The American Academy of Sleep Medicine (AASM) supports the legal petition recently filed by the Texas Medical Association (TMA) asking the court to void Rule 108.12 of the Texas Administrative Code, Dental Treatment of Sleep Disorders, which was adopted by the Texas State Board of Dental Examiners (TSBDE) in June. The AASM is in agreement with the TMA that the rule exceeds the scope of practice for dentistry and unlawfully authorizes dentists to practice medicine in violation of the Texas Medical Practice Act, thereby jeopardizing the quality of care for patients in Texas who have sleep-disordered breathing.

The TSBDE adopted Rule 108.12 after multiple revisions of its initial proposal. The AASM repeatedly submitted to the TSBDE detailed comments comprising specific objections to the proposed language along with recommendations to improve both the legality and the clarity of the rule. It was the hope of the AASM that the final rule would contain concise and precise language that aligned with the well-defined boundaries established by all medical and dental practice acts.

Regrettably, the TSBDE adopted an imprecise rule with contradictory language that allows dentists to diagnose and evaluate sleep disorders by ordering diagnostic sleep studies for the purpose of identifying snoring and obstructive sleep apnea (OSA). The rule also opens the door for dentists to provide independent treatment of sleep-disordered breathing without prior referral of patients to a licensed physician for a comprehensive evaluation and diagnosis. The AASM recognizes the important value of the collaborative care provided by qualified dentists who treat select OSA patients using custom fabricated oral appliances. However, Rule 108.12 unlawfully authorizes Texas dentists to engage in the practice of medicine, blatantly ignoring the distinct differences between the two professions. If left unchecked, Rule 108.12 would set a dangerous precedent for professional licensing boards in other states. Such infringement undermines the professional stability afforded by a practice act, threatening the regulatory protection that benefits all licensed professionals.

Practice acts also serve a dual purpose of protecting the public. Any encroachment on a scope of practice is a threat to public safety, undermining patients’ basic expectation to receive care from fully qualified practitioners with the requisite education, training and knowledge. Rule 108.12 fails to ensure that patients with sleep-disordered breathing receive comprehensive care from licensed providers with the necessary expertise. This negligence puts at-risk the health and safety of patients with OSA, a chronic disease that frequently occurs with other serious medical conditions including systemic hypertension, congestive heart failure, myocardial infarction, stroke and Type 2 diabetes.

The AASM is unwavering in its commitment to protect patients and uphold the right of physicians to practice medicine. Members will be notified by the AASM of any decision made by the Texas court.

AASM members can direct questions about this issue to