How to Build a Scalable Dental Sleep Medicine Practice

A scalable dental sleep medicine program combines consistent screening, clear team ownership, physician collaboration, structured appliance care, medical billing infrastructure, and measurable follow-up. The dentist focuses on clinical decisions. Meanwhile, a trained coordinator manages records, referrals, benefits, scheduling, claims, and communication.

A Scalable Dental Sleep Medicine Practice requires more than clinical training or interest. It needs clear systems, defined roles, medical collaboration, and consistent follow-up.

Dental sleep medicine can offer dentists a meaningful growth opportunity. However, a practice cannot manage it like a routine dental procedure. Obstructive sleep apnea is a medical disorder. Therefore, oral appliance therapy must operate within a coordinated medical care pathway.

That pathway starts with screening. It continues through medical diagnosis, dental evaluation, appliance delivery, titration, and outcome verification. Long-term dental monitoring must also remain part of the process.

A dentist can manage a few cases through personal effort. However, growth exposes every weak handoff. Missing records cause delays. Unclear responsibilities create confusion. Poor financial communication can prevent patients from moving forward.

The solution is not simply to work harder. Instead, the practice needs a repeatable operating model.

Many dental sleep medicine programs begin with enthusiasm. The dentist completes training, introduces screening, and starts accepting cases.

However, the program may lose momentum within several months.

In many practices, oral appliance therapy is not the main problem. Instead, the workflow surrounding it creates friction.

Screening may depend on whether the dentist remembers to ask a question. Staff members may not know how to discuss an elevated screening result. Medical records may arrive late or remain incomplete.

In addition, patients may not understand their medical benefits or estimated financial responsibility. Follow-up may also become reactive rather than planned.

These gaps make every case feel different. Consequently, the team cannot build speed or confidence.

A mature dental sleep medicine program works differently. Screening happens consistently. Each task has an owner. The team uses standard forms, checklists, and communication templates.

Patients know what will happen next. Referring physicians receive useful updates. The practice also tracks each case from screening through long-term follow-up.

As a result, the service line feels organized rather than burdensome.

A Scalable Dental Sleep Medicine Practice depends on five connected systems:

1. Patient screening and identification
2. Medical diagnosis and referral coordination
3. Dental evaluation and appliance management
4. Medical billing and financial communication
5. Follow-up, outcome verification, and long-term care

Each system must connect with the next one. Otherwise, patients can stall between steps.

For example, a completed screening form has limited value without a referral process. Likewise, a physician’s prescription does not lead to treatment unless the practice gathers the required records.

Standardization does not replace professional judgment. Instead, it protects time for clinical judgment.

When routine steps follow a consistent process, the dentist can focus on dental candidacy, appliance selection, fit, titration, side effects, and long-term oral health.

Dentists play an important role in obstructive sleep apnea care. However, they do not diagnose OSA.

A physician makes the diagnosis using an appropriate medical evaluation and objective sleep testing. The physician also determines whether oral appliance therapy fits the patient’s medical treatment plan.

The dentist’s role starts with screening and recognition. Dentists regularly observe oral and craniofacial findings that may support a referral for medical evaluation. They may also see patients more consistently than many medical providers do.¹˒²

After medical diagnosis, a qualified dentist can complete the dental evaluation. The dentist may then provide and manage an appropriate mandibular advancement device.²˒⁴

Long-term dental responsibilities may include:

• Evaluating dental candidacy
• Selecting an appropriate appliance
• Delivering and fitting the appliance
• Supporting titration
• Monitoring side effects
• Evaluating occlusal changes
• Communicating with the physician
• Providing ongoing dental follow-up

Clear boundaries improve scalability. Specifically, they help the team answer several important questions:

• Who identifies possible risk?
• Who confirms the diagnosis?
• Who provides the treatment order?
• Who evaluates dental candidacy?
• Who manages appliance titration?
• Who verifies the medical outcome?
• Who monitors long-term dental health?

When everyone understands these roles, referrals become easier to manage. Physician confidence may also improve because the practice respects the medical care pathway.

Screening cannot depend on occasional conversations. Instead, it should become part of the standard patient workflow.

A practice may include a validated questionnaire with new-patient forms or health-history updates. STOP-Bang and the Berlin Questionnaire are commonly used adult screening tools.²˒⁶

However, a questionnaire alone does not create a program. The team must know what happens after a result suggests elevated risk.

A basic screening process may include these steps:

1. The patient completes the screening form.
2. A trained team member reviews the result.
3. The clinical team records relevant oral findings.
4. The dentist explains the need for medical evaluation.
5. The coordinator starts the referral process.
6. The practice tracks the referral until it closes.

The process should remain simple. Therefore, the team should use the same screening form, referral language, and tracking method whenever possible.

The goal is not to diagnose sleep apnea. Rather, the goal is to identify patients who may need medical evaluation.

An elevated screening result is only the beginning. The patient must still move from dental identification to medical diagnosis.

That transition often causes delays.

Some patients do not know which physician to contact. Others receive a referral but never schedule an appointment. Medical offices may also request information the dental team did not expect.

A scalable workflow removes as much uncertainty as possible.

First, identify the medical professionals who can evaluate referred patients. These may include primary care physicians, sleep physicians, pulmonologists, or otolaryngologists.

Next, create a standard referral package. It may include:

• The screening result
• Relevant health-history information
• Pertinent dental and oral findings
• The reason for referral
• Practice contact information
• A request for the diagnostic report
• A request for the treatment order when appropriate

The coordinator should track every referral. For example, the practice can use these status categories:

• Referral recommended
• Referral sent
• Medical appointment scheduled
• Testing scheduled
• Testing completed
• Diagnosis received
• Oral appliance therapy ordered
• Patient not eligible
• Patient declined
• Unable to contact

This visibility prevents patients from disappearing between offices.

In addition, the dental practice should send concise updates to the physician. Reliable communication shows that the practice manages oral appliance therapy as part of coordinated care.

A scalable program needs a clear operational owner. This person may be called a dental sleep coordinator, treatment coordinator, or sleep champion.

The title matters less than the responsibility.

The coordinator should own the nonclinical movement of each case. Therefore, the role may include:

• Monitoring screening results
• Coordinating medical referrals
• Gathering sleep studies and prescriptions
• Verifying medical benefits
• Managing authorization requirements
• Explaining estimated patient responsibility
• Scheduling dental sleep visits
• Tracking appliance production
• Monitoring claims and denials
• Scheduling titration and follow-up
• Sending reports to referring physicians

The coordinator should have protected time for this work.

For example, a coordinator may begin the day with ten open cases. If that person repeatedly covers unrelated front-office duties, referral calls and claim follow-up may not happen.

Consequently, treatment timelines grow longer.

A practice does not always need a full-time coordinator at launch. However, one person must remain accountable for the workflow.

Some practices may outsource selected duties. Medical billing, credentialing, benefits verification, or referral coordination can move to an outside partner.

A hybrid model may also work. Regardless of the model, every responsibility needs a named owner.

Once a physician confirms the diagnosis and recommends oral appliance therapy, the dental team begins its clinical evaluation.

The practice should use a consistent examination template. This supports clinical quality and complete documentation.

The evaluation may include:

• Dental and periodontal health
• Existing restorations
• Tooth stability
• Occlusion
• Mandibular range of motion
• Temporomandibular joint findings
• Muscle findings
• Available protrusion
• Patient comfort and dexterity
• Relevant imaging
• Contraindications or risk factors

The dentist then decides whether the patient is an appropriate dental candidate.

When treatment is appropriate, the practice should explain the complete care pathway. Patients need to understand that appliance delivery is not the final step.

Instead, treatment generally includes adaptation, advancement, reassessment, and communication with the medical provider.²

A dependable appliance workflow can reduce delays, remakes, and unnecessary chair time.

The practice should define each step:

1. Confirm the diagnosis and physician order.
2. Complete the dental evaluation.
3. Gather payer documentation.
4. Obtain authorization when required.
5. Capture digital or physical records.
6. Select an appropriate appliance.
7. Submit the case to the manufacturer.
8. Track appliance production.
9. Inspect the appliance before delivery.
10. Deliver and document the starting position.
11. Schedule follow-up before the patient leaves.

Digital workflows can support consistency. Clear scans, complete prescriptions, and accurate bite records reduce avoidable production questions.

In addition, the practice should track turnaround time. A predictable timeline helps the team set accurate patient expectations.

Appliance delivery begins the therapeutic process. It does not complete it.

The initial mandibular position should reflect the patient’s clinical needs and tolerance. The dentist can then advance the appliance through a planned titration process.²

A structured protocol may include:

• A documented starting position
• Written advancement instructions
• A scheduled adaptation review
• A defined advancement interval
• Comfort and side-effect checks
• Symptom and adherence questions
• Communication with the physician
• Objective reassessment when appropriate

Patients should know whom to contact with questions. However, the practice should not rely only on patient-initiated calls.

Instead, the team should schedule the next visit before the patient leaves. Automated reminders and coordinator follow-up can also reduce missed appointments.

A predictable schedule protects clinical quality. It also improves capacity planning because the team can estimate future chair-time needs.

Oral appliance therapy can involve side effects. These may include dry mouth, increased saliva, temporary tooth soreness, jaw discomfort, and bite changes.²˒⁵

The team should explain these possibilities before treatment. Clear informed consent supports realistic expectations.

However, communication should remain balanced. The practice should neither dismiss side effects nor present them as unavoidable complications.

A better approach is professional normalization:

• Explain what may occur.
• Describe what the practice monitors.
• Provide instructions for common concerns.
• Schedule regular reassessment.
• Document changes over time.
• Intervene when findings require attention.

Supportive measures may include exercises or a morning occlusal guide when clinically appropriate.²˒⁵

Consistent monitoring protects patient trust. It also shows referring physicians that the practice provides ongoing dental oversight.

Medical billing is not simply a claim-submission task. It affects patient access, documentation, staffing, payer relationships, and financial communication.

Oral appliance therapy for OSA generally follows a medical-benefit pathway rather than a routine dental-benefit pathway. Therefore, practices that want to increase case volume must decide how they will approach medical insurance.

Common models include:

• Cash payment
• Out-of-network medical billing
• In-network medical billing
• Medicare enrollment
• A hybrid approach

A cash model may be simpler to launch. It requires less credentialing and fewer administrative systems. However, a substantial out-of-pocket cost may prevent some patients from proceeding.

Out-of-network billing can provide flexibility. Yet deductibles, coinsurance, and uncertain reimbursement may create financial barriers.

An in-network model can provide clearer benefit expectations for some patients. However, it requires contracting, credentialing, documentation, and administrative capacity.

The right choice depends on the practice’s goals, market, payer mix, and internal resources.

Panthera Dental’s guide to medical billing for dental sleep medicine emphasizes two common operational barriers: limited insurance knowledge and insufficient internal bandwidth.

That distinction matters. A practice may understand what needs to happen but lack the personnel to complete it consistently.

Therefore, billing must become part of the operating model. It cannot remain an occasional front-desk task.

Payer participation affects more than reimbursement. It can also influence patient cost clarity, case acceptance, referral relationships, and administrative workload.

An in-network approach may fit practices that want:

• Broader patient access
• More predictable benefit discussions
• Stronger physician referral pathways
• A larger dental sleep medicine service line
• Deeper integration with medical care

However, network participation creates additional responsibilities. The practice must understand contracts, allowed amounts, documentation requirements, patient responsibility, and timely claim submission.

An out-of-network model may fit a practice that treats fewer cases. It may also work when patients have usable out-of-network benefits or can manage a higher upfront expense.

Still, the practice should explain financial uncertainty clearly. Out-of-network benefits are not guaranteed, and actual reimbursement may differ from an estimate.

A hybrid model may offer another option. The practice can contract with selected major payers while remaining out-of-network with others.

Panthera Dental’s comparison of in-network vs. out-of-network dental sleep medicine explains how each strategy affects patient access, administrative complexity, referrals, and long-term program growth.

The best model is not simply the one with the highest submitted charge. Instead, it is the model the practice can execute consistently and explain accurately.

A scalable billing system begins before the claim reaches the payer.

The practice must gather the correct documents at the correct time. Missing records can cause delays, denials, or requests for additional information.

Requirements vary by payer. However, the case file may need:

• A documented OSA diagnosis
• The sleep study report
• A physician’s prescription or order
• Medical-necessity documentation
• Clinical evaluation records
• Appliance information
• Insurance verification
• Required authorization
• Delivery records
• Fitting and adjustment notes
• Follow-up documentation
• Physician communication

The coordinator should use a payer-specific checklist. That checklist should remain attached to the case from initial verification through final payment.

In addition, the practice should confirm the correct billing code and current payer rules.

HCPCS code E0486 commonly describes a custom-fabricated oral device used to reduce upper-airway collapsibility. The code includes fitting and adjustment. However, coverage depends on the applicable payer policy and the specific appliance.

Medicare also has defined coverage, supplier, documentation, and appliance requirements. Therefore, practices should confirm current rules through CMS, the appropriate DME Medicare Administrative Contractor, and qualified billing or compliance advisers.

Panthera Dental’s overview of E0486 documentation requirements explains why the chart should support the diagnosis, physician-directed treatment pathway, appliance selection, delivery, adjustments, and follow-up.

Documentation is not a back-office task added after treatment. It is part of the therapy pathway.

One common problem is trying to rebuild the record after the appliance has already been delivered.

That approach creates avoidable risk.

Before delivery, the office should confirm that the core supporting records are complete. These may include:

• Patient intake materials
• Relevant medical and sleep history
• Diagnostic sleep-test documentation
• Physician prescription or order
• Treatment discussion notes
• Informed consent
• Dental evaluation
• Appliance selection details
• Medical-necessity documentation
• Payer records when applicable

The practice should treat missing records as a workflow stop.

It should not rely on statements such as:

• “The patient said the physician recommended it.”
• “The sleep study was completed somewhere.”
• “We can request the prescription later.”
• “The billing company will find the missing record.”

The chart should contain legible and retrievable documentation before delivery.

This process protects the patient, the practice, and the payer relationship.

Documentation does not end when the appliance is inserted.

A complete delivery note should identify:

• The delivery date
• The appliance provided
• Fit and insertion findings
• The starting position
• Instructions given to the patient
• Initial patient tolerance
• Adjustments completed
• Planned follow-up

Follow-up notes should continue the treatment story.

They may include:

• Appliance fit
• Patient comfort
• Titration progress
• Reported use
• Side effects
• Dental or occlusal findings
• Adjustments completed
• Next steps
• Physician communication

Notes should remain specific to the individual encounter. Templates can support completeness. However, generic copied language can weaken the record.

Real-time documentation is usually stronger than a narrative reconstructed later.

Before a claim is submitted, a trained team member should confirm that the record supports the billed service.

A pre-submission review can address:

• Patient identification
• Payer information
• Provider enrollment status
• Diagnosis information
• Physician order
• Sleep study
• Medical necessity
• Appliance classification
• Authorization requirements
• Delivery documentation
• Coding
• Claim-form accuracy

The practice should also track denials and documentation requests.

Useful denial categories include:

• Eligibility issue
• Missing authorization
• Missing sleep study
• Missing physician order
• Coding issue
• Provider enrollment issue
• Timely-filing issue
• Medical-necessity issue
• Noncovered benefit
• Coordination-of-benefits issue

Denial tracking turns individual problems into operational information.

For example, repeated requests for sleep studies may reveal a records-intake failure. Frequent eligibility denials may indicate that the practice verifies benefits too early or incompletely.

The goal is not merely to resubmit claims. Instead, the goal is to prevent the same problem from recurring.

Patients need clear information before treatment begins.

However, benefits verification is not a guarantee of payment. Therefore, the practice should distinguish between:

• Submitted charges
• Contracted or allowed amounts
• Deductibles
• Coinsurance
• Copayments
• Noncovered services
• Estimated insurance payment
• Estimated patient responsibility

The financial discussion should occur before final records or appliance ordering whenever possible.

A written estimate can improve clarity. It should state that the payer makes the final coverage and payment decision.

The coordinator should also explain payment timing.

For example, some practices collect the estimated patient portion before treatment. Others require full payment and submit an out-of-network claim. The process depends on the practice’s payer status and financial policy.

Consistent communication reduces confusion. It also prevents the dentist from handling detailed insurance questions during clinical visits.

The practice should not select an oral appliance fee by copying another office.

Instead, the fee should reflect the complete care pathway.

That pathway may include:

• Dental evaluation
• Clinical records
• Appliance production
• Delivery
• Titration
• Follow-up
• Side-effect management
• Administrative work
• Medical billing costs
• Expected remakes
• Long-term monitoring

Payer contracts may limit the allowed amount. Therefore, the practice should understand each contract before deciding whether to participate.

The fee schedule should also remain consistent and defensible.

Charges that are too low may not cover the cost of care. However, charges that differ significantly from relevant market patterns may create additional scrutiny.

The practice should document how it established its fees. Useful inputs include:

• Regional payer information
• Medicare fee schedules
• Contracted allowed amounts
• Appliance costs
• Staff time
• Dentist time
• Billing expenses
• Follow-up requirements
• Overhead
• Market conditions

The goal is not to maximize the submitted charge at any cost. Instead, the goal is to create a lawful and sustainable fee structure.

Revenue alone does not show whether the program is healthy.

A practice may deliver more appliances while losing efficiency. Therefore, leaders should measure the full cost of the service line.

Useful financial metrics include:

• Average submitted charge
• Average allowed amount
• Average collected revenue
• Patient collection rate
• Payer collection rate
• Days in accounts receivable
• Denial rate
• Appeal rate
• Appliance cost
• Billing cost
• Remake cost
• Coordinator time per case
• Dentist time per case
• Contribution margin per completed case

The practice should separate billed revenue from collected revenue.

A large submitted claim provides limited information if the payer reduces, delays, or denies it.

Monthly reporting can also reveal payer-specific problems.

For example, one plan may generate significant case volume but slow payment. Another may pay consistently but require extensive authorization work.

These findings can guide contracting, staffing, and financial decisions.

A Scalable Dental Sleep Medicine Practice measures movement through the entire care pathway.

Screening KPIs

• Percentage of eligible patients screened
• Percentage with elevated risk
• Percentage accepting a medical referral

Referral KPIs

• Time from screening to referral
• Percentage scheduling medical evaluation
• Percentage completing diagnostic testing
• Percentage returning with a diagnosis

Case-conversion KPIs

• Percentage receiving an oral appliance order
• Evaluation-to-treatment acceptance rate
• Main reasons patients decline

Production KPIs

• Days from records to case submission
• Appliance turnaround time
• Remake rate
• Delivery delays

Follow-up KPIs

• Adaptation-visit completion
• Titration-visit completion
• Objective reassessment completion
• Annual recall completion

Financial KPIs

• Benefits-verification turnaround
• Authorization approval rate
• Clean-claim rate
• Denial rate
• Days to payment
• Net collection per case

The team should review these measures monthly.

However, the practice should not track numbers that never guide decisions. Start with a focused scorecard. Then add detail as the program grows.

A program cannot scale when every question reaches the dentist.

The dentist should focus on work that requires clinical judgment. That includes:

• Evaluating dental candidacy
• Selecting the appliance
• Reviewing clinical records
• Delivering the appliance
• Making titration decisions
• Assessing side effects
• Monitoring occlusion
• Communicating relevant findings to the physician

The coordinator can manage many administrative steps. Standard educational materials can also answer common patient questions.

In addition, the practice can group similar visits. For example, dedicated dental sleep blocks may improve focus and reduce setup changes.

Capacity planning must consider the full case cycle.

Twenty appliance deliveries will create future titration, adjustment, and follow-up visits. Therefore, the schedule should reserve time for existing patients as well as new cases.

Physicians need dependable referral partners.

A brochure may introduce the practice. However, reliable communication builds long-term trust.

The dental practice should make referrals easy. It should explain its process and respond promptly to questions.

After delivery and titration, the practice can send a concise report that includes:

• Appliance delivered
• Starting position
• Titration progress
• Patient-reported use
• Dental side effects
• Request for objective reassessment
• Ongoing dental follow-up plan

The physician remains responsible for medical outcome assessment.

Consistent reports show that the dental practice understands collaborative care. They may also support future referrals.

A practice should not redesign every system at once. Instead, it should use a phased launch.

Days 1–30: Design the workflow

During the first month:

• Define the program’s goals.
• Select the screening process.
• Assign the coordinator.
• Map medical referral options.
• Choose evaluation templates.
• Select a payer strategy.
• Identify required training.
• Create a case tracker.
• Establish baseline KPIs.

The team should also define scope boundaries and escalation rules.

Days 31–60: Build the infrastructure

During the second month:

• Train the team.
• Test screening forms.
• Create referral templates.
• Build payer checklists.
• Establish financial policies.
• Select billing support.
• Organize appliance records.
• Create delivery templates.
• Create follow-up templates.
• Develop physician reports.
• Test the workflow with a small number of cases.

The team should document each problem during the pilot.

Days 61–90: Launch and improve

During the third month:

• Expand screening.
• Begin structured referral outreach.
• Review open cases weekly.
• Measure conversion and delays.
• Audit documentation.
• Review denied or delayed claims.
• Gather patient feedback.
• Adjust staffing and scheduling.
• Report results to the team.

At day 90, leadership should review the scorecard.

The practice should identify its largest bottleneck. Then it should fix that bottleneck before adding more volume.

Avoid Common Scaling Mistakes

Several predictable mistakes can weaken a growing program.

Depending on one motivated dentist

The dentist may launch the program. However, the team must support it. Otherwise, growth increases personal workload without building capacity.

Screening without tracking referrals

An elevated screen does not improve access unless the patient moves toward medical evaluation.

Ordering before confirming documentation

Incomplete records can create billing, compliance, and continuity problems.

Treating delivery as completion

Titration and objective outcome verification remain important parts of care.

Presenting benefits as guaranteed payment

Benefits can change. Therefore, financial estimates need clear limitations.

Ignoring accounts receivable

Production can grow while cash flow weakens.

Pulling the coordinator into unrelated duties

Without protected ownership, referrals, records, and claims can stall.

Growing referrals before fixing operations

Additional referrals will magnify existing problems. First, stabilize the workflow.

A Scalable Dental Sleep Medicine Practice does not depend on enthusiasm alone.

It uses consistent screening, clear role boundaries, reliable medical referrals, and structured appliance care. It also treats titration, side-effect management, and outcome verification as essential steps.

Medical billing must support the same operating model. Credentialing, documentation, financial communication, claims, and collections all require defined ownership.

Most importantly, the practice measures what happens. It tracks patients from screening through long-term follow-up. It also monitors financial and operational performance.

These systems do not remove clinical judgment. Instead, they protect it.

When the team understands the process, the dentist can focus on patient care. Physicians receive clearer communication. Patients face fewer surprises.

Meanwhile, the practice gains the capacity to grow without creating operational chaos.

That is the blueprint for sustainable dental sleep medicine.

1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–698. doi:10.1016/S2213-2600(19)30198-5.
2. Glick A, Chiang HK, Huynh N, Levine M. Awakening to opportunity: dentistry’s role in the evidence-based management of adult obstructive sleep apnea, a narrative review. J Am Dent Assoc. 2026. doi:10.1016/j.adaj.2025.12.020.
3. Rehman U, Ahn Y, Yerushalmi E, et al. Neglected burden of obstructive sleep apnoea: workplace productivity loss in the USA and UK. Thorax. 2026. doi:10.1136/thorax-2025-223550.
4. Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773–827. doi:10.5664/jcsm.4858.
5. Sheats R, Schell T, Blanton A, et al. Management of side effects of oral appliance therapy for sleep-disordered breathing. J Dent Sleep Med. 2017;4(4):111–125.
6. Chung F, Yang Y, Brown R, Liao P. Alternative scoring models of the STOP-Bang questionnaire improve specificity to detect undiagnosed obstructive sleep apnea. J Clin Sleep Med. 2014;10(9):951–958. doi:10.5664/jcsm.4022.

Continue exploring the clinical, administrative, and business systems that support a successful dental sleep medicine program.

Medical billing can be one of the most challenging parts of building a dental sleep medicine program. In this article, Randy Curran explains the importance of documentation, benefits verification, workflow management, and clear financial communication.

Continue reading: Medical Billing for Dental Sleep Medicine Dentists – Randy Curran

Dentists can play an important role in identifying patients who may be at risk for obstructive sleep apnea, referring them for medical diagnosis, and providing oral appliance therapy when prescribed. This article reviews screening, referral, interdisciplinary collaboration, and the dental treatment workflow.

Continue reading: Obstructive Sleep Apnea Screening, Referral, and OAT for dentists