manage a sleep-related breathing disorder using established medical protocol. So I would suggest, in this situation, not taking a shot at dentists but, rather, at ignorance and bias.

Later on in your post, you say "Which brings us to the dentist behind the IHateCpap.com website. In a promotional video he features on his website, below, he says the reason he got involved with Sleep Apnea and developed the oral appliance he markets was to help his 5-year old son, who was diagnosed with severe obstructive sleep apnea. But if the consensus among even the dental lobbying group is that oral appliances should not be a first choice therapy for severe obstructive sleep apnea, we believe the founder of IHateCPAP.com should offer up CPAP first to his patients with severe OSA, including his 5-year old son. After all, they shouldn't become innocent victims of a turf war?"

If you watch the video, that isn't what the dentist says at all. The news anchor reporting this story clearly states at the beginning, "Snoring and apnea are best treated by your sleep doctor and dentist working together". At no point in this story does the dentist say that he treated his 5 year old son with an oral appliance. The vast number of children of that age with sleep apnea have enlarged tonsils and adenoids. The first line therapy is almost always surgical. An oral appliance is contraindicated in a growing child UNLESS they have mandibular insufficiency. In this situation, a dental orthopedic appliance can be used to deal with the mandibular insufficiency as well as the sleep apnea.

I will say that I am uncomfortable with the title of the Ihatecpap website. The very name is counter to what we are all trying to do, enhance the sleep health of people suffering from sleep related breathing disorders. The only way this can happen is by informing patients of their options and facilitating a process in which we assist them in the use of the most effective therapy for them based on what they can and will tolerate. The truly unfortunate thing is that patients are rarely told of the option of oral appliance therapy. As a result of this, those that cannot or will not tolerate CPAP go on to live shortened lives of diminished quality with medical expenses soaring far above those whose disorders are well managed.

David E. Lawler DDS, D. ABDSM
www.thecenterforsoundsleep.com