DISAPPOINTMENT IS A SMALL OBSTACLE ON THE ROAD TO SUCCESS

Tracie Harley, RDH was a Super Hygienist. She exuded a contagious passion for helping her patients, and everyone loved her. She was admired for her clinical skills and successful patient compliance. Tracie enjoyed working as an itinerant “temp” hygienist because it gave her the opportunity to meet new dental professionals and learn from them.When COVID-19 set in and dental practices needed to shut down, (Periodontal disease was not classified as an “essential” medical service), Tracie had time to reflect on her future.

Her love for dental hygiene was overshadowed by the fear of returning to a risky dangerous occupation. Her concern about contaminated aerosols and the intimate physical contact with unknown strangers made her re-think her future. 

ONE DOOR CLOSES, A BETTER ONE OPENS

 

That’s when she made the painful decision to investigate other options. She wanted to stay in Dentistry. She spoke with her friend Susan who was working as a Dental Sleep Coordinator in a Sleep Practice.  With the advice of her friend, Tracie took a Sleep Coordinator training course, got placement assistance, became situated in a high value private dental practice and quickly concentrated on screening patients for Sleep Breathing Disorders like Obstructive Sleep Apnea. 

Within two months of making her decision she was helping the dentist treating patients, on average three each day, for sleep apnea. The average income for each case was $4000. This generated for the office $12,000 a week for three easy, relaxed, rewarding half days a week.  And Tracie‘s income for this was three times greater than before as a hygienist. 

This may sound like “pie in the sky” but it is a conservative example. When you check around you will find examples like this being quietly conducted all throughout the nation. The happy ending- Tracie stayed on 3 half days a week as the Sleep Coordinator. How is that for a ROI of 6 weeks’ training?

 

HOW LACK OF SLEEP EFFECTS WEIGHT GAIN

“I’ve tried so many diets and none of them work”  How many times have you heard that? Have you said that?  NOW YOU MAY HAVE A SOLUTION.

Lack of sleep is causally connected to many physical problems. We know that from numerous reliable studies.

 Obstructive Sleep Apnea (OSA) is a major cause of sleep loss and one of the common symptoms of (OSA) is being overweight. Sleeping less than six hours, or more than nine hours a night appears to increase the likelihood of weight gain. So then, how does OSA effect weight gain?

There are three hormones that factor in the equation of lack of sleep contributing to weight gain.

1. Ghrelin: the Hunger Hormone

Lack of sleep increases ghrelin, and decreases leptin, both effects influencing increased hunger and obesity. Ghrelin is produced in the gastrointestinal tract and functions as a neurotransmitter. When the circadian rhythm is interrupted by exposure to light at night, gherlin is released.

 2.  Leptin: the Anti-hunger Hormone.

Leptin is the satiety hormone that has opposite effects from ghrelin.  The receptor for leptin is found on the same cells in the brain as the receptor for ghrelin.

3. Melatonin

Melatonin maintains the body’s circadian rhythm by regulating the other hormones. The circadian rhythm is an internal 24-hour “clock” that plays a critical role in when we fall asleep and when we wake up. When it is dark, your body produces more melatonin. When it is light, the production of melatonin drops. Being exposed to bright lights in the evening, or too little light during the day, can disrupt the body’s normal melatonin cycles. For example, jet lag, shift work, and poor vision can disrupt melatonin cycles.

Melatonin supplements can be helpful for those who are sleep disadvantaged but adherence to directions is recommended.

The Process

An inverse relationship between the hours of sleep and blood concentrations of ghrelin exists: as the hours of sleep increase, ghrelin levels trend lower and obesity is less likely.  Short sleep duration is associated with high levels of ghrelin and obesity.

When the stomach is empty, ghrelin is secreted. When we eat something the stomach is stretched and ghrelin secretion stops. Ghrelin acts to increase hunger and to increase gastric acid secretion and gastrointestinal motility to prepare the body for food intake.

What else does Ghrelin do to effect weight gain?

Beyond regulating hunger, ghrelin also plays a significant role in other systemic functions. Ghrelin influences body composition, it stimulates the release of growth hormone and regulates the distribution and rate of use of energy.

Conclusion

This is just another convincing reason to get adequate healthy sleep…. at the right time. 

Light is the circadian rhythm disrupter. Avoid light disturbances during sleep: have no lights in the bed room, pull the shades down to block any outside light, turn off the TV and computer. Blue light at the end of the spectrum is the most disruptive. When you are ready for sleep, wear an eye mask.

WHAT IS SLEEP COORDINATOR ACADEMY?

 WHAT IS SLEEP COORDINATOR ACADEMY?

Every dentist wants to develop a strong presence in the exciting and profitable world of Dental Sleep Medicine. We have all heard the stories of phenomenal success some dentists have in treating patients for Obstructive Sleep Apnea.   There are approximately 200,000 licensed dentists in the USA and as of last year less than 5% of them are qualified to treat the millions of sleep apnea afflicted patients. Why such a disparity? The most common responses are, “I’m too busy to learn a new service.”,  “My staff is too busy.”,  “I don’t know where to begin.”

DO YOU SEE THE COMMONALITY?  

But we do have a solution for them

In comes Sleep Coordinator Academy, wearing a shiny suit of armor, on her/his white horse, and says, “ Doctor, I have the solution for you. I will provide you with a comprehensively trained sleep coordinator who will establish a dental sleep medicine service in your practice for you and s/he will handle all the screening of your patients, marketing for new patients, present the case plan (sell), manage the medical billing and record-keeping and assist you in taking the impressions and adjusting the appliances. S/he may be in independent contractor and you can work out the schedule of days and hours with her. 

Sleep Coordinator Academy presents an A to Z practical training course that prepares the candidates for a confident position in the most highly respected Dental Offices and after graduation assists in placement and follow up.  

You may email me with any questions

ABFRACTIONS: # 4, ORAL MANIFESTATIONS OF OSA

Abfractions- Common in patients with Obstructive Sleep Apnea.

Nocturnal bruxism, which is indicative of OSA, plays a major role. The effective solution requires treatment of the causes- OSA with occlusal imbalance.

 

Abfractions are non-carious cervical lesions (NCCL) caused by flexural forces; the enamel, especially at the cemento-enamel junction (CEJ), undergoes this pattern of destruction by separating the enamel rods.  Studies show that within the same patient, teeth with abfractions presented more gingival attachment loss than those without abfractions.  

 

 

 

An abfraction occurs on the lower part of the crown of a tooth, near the gum line.

            The enamel covering the crown tapers down to its thinnest there.  Uneven pressures on the biting surfaces of teeth cause a torque on the tooth which produces a slight bend at the center where the crown meets the root. As the tooth keeps bending, the thin enamel at the bottom of the crown, near the gum line, chips away.

 

The sensitive “dentin” surface inside the enamel is now exposed. Vigorous, improper teeth brushing will then wear away the unprotected dentin and the notches will grow deeper and larger.  The dentin also becomes vulnerable to acid erosion from foods such as citrus.

 

 

NOCTURNAL BRUXISM:

#3  THE ORAL MANIFESTATIONS OF OSA 

NOCTURNAL BRUXISM

The coincidence is very high between Obstructive Sleep Apnea  and grinding and bruxing while asleep.

Most of the sleep bruxism events happen when a subject is lying on his or her back.

Immediately after the apnea episode, when the ventilation process resumes, activation of the process of jaw-opening and closing begins. This is an involuntary effort to dilate the upper airway and reduce the resistance in order to ease normal breathing.  

This continuous, repeated process of empty-mouth mastication throughout a night of apnea events causes wear on the occlusal surfaces and incisal edges which is readily detected in a dental exam.  

There is a marked decrease of nocturnal bruxism when apnea/hypopnea episodes are completely eliminated.

 

 

 

   

THE ORAL MANIFESTATIONS OF OBSTRUCTIVE SLEEP APNEA #2 Scalloped Tongue

1. Mallampati Airway Exam  

2. Scalloped tongue

 

 

During an apnic event the tongue will force itself forward to remove itself as an air-blocking barrier.  Repeated compressions like this, pushing against the teeth, will leave impressions in the lateral edges of the tongue. The patient subconsciously  tries to force the tongue to move forward from the air tract and forces it against the teeth.This sign is readily detectable. This is also called Crenulated Tongue.

 

This indicator is nearly infallible; it must be differentiated from a similar condition (sign) in  a thyroid disorder.

 

 

We are in an excellent position to screen for sleep apnea and to help identify our undiagnosed (and therefore, untreated) OSA patients.

How can you miss these clinical signs?

You…..

• have direct observational access to the physiological structures of your patients’ upper airways

• are already screening chair side for other health conditions that can be easily spotted during a dental visit

• may see these patients more frequently than primary care physicians will, and are nearly one quarter more likely to see a dentist than a physician over any given time period.

Your field of operations is right next to the opening of the airway.

HOW CAN YOU MISS THESE ORAL SIGNS OF OSA ?

1. Mallampati Airway Exam

  

2. Scalloped tongue

During an apnic event the tongue will force itself forward to remove itself as an air-blocking barrier.  Repeated compressions like this, pushing against the teeth, will leave impressions in the lateral edges of the tongue. The patient subconsciously  tries to force the tongue to move forward from the air tract and forces it against the teeth.This sign is readily detectable. This is also called Crenulated Tongue.

This indicator is nearly infallible; it must be differentiated from a similar condition (sign) in  a thyroid disorder.

We are in an excellent position to screen for sleep apnea and to help identify our undiagnosed (and therefore, untreated) OSA patients.

How can you miss these clinical signs?

You…..

• have direct observational access to the physiological structures of your patients’ upper airways

• are already screening chair side for other health conditions that can be easily spotted during a dental visit

• may see these patients more frequently than primary care physicians will, and are nearly one quarter more likely to see a dentist than a physician over any given time period.

Your field of operations is right next to the opening of the airway.

THE MALLAMPATI AIRWAY EXAM

                  MALLAMPATI EXAM

The Mallampati Scale is a simple but effective test to assess your patient’s (or your own) airway .

The subject should be sitting or standing with their head on a 90 degree axis to the floor.

They protrude their tongue (not necessary to say “ahh”) and with a direct light into the  mouth, look in and/ or take a picture.

 

Class III or IV conditions are certain candidates for further testing and possible therapy.

The tongue is the most common factor in Obstructive Sleep Apnea.

Now that you learned this you will probably be heading for a mirror. How did you rate?                                     

THE MALLAMPATI AIRWAY EXAM

                                  MALLAMPATI EXAM

The Mallampati Scale is a simple but effective test to assess your patient’s (or your own) airway .

The subject should be sitting or standing with their head on a 90 degree axis to the floor. They protrude their tongue (not necessary to say “ahh”) and with a direct light into the  mouth, look in and/ or take a picture.

 

Class III or IV conditions are certain candidates for further testing and possible therapy.

The tongue is the most common factor in Obstructive Sleep Apnea.

Now that you learned this you will probably be heading for a mirror. How did you rate?   

ONE DOOR CLOSES, A BETTER ONE OPENS

Tracie Harley, RDH was a Super Hygienist. She exuded a contagious passion for helping her patients, and everyone loved her. She was admired for her clinical skills and successful patient compliance. Tracie enjoyed working as an itinerant “temp” hygienist because it gave her the opportunity to meet new dental professionals and learn from them.

 

When COVID-19 set in and dental practices needed to shut down, (Periodontal disease was not classified as an “essential” medical service), Tracie had time to reflect on her future. Her love for dental hygiene was overshadowed by the fear of returning to a risky dangerous occupation. Her concern about contaminated aerosols and the intimate physical contact with unknown strangers made her re-think her future.

 

 

DISAPPOINTMENT IS A SMALL OBSTACLE ON THE ROAD TO SUCCESS

 

That’s when she made the painful decision to investigate other options. She wanted to stay in Dentistry. She spoke with her friend Susan who was working as a Dental Sleep Coordinator in a Sleep Practice. 

 

With the advice of her friend, Tracie took a Sleep Coordinator training course, got placement assistance, became situated in a high value private dental practice and quickly concentrated on screening patients for Sleep Breathing Disorders like Obstructive Sleep Apnea.

 

Within two months of making her decision she was helping the dentist treating patients, on average three each day, for sleep apnea. The average income for each case was $4000. This generated for the office $12,000 a week for three easy, relaxed, rewarding half days a week.  And Tracie‘s income for this was three times greater than before as a hygienist.

 

This may sound like “pie in the sky” but it is a conservative example. When you check around you will find examples like this being quietly conducted all throughout the nation.

 

The happy ending- Tracie stayed on 3 half days a week as the Sleep Coordinator. How is that for a ROI of 6 weeks’ training?

 

If you are interested in getting into this exciting, rewarding, life-saving Dental Sleep Medicine field you may contact me at cskdoc@aol.com for more information