Abstract
On March 11, 2020, the World Health Organization declared a pandemic caused by coronavirus disease 2019 （COVID-19）, which is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 （SARS-CoV-2）. Due to its highly contagious nature, the pandemic has changed lives drastically all over the world. Since mid-March 2020, dentists in many countries were recommended to postpone all but urgent and/or emergency treatment and care in order to reduce the risk of COVID-19 spreading and to save personal protective equipment. Oral appliance （OA） therapy for patients with obstructive sleep apnea （OSA） had also been postponed.
Epidemiological studies have shown that patients with OSA are at high risk of developing severe complications of COVID-19. Sleep physicians/dentists should continue to manage both patients with and without COVID-19 during the pandemic. However, continuous positive airway pressure （CPAP） is considered to be an aerosol-generating procedure and could transmit the virus to household members as well as healthcare workers if the patient is infected by the virus. The decision of whether to continue or stop CPAP therapy should be based on a risk-benefit analysis. In turn, oral appliance therapy could be the first-line treatment for patients with OSA during the COVID-19 pandemic, because OAs do not generate aerosols, can be easily disinfected, and feature better adherence than CPAP. Sleep physicians should take account of the predictors of OA treatment and obtain informed consent from patients with respect to the merits and demerits of switching the use of CPAP to OAs.
In the course of OA therapy during the COVID-19 pandemic, most face-to-face consultations, device delivery, titration, short-term and long-term follow-up appointments, and part of the management of side effects or problems with appliances could be replaced by teledentistry. When face-to-face treatment is implemented in the dental clinic, dentists and staff members should follow appropriate local guidance to mitigate SARS-CoV-2 transmission.
