For Referring Physicians
COLLABORATIVE CARE FOR PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Monticello Sleep Dentistry works collaboratively with sleep physicians, primary care providers, and other healthcare professionals to provide oral appliance therapy for appropriate patients with obstructive sleep apnea.
Our goal is to make the referral process straightforward while keeping you informed throughout your patient’s care – from the initial consultation, appliance delivery, titration, referral back for assessment of treatment outcome, and follow-up.
When to Consider Oral Appliance Therapy
Oral appliance therapy (OAT) is an effective treatment option for obstructive sleep apnea. For appropriate patients, a custom, titratable oral appliance can provide an alternative to positive airway pressure therapy or be incorporated into a broader treatment strategy.
Consider referral for oral appliance therapy when a patient:
✓ Is intolerant of CPAP/PAP therapy
✓ Prefers an alternative to CPAP/PAP
✓ Had difficulty maintaining consistent PAP use
✓ May benefit from combination therapy with PAP
What Happens After You Refer a Patient?
We believe successful oral appliance therapy requires ongoing collaboration between the dentist and the patient’s medical providers. When you refer a patient to Monticello Sleep Dentistry, we keep you informed throughout the treatment process and return the patient for verification of treatment effectiveness.
01
physician referral
We review the patient’s sleep study, diagnosis, prescription, and relevant medical information.
04
titration &
follow-up
The appliance is progressively adjusted while comfort, adherence, symptoms, side effects, and clinical response are monitored.
02
ClINICAL EVALUATION
The patient’s oral health, dentition, TMJ function, airway-related findings, and suitability for oral appliance therapy are evaluated.
05
effectiveness testing
Once an appropriate therapeutic position has been reached, the patient is referred back for objective assessment of treatment effectiveness.
03
custom appliance therapy
Digital records are used to fabricate a custom, titratable oral appliance selected for the patient’s individual dental and clinical needs.
06
long-term collaborative care
We provide ongoing dental sleep medicine follow-up and communicate clinically relevant changes or concerns with the patient’s treating physician.
CPAP Intolerance & Transitioning to Oral Appliance Therapy
Positive airway pressure (PAP) therapy remains an important treatment for obstructive sleep apnea; however, some patients are unable to tolerate or consistently use PAP therapy. For appropriate patients, oral appliance therapy can provide an alternative treatment option when PAP therapy is unsuccessful, poorly tolerated, or the patient prefers an alternative therapy.
When a patient is referred to Monticello Sleep Dentistry, we coordinate with the treating physician to help facilitate the transition to oral appliance therapy. Following dental evaluation and treatment, the appliance is progressively titrated, and the patient is referred for objective assessment of treatment effectiveness.
The goal is not simply to replace CPAP.
It is to help the patient remain effectively treated
for obstructive sleep apnea.
Medicare Patients Transitioning from CPAP to Oat
Medicare coverage can require additional coordination when a patient transitions from CPAP to oral appliance therapy. The process may differ depending on how long the patient has had the CPAP device. Monticello Sleep Dentistry works with the patient and referring physician to help obtain the documentation needed for oral appliance therapy.
CPAP FOR 90 DAYS OR LESS
If a Medicare patient is unable to tolerate CPAP during the initial 90-day trial period, the prescribing physician documents the patient’s CPAP intolerance and determines whether the patient meets Medicare coverage requirements for oral appliance therapy.
If transitioning to OAT, the 90-day CPAP recertification should not be submitted, allowing Medicare reimbursement for the CPAP device to cease. The physician provides the prescription and supporting documentation for OAT, and the patient returns the CPAP device to the supplier and obtains documentation of its return.
CPAP FOR MORE THAN 90 DAYS BUT LESS THAN 5 YEARS
Patients who have already passed the initial CPAP trial period may require a different Medicare process. The physician documents why CPAP could not be continued and why OAT is reasonable and necessary. The patient returns the CPAP device and obtains documentation of the return. Documentation of the CPAP return should be retained with the supporting records submitted with the oral appliance claim or subsequent appeal.
Because Medicare may initially deny the oral appliance claim under its “same or similar” equipment rules, additional documentation and an appeal may be required.
Medicare coverage requirements are subject to change and depend on individual circumstances. Our office can help coordinate the documentation required for patients transitioning from CPAP to oral appliance therapy.
Combination Therapy: CPAP + Oral Appliance Therapy
For some patients, treatment does not have to be a choice between PAP therapy and oral appliance therapy. A custom oral appliance may be used in combination with PAP therapy when PAP alone is difficult to tolerate or when additional therapeutic support is needed.
By advancing the mandible and helping maintain upper-airway patency, an oral appliance may reduce the PAP pressure required to control obstructive sleep apnea in selected patients. Lower pressure requirements may improve comfort and make PAP therapy easier to tolerate.
Combination therapy may be considered when:
✓ Higher PAP pressures are difficult to tolerate
✓ PAP adherence is limited by pressure-related discomfort
✓ OAT alone does not provide adequate control of OSA
✓ Additional airway support may improve treatment
Treatment Verification & Ongoing Follow-Up
Coordinated follow-up ensures that treatment remains effective over time, that oral health is protected, and that any changes are communicated promptly to the treating physician.
Treatment Verification
Delivery of an oral appliance is not the end of treatment. Following appliance delivery, the mandibular position is progressively adjusted while we monitor comfort, adherence, symptoms, side effects, and clinical response.
Once an appropriate therapeutic position has been reached, the patient is referred back to the treating physician for objective assessment of treatment effectiveness. Results can then be used to determine whether additional appliance adjustment or modification of the overall treatment plan is appropriate.
Long-Term Follow-Up
Monticello Sleep Dentistry continues to monitor appliance condition, fit, oral health, occlusion, treatment adherence, and potential side effects. Clinically significant changes or concerns are communicated to the patient’s treating physician to support coordinated long-term care.
Our goal is to ensure the best possible outcomes for every patient through ongoing monitoring, open communication, and true collaboration.
We value our partnership and are committed to keeping you informed.
—- PHYSICIAN RESOURCES —-
Clinical evidence and Medicare resources for physicians
considering oral appliance therapy for their patients.
CLINICAL EVIDENCE
Oral Appliance
Therapy Evidence
Brief for Physicians
Research on oral appliance therapy efficacy, adherence, comparisons with CPAP, and combination therapy.
medicare resource
CPAP for
90 Days or Less
…
AADSM Medicare Patient Checklist for patients who have had their CPAP for 90 days or less.
medicare resource
CPAP for More Than
90 Days but
Less Than 5 Years
AADSM Medicare Patient Checklist for patients who have had their CPAP for more than 90 days less than 5 years.
Resources provided by the
—- WHY REFER TO —-
MONTICELLO SLEEP DENTISTRY
————————
Monticello Sleep Dentistry provides dental sleep medicine care with an emphasis on
clinical collaboration, communication, and long-term patient management.
Our goal is to make oral appliance therapy a seamless part of the patient’s overall sleep apnea treatment plan.
Dental Sleep
Expertise
Dr. Dejti is a Diplomate of the American Board of Dental Sleep Medicine with advanced training and experience in oral appliance therapy.
Collaborative
Physician Care
We communicate with the patient’s treating physician throughout therapy and refer patients for objective assessment of treatment effectiveness.
Individualized
Appliance Therapy
Patients receive a comprehensive dental evaluation and a custom, titratable oral appliance selected according to their individual clinical and dental needs.
Long-Term
Follow-Up
We continue to monitor the patient’s appliance condition, oral health, occlusion, adherence, side effects, and clinically relevant changes over time.
HOW TO REFER A PATIENT
Referring a patient to Monticello Sleep Dentistry is simple. Our office will coordinate with your team and keep you informed throughout oral appliance therapy.
Send the
Referral
Provide the patient’s prescription for oral appliance therapy along with the sleep-study and relevant documentation.
We Contact
the Patient
We contact the patient to schedule a dental sleep medicine evaluation and determine suitability for oral appliance therapy.
We Keep
You Informed
We communicate treatment updates and coordinate once an appropriate therapeutic position has been reached.
REFERRAL OPTIONS
636-244-2080
636-300-4290 (fax)
info@monticello
sleepdentistry.com
530 Huber Park Court
Suite 201
Weldon Spring, MO 63304
We appreciate the opportunity to care for your patients.