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Friday, June 12, 2015

Expand your Practice with Sleep Dentistry

In recent years, one of the most significant and impactful trends in the industry has been the direct connection between the dental health professional and physicians in the management of patients with sleep disordered breathing syndromes. This partnership, a symbiotic relationship between vital healthcare professionals from a variety of fields, means that millions of patients with previously undiagnosed and untreated breathing and sleep issues are now being afforded an exemplary level of care and concern by care providers working together for the first time to serve the best interests of the patient.

Dentists and physicians now stand together on the watershed of care paradigms where whole health becomes paramount. Practical assistance between the dental professional and physicians offers seamless communication and adaptations of new treatment modalities, and implementation of care model delivery systems to better serve the whole patient. This empowerment of interdisciplinary care models ultimate goal is to serve the whole patient while at the same time walking them towards a healthier life that they in turn take full responsibility for dentistry. Increasingly, dental practices across the country are beginning to incorporate airway focused dental sleep medicine into their practices with great results for the patients, the practice, and referring physicians.

As dentists learn to appreciate the value and satisfaction of being able to help patients suffering from Obstructive Sleep Apnea (OSA) and Sleep Disordered Breathing Syndromes such as Upper Airway Resistance Syndrome (UARS) there is more demand than ever to understand the methodology of implementing dental sleep medicine into an existing dental practice. There is a serious need for more, and better qualified dental sleep medicine clinicians. Sleep physicians, pulmonologists, cardiologists, and primary care physicians as an example now see dentists, dental hygienists and auxiliaries as a critical resource for identifying individuals at risk for OSA and SDB; especially for dental patients who do not regularly have contact with a primary care physician. It is estimated that roughly 23% of all adults do not see a physician regularly in the USA, according to the Commonwealth Fund. Escalating costs for insurance or non coverage accounts for numbers likely far higher than 23%. Most of those people do however see their dentist regularly, often, more than two times a year, for over an hour for each visit.

OSA, if left untreated, can cause a host of physical and emotional issues for the patient and his/her partner, employers and family. In addition to the most obvious symptom snoring, sleep breathing disorders also impact the quality of sleep for the affected person’s spouse and children. OSA/SDB can lead to excessive daytime sleepiness, irritability, morning headaches, memory loss, impaired concentration, decreased sex drive, and depression among other symptoms. The American Academy of Sleep Medicine (AASM) estimates 80 to 90 percent of OSA/SDB cases of the 18 million Americans affected remain undiagnosed and untreated. These numbers alone are a call to action for all medical care professionals.


The First Step into Sleep Dentistry

The first steps for dentists considering an expansion into sleep dentistry can appear daunting but the journey begins with simply a change in care provision philosophy. Commitment to sleep disordered breathing dentistry means that dental professionals will develop the capacity to exponentially change the lives of their patients for the better. Sleep dentists focus on creating beautiful smiles with their clinical dentistry, then protecting that dentistry by saving lives with their treatment of sleep disorders. Interested parties should begin by researching, understanding and educating themselves on the signs of sleep apnea then assessing everyone who comes to their practice. This can be done by downloading a free “STOP-BANG” sleep apnea risk assessment survey off the internet to give patients.

“The first thing to remember is that anyone, regardless of age or physical health can be suffering from sleep apnea or sleep disordered breathing,” said Pat McBride, BA, RDA, CCSH and a practicing Dental Sleep Medicine Clinician for both physician and dental groups in California. “Working together with physicians and dentists in partnership better affords the best patient outcomes. Understanding that the risk for OSA/SDB increases with age and weight, we must be vigilant and screen every patient, man, woman, or child who presents to your practice. Important red flags include high BMI, history of snoring, gasping for air, insomnia, daytime fatigue, nocturnal bruxism, witnessed arousals, or a larger than average neck circumference in adults. OSA/SDB is no longer only for old fat men, there are plenty of thin fit females who have serious sleep disordered breathing. They deserve special attention, consideration and clinical understanding of their symptoms when presenting to us. For children, the cardinal rule is that a child should NEVER snore. Partnering successfully with physicians means that a parent of a child or young adult can have their symptoms recognized by the Dental Sleep Physician and appropriate referral made in the best interests of the patient.”

Dentists are not allowed to diagnose sleep apnea; however, they can screen for OSA/SDB by providing questionnaires assessing risk for sleep apnea/sleep disordered breathing then advise at-risk patients to visit their primary care physician, pulmonologist, or refer to a local sleep center for comprehensive evaluation and definitive diagnostic testing. Diagnosing Sleep Apnea can only be done by a physician either via home sleep test or a polysomnography which is performed as an overnight stay at a sleep lab. This comprehensive diagnostic study measures the patient’s Apnea-Hypopnea Index/Respiratory Disturbance Index and oxygen saturation levels throughout the night using multiple electrodes and channels. Apnea-Hypopnea Index (AHI) is the average number of partial and complete pauses in breathing that occur per hour of sleep. Respiratory Disturbance Index (RDI) is a more complex equation of the Apneas + Hypopneas + RERAS (Respiratory Effort Related Arousals).


Treating Sleep Apnea

If a sleep physician diagnoses a patient as having severe sleep apnea, often they’ll recommend fitting a CPAP (Continuous Positive Pressure, AKA the mask). In mild to moderate forms of sleep apnea, or if the patient refuses or fails to comply with CPAP, a sleep physician may provide a prescription for an Oral Appliance, and refer their patient to a trusted Dental Sleep Medicine Professional for fabrication fitting, and follow up. Even in severe cases, the AASM has recently changed the guidelines to accommodate patient preference. An Oral Appliance may be prescribed for severe patients who either cannot or will not comply with PAP therapy.

“Oral appliances are used to effectively alleviate mild to moderate cases of OSA for a broad range of patients, and now we are able to help even severely affected patients with this treatment modality. We are seeing great success with both acceptance of the appliance in terms of compliance, and efficacy of the treatment through follow up sleep testing with the appliances in place.” said David Walton, Co-Founder of Respire Medical an oral appliance company, which was recently acquired by Whole You. “There are a lot of products on the market so it’s essential you do your research when deciding which lab to work with. I know a lot of our clients appreciate the fact that we only make oral sleep appliances and so can be more responsive to their needs and requests.”

Whole You’s Respire Medical is an ideal partner for both aspiring and established sleep dentists as it’s dedicated to making oral appliances for sleep apnea and TMJ. Developing relationships with sleep physicians and a reputable oral appliance lab is a crucial second step in establishing a sustainable sleep dentistry practice. There are several ways to go about building up a relationship with a local sleep specialist, but before dentists take that first step and introduce themselves it is important they have a deep understanding of all the terminology and latest sleep dentistry practices.

Once the initial contact with a local sleep lab has been made and the dentist is ready to start sending patients with potential sleep apnea for testing, they should use standard medical SOAP (Subjective, Objective, Assessment, and Plan) format narrative reports documenting the patients’ treatment to show they are familiar with the medical language. Maintaining a relationship with both the patient and sleep physician is important to ensure they are happy with their current treatment and whether the patient needs an oral appliance for increased compliance.


Learn more:

● Read about steps to make your sleep dentistry practice more successful here

● Read about treating sleep apnea with oral appliances here

● The healthcare company Whole You, offers a number of sleep appliance solutions and its representatives will be happy to talk through solutions with you, learn more here or by calling 1-844-548-3385


For more information on any of the above please email us at: