By: Todd Sander, DMD
Topic Originally Appeared on PankeyGram.Org. Dr. Sander granted igniteDDS permission to share with our readers.
Patients suffering from obstructive sleep apnea (OSA) look for alternatives to continuous positive airway pressure (CPAP) or an integrated approach that would improve the quality of their lives and is easier to adapt.
Clinicians struggle because most of these patients are also non-compliant, one thing I noticed as I was doing my residency in the Army. Pilots were desperate for an alternative to CPAP (continuous positive airway pressure) because CPAP would ground them. Today, in my adult restorative practice, it’s clear that many patients benefit from an integrated approach to their oral health care and OSA therapy.
When I started my private practice in Charleston, SC, in 2005, I was working with occlusal disorder and facial pain patients and several of them were non-compliant CPAP patients. One day, after hearing Dr. Henry Gremillion’s presentation at the Hinman Meeting on the connection between bruxism and sleep apnea and reading the recommended literature, I thought sleep-disordered breathing may be at the root of many of my patients’ parafunction, evidenced by their persistent symptoms and the wear on their occlusal appliances.
And it was this same population of patients who needed significant reconstructive restorative dentistry.
Addressing Sleep Disorders In My Restorative Practice
I needed to develop a vision and framework for a comprehensive practice that would allow me to guide my team and focus my energies on more than just restoring a patient’s dentition. It was important to me to treat the root cause of patients who struggle with sleep disorders.
I knew that integrating dental sleep medicine into my practice protocols and educating my team and patients would take a deliberate effort, so I started with the introductory courses held by the American Academy of Dental Sleep Medicine.
There were also some questions I would have to address:
- How much time would I need to invest in training for myself and my team?
- How should I work sleep patients into my schedule?
- Which of the 32 FDA-approved appliances should I use? (Now, there are several hundred to choose from.)
- Should I invest in special software?
- Which medical providers could I work with, and how?
- How would I manage referrals?
I knew I would not be able to compete with others who were treating only sleep apnea patients. I decided that developing relationships with my patients would be as important for sleep dentistry as it is for restorative dentistry. And because I would also be dedicated to restorative dentistry, I would need to efficiently use my time to develop a niche practice in both restorative dentistry and dental sleep medicine.
With intentional forethought, my team learned how to screen interested patients and prequalify them for a comprehensive dental sleep medicine examination and consultation. I developed key people on my team to answer questions, gather the necessary information, and do preliminary work with incoming new sleep medicine patients.
This preliminary work is much the same as that done by dental assistants in a restorative practice…reviewing the patient’s medical and dental history and taking digital impressions and X-rays.
Comprehensive Treatment Planning
When a restorative patient comes to my practice, I do a 90-minute co-discovery examination, including sleep apnea screening. Then I take time in my lab doing diagnostic work with mounted models and plan treatment based on the radiographs, photographs, and other records we took during the comprehensive exam.
The patient then returns for a consultation. If it is a complex restorative case, I spend time going over the treatment options, answering the patient’s questions, and developing my relationship with the patient. At this point, the patient is often ready to select treatment, and we move ahead with dental treatments. If the patient has the signs and symptoms of OSA, time is spent discussing the oral and systemic health benefits of having a sleep study and prescribed therapy. I refer my patient to sleep specialists I have developed a relationship with and know will provide a thorough evaluation. These specialists continue the OSA conversation and order a polysomnogram (sleep study) if deemed appropriate.
When a patient is referred to me by a physician to provide an oral appliance to replace CPAP or to be used in combination with CPAP, my comprehensive examination is a little different—with adaptations for medical documentation, but it is still 90 minutes. I have found that dental sleep medicine patients referred for sleep apnea treatment can usually be processed through their examination and treatment consultation in a single two-hour appointment.
Today there are many opportunities for clinicians who want to enhance their knowledge in dental sleep medicine, compared to when I started. If you’re striving to creating healthier patients and practices, consider enrolling in advanced courses at The Pankey Institute about Integrating Dental Sleep Medicine as part of your everyday routine.
Visit The Pankey Institute to significantly impact your patients and practice success!
