By Alyx Arnett

Oral appliance therapy is a recommended treatment for obstructive sleep apnea—not just when CPAP fails, but also when patients prefer an alternative. Yet for many sleep physicians, referring for an oral appliance is easier said than done. 

In some parts of the United States, there isn’t a single dentist nearby who has training in dental sleep medicine. Without a provider to refer to, some physicians stop there, and treatment stalls.

“The reality is most people in this country don’t have access to oral appliance therapy,” says Madan Kandula, MD, an otolaryngologist (ENT) and CEO of ADVENT, a 34-location practice that treats sleep-disordered breathing and sinus complaints.

So what happens when a patient wants—or needs—an oral appliance, but no qualified provider is nearby? Consider these workarounds to increase access. 

1. Turn to Virtual Programs

Telemedicine-based models can help fill care gaps, either by referring patients there or partnering with them directly. These programs vary in structure, with some requiring in-person digital scans with dentists and others using at-home impression kits—or a mix of both.

BlueSleep is one example. It operates in nine states and maintains an in-person oral appliance digital scanning site open six days a week in the New York-New Jersey area, where 85% of its patients are. 

For patients outside the region, BlueSleep can coordinate with patients’ existing dentists—many of whom have digital scanning capabilities through their experience with products like Invisalign—to secure scans. In about 5% of cases, at-home impression kits are used.

Treatment effectiveness is assessed through follow-up home sleep studies. “We have excellent results,” says founder and director Jordan Stern, MD, board-certified in otolaryngology and sleep medicine, noting that BlueSleep will present an abstract at World Sleep 2025 reporting outcomes from 3,000 patients treated using its virtual workflow, including those with mild, moderate, and severe sleep apnea. 

Direct-to-consumer sleep apnea care company Daybreak recently expanded to include a physician-integrated option in response to physicians seeking referral pathways for oral appliance therapy. The company adapted its infrastructure to support care initiated from a physician’s office.

In this model, physicians diagnose the patient and make a referral. Daybreak then manages the rest of the process, including impressions, appliance fabrication, fit optimization, and ongoing treatment support. Impressions are typically collected using an at-home kit that is delivered to the patient, though providers with in-office scanners can submit digital scans. Licensed dentists in the patient’s state review each case for clinical appropriateness before approving treatment.

Daybreak uses a treatment protocol that involves weekly check-ins over a four- to 12-week period, during which the appliance is adjusted based on the patient’s symptoms and comfort. Patient progress updates are provided to the referring physician, and follow-up sleep testing is used to assess whether therapeutic goals have been met.

By offering fully remote care nationwide, Daybreak increases access to oral appliance therapy for sleep apnea patients who would otherwise have limited options and may even abandon treatment entirely, according to Daybreak’s founder. “What we’re doing is getting to that 90% [of sleep apnea patients] that aren’t actively treated today and helping them get treated,” says Wesley Lones, founder of Daybreak. 

With both BlueSleep and Daybreak, care is billed through medical insurance.

2. DIY—If You’re an ENT

While dentists trained in dental sleep medicine are typically thought of as the providers of oral appliance therapy, they aren’t the only option. ENTs can also deliver this treatment. “Oral appliance therapy is part of our scope of practice, and that sort of sometimes gets missed in all of this,” says ADVENT’s Kandula.

According to a position statement from the American Academy of Otolaryngology–Head and Neck Surgery, ENTs are “clearly and uniquely well-qualified” to provide oral appliance therapy, based on their training in sleep medicine, TMJ and occlusal disorders, and oral cavity treatment.¹

Kandula says that, as his practice expanded, he encountered communities without any dentists trained in dental sleep medicine, prompting him to build an in-house oral appliance therapy program to serve those areas. Today, that model is in place at five ADVENT clinics, where digital scans are performed on-site. Nearby ADVENT offices without scanning capabilities refer patients to those locations. “Bottom line is that in the markets where we’re doing it in-house, without us doing it, there isn’t access to oral appliance therapy,” he says. “It’s been very, very beneficial to the communities that we serve.”

Ofer Jacobowitz, MD, PhD, FAASM, FAAOA, a board-certified ENT and sleep medicine physician, took on the process himself nearly 20 years ago. While he practices in the New York area, where trained dentists are available, he found that many patients couldn’t afford oral appliance therapy because most dentists don’t bill through medical insurance. 

By offering the process in-house and billing through medical insurance, he says he’s been able to increase access. “It’s much easier to say, “OK, we selected this treatment. I’ll help you with it,’ rather than have the patient make another trip, make more appointments,” he says. “Anytime you send the patient somewhere, there’s some fragmentation of care, and it’s more difficult for the patients.”

Still, ENT-based models remain uncommon. Jacobowitz encourages those interested to start by taking a training course. In fact, he teaches a hands-on oral appliance course each year at the annual American Academy of Otolaryngology–Head and Neck Surgery meeting.. 

Jacobowitz suggests that in the absence of a nearby dentist, physicians who aren’t ENTs may want to check whether a local ENT provides this service and partner with them.

3. Encourage a Local Dentist to Get Trained

Another option is to encourage a local dentist to pursue dental sleep medicine training. According to Shane Ricci, DDS, FAGD, FICD, FACD, chair of the American Dental Association (ADA) Council on Dental Practice, this “is a promising strategy to expand access, especially in areas with limited specialty providers.” 

To become a “qualified dentist” by the American Academy of Dental Sleep Medicine (AADSM), the dentist must complete the Mastery 1 course through the AADSM Mastery Program or through a dental school accredited as an AADSM Mastery Program Provider. The designation signals foundational competency in dental sleep medicine and must be renewed every two years with 15 hours of continuing education 

Encouraging local dentists to obtain this training could help address access disparities—something the AADSM has actively worked on. “We did have a discussion with [American Academy of Sleep Medicine] a few years ago and tried to overlap where there weren’t diplomats or qualified dentists in those areas and do outreach in those areas to try to get dentists to get the necessary education to treat these patients,” says Kevin Postol, DDS, president of the AADSM. Amid those efforts, interest has been growing steadily, he says, with the number of qualified dentists increasing tenfold in the last six years—from about 200 to more than 2,400.

Ricci also has seen interest increase among general dentists, especially as awareness of the connection between oral and systemic health increases. Still, barriers remain. “The biggest challenges tend to be uncertainty around how to get started and how to coordinate care with physicians,” he says. “Navigating diagnostics, referrals, and treatment planning in a medical-dental collaborative model requires a shift in how many general dentists are used to practicing.” 

He notes that the ADA provides continuing education courses, resources, and policy guidance to help ease that transition.

4. Consult Online Directories—and Cast a Wider Net

Online directories can help sleep physicians locate trained dentists. The AADSM offers a searchable online directory that allows users to filter by zip code, radius, and other factors. Results, shown in list view and on a map, include information on whether the dentist is AADSM-qualified or a Diplomate of the American Board of Dental Sleep Medicine (ABDSM) (considered the highest credential in the field). The ABDSM also provides its own searchable Diplomate directory. 

Some oral appliance manufacturers offer similar directories. ProSomnus, for example, maintains a “Find a Provider” tool. Great Lakes Dental Technologies is developing an online directory of its own to meet growing demand from sleep physicians looking for trusted dental partners. “They want to do something for their patients, but they don’t know where to go,” says Jennifer O’Hare, sleep specialist at Great Lakes Dental Technologies. 

While the directory is in the works, O’Hare has been helping connect interested physicians with dentists who’ve worked with the company to fabricate oral appliances. “I get them acquainted, so that way the sleep doctor will know, ‘Oh, there’s this dentist in my area that is doing sleep medicine.’ They can feel confident sending it to that dentist so that the patient can get treated,” she says. 

It may also be worth casting a wider geographic net. A dentist two hours away might not feel local—but for many patients, that’s not a dealbreaker. “I have patients who travel two hours to see me,” says Postol. “In rural areas especially, patients are used to driving long distances for medical care.”

ADVENT’s Kandula has similarly seen patients travel great distances—even by plane—to seek treatment. He says not to rule out dental sleep medicine professionals who aren’t immediately local.

Expanding Patient Access

Access challenges remain, but sleep physicians are well-positioned to help bridge the gap. Practical steps—such as referring to virtual programs, encouraging a trusted local dentist to seek training, broadening your referral radius, or even pursuing training yourself—can help more patients receive oral appliance therapy.

“More people deserve to have access to this treatment option, and it’s unacceptable that so few people have access to it,” says Kandula. “I can’t change the whole thing by myself, but I can do my part.”

References

1. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Position statement: Use of oral appliances for the treatment of obstructive sleep apnea (OSA). 2021 April 22. Available at

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