First Choice Practice Sales and Sleep Group Solutions

present an exciting training course on Dental Sleep Medicine with an amazing offer.

Treating Snoring and Sleep Apnea in the Dental Office – An effective protocol

Including Medical Billing for Dentists

Date:          June 22,23, 2018

Time:          8 A.M. to 5 P.M.  Both days

Location:   Ayres Hotel, Costa Mesa/Newport Beach, CA
Presenter: Dr. Dan Tache’
16 CE Credits awarded
This special program is offered by First Choice Practice Sales and Sleep Group Solutions

Of the next three patients that walk thru your doors, one will be a victim of a sleep breathing disorder….will YOU be able to identify and treat that patient?

Today’s “Hot Button”, Dental Sleep Medicine, will make YOU stand out, be sought out and become your uniqueness to serve the needs of 34% of your existing patients and… to attract many new patients. 


You will be able to offer not only your EXCELLENCE but also DIFFERENCE.  In this sluggish economy, where there is a perception of “financial doom”,  dental consumers have a tight hold on their wallets; dental service acceptance shows a concerning drop.
Your First Class Service and Patient Engagement are expected as basic “givens”. But what is your clinical niche?
Are YOU the dental practice they must go to? Are you the only practice around that is the “Snooze Dentist”,  the “Snore Dentist”? Are you the “Sleep Dysfunction Dentist”?

Dental Sleep Medicine is where Teeth Whitening was 20 years ago.
It is the “hot button” where Implant Dentistry was 10 years ago.
Strike while the iron is hot. Brand yourself as the “Sleep Dysfunction Dentist”
Sleep Group Solutions is the world’s largest Sleep Apnea company, concentrating on education, intra-oral appliances and supplies for the dental community

This Dental Sleep Training course may be the most valuable CE Seminar you have taken. *

Here’s one example of a very useful test that anyone can do to determine the likelihood of Obstructive Sleep Apnea.
The  Mallampati Score is a very simple exam and is an effective indicator of a compromised airway.   The subject can be sitting or standing with a vertical axis of their body and head.  As long as the tongue is protruding we are able to see the airway. The variables are, above, the soft palate and uvula, laterally, the walls of the fauces (or the tonsils and adenoids), and below, the base of the tongue.
The tongue is the most common offender for obstructive sleep apnea. Macroglossia can be effectively dealt with by oral appliance therapy- a mandibular advancement device (MAD).
Imagine trying to breathe with an obstructed airway… and a nasal obstruction!
Your Sleep Coordinator or Hygienist can do this exam as part of routine screening on every patient. Class III and IV must be treated.

About the SGS Course Instructor: Dr. Jeff Horowitz

Dr. Jeff Horowitz, a native of Old Bridge, New Jersey, completed his undergraduate studies at the University of Pittsburgh , receiving early admission to dental school after his junior year. In 1991 he earned his Doctorate of Dental Medicine degree from the Medical University of South Carolina. Dr Horowitz has dedicated himself to continuing education, earning him the fellowship award from the Academy of General Dentistry.  Dr. Horowitz is also a member of the American Association of Dental Sleep Medicine.

* You will receive 16 CE credits and a training in the most exciting and rewarding dental service.

Read the course outline and register here with Promo Code TN500 to get a 50% tuition saving:

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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 producing 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.

melatonin 5-6-15

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.


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, wear an eye mask.

Zarouna SWozniak, G, Papachristou, Stalo Zarouna,
Psychology Department, University of Cyprus, Nicosia 1678, Cyprus.
  • Department of Cell Biology, Physiology and Immunology, University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), and CIBER Fisiopatología de la Obesidad y Nutrición, 14004 Córdoba, Spain.
One of the most common symptoms of Obstructive Sleep Apnea (OSA) is Gastro-Esophageal Reflux Disease (GERD)
 During the cessations of breathing the body will increase its efforts to take in air. Abdominal contractions are exaggerated and increase until breathing resumes.
The contractions squeeze the stomach and force acid up the esophagus.
The efforts to breathe also increase a negative pressure in the esophagus which also pull up acid.
Patients in the dental office can be easily screened for Obstructive sleep Apnea (OSA) at the initial oral exam. The signs of Acid Reflux (GERD) are screaming to be noticed: Acid tooth erosion is one consequence,  bruxism is another.  A sleep questionnaire and other signs and symptoms of sleep apnea will prompt the need for a HSS (home sleep study).  This will help determine the diagnosis of OSA and  the severity. By treating the sleep apnea we can save teeth and possibly the patient’s life.
It’s so important to treat sleep apnea for many reasons.  GERD is just one of them.  One out of 3 people have a sleep disorder.  Everyone knows someone with sleep apnea and has a story to tell about it.   Don’t we, as dental professionals, have an obligation to help our patients live healthier and live longer? Every dentist should receive training to identify and treat their OSA affected patients.
By Charles Kravitz, DDS
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.
This article will provide you with the solutions to your questions and get you excited about incorporating Dental Sleep Medicine (DSM).into your Dental Practice.
 “How Will Benefit by DSM in my Dental Practice?”
     This is a huge winner for your practice, for you, for your team, and for your patients.
    A.  The Benefits for you and your Dental Practice
              1.  Acquire New Patients- lots of them.
You will be sought for your unique professional dental service. Awareness of sleep apnea in America is at an all-time peak. The fires of awareness are being stoked by the public media and by social media. Patients are understanding and becoming increasingly more concerned about the blockage of oxygen to their brains and to other organs. Strokes. Heart attacks. Diabetes. Dementia. People are recognizing that they have the symptoms and are asking their Dentists about it. 
When people learn that you are “The Sleep Dentist” or “The Snore Clinic”, and you can help them, they will call you. “Build a field and they will come.”( from Field of Dreams.)Your New Patient flow will increase.
            2.  Greatly Increased Income
With the new patients come new needed services. People who are health conscious and are concerned about their sleep disorder will be equally concerned about their oral health. You will enjoy new opportunities to help your new patients.
We know that this dental practice “niche” has quickly evolved into a full time “specialty” for energetic, dedicated dentists. The revenues generated from sleep services are impressive.
            3. A Unique Life-saving Service
I’m sure you understand that now, more than ever, you need to stand out and be able to offer not only EXCELLENCE, but also DIFFERENCE.  In this sluggish economy, where there is a perception of “financial doom”, (I personally don’t believe in that.), dental consumers have a tight hold on their wallets, and reports of dental service acceptance show a concerning drop. With DSM you will offer a unique dental/medical service.
What are YOU doing now to offer a unique service? Your First Class Service and Patient Engagement are expected as basic “givens”.  But what is your niche ? Are YOU the dental practice they must go to? 
            4. Serve an Underserved Need
According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea and 40% (1.3 million) of CPAP users are non-compliant. So that alone conservatively projects 20.2 million victims of obstructive sleep apnea who may be helped by a dentist trained in Oral Appliance Therapy (OAT). 
            5. Significance
One of the basic human needs is to feel significant. It is a personal reward we can give ourselves. We dentists enjoy a lifetime of helping our patients. Caring for people is one of the driving forces that made us choose this career. It makes us feel good to know we are helping people to avoid pain, eat healthier, and feel more confident about their appearance. That is all great. But how does it compare to the feeling of saving a patient’s life? When you know you have taken patients who spend half their night’s sleep without oxygen going through their airway and to their brain- and you have corrected their life threatening disease, how does that make you feel? Significant! You will be seen as a hero.
    B.  The Benefits to Your Dental Team
Every member of your team plays an important role in the Dental Sleep Medicine service and they will enjoy the following benefits: 
            1. Professional Pride, Prestige 
All team members will know, as you know, that they are steps above the dental community in truly providing comprehensive health care. 
            2. Providing a Needed Service
Studies show that 34 percent of the American public have symptoms of sleep disorder. That means that one of every three people that you currently treat and of those that are new patients, are there for you to help them.
Your team members will be perfectly positioned to help their family, neighbors, and new friends.
According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea. 
            3.  Rewards  
On top of the emotional rewards that your team members receive, they are contributing to the financial success of your practice. DSM is over 80 percent staff driven and you may feel they deserve to share rewards with you. 
            4.  Job Security  
DSM in a practice can build quickly and strong.Your employees make valuable contributions to its success and have the good feeling of being needed. By the same token, you will know that they are critical to your success and would not want to lose them. 
            5.  Feeling of Significance 
Like you, your employees enjoy the feeling of “making a difference”. Everyone needs to feel significant. It is a personal reward we can give ourselves. Caring for people is one of the driving forces that made your staff want to be a dental professional.  When they know they have taken patients who spend half their night’s sleep without oxygen going through their airway and to their brain- and they have contributed to correcting their life threatening disease, how does that make them feel? Significant! They will be seen as heros.
    C.  Benefits for Your Patients
              1. Your patients will now have a convenient and caring source (you) that can discover and treat that serious disease- Obstructive Sleep Apnea- that wakes them up all through the night and diminishes their quality of living.
            2.  They will understand that trained dental professionals are the best source for discovery of  Obstructive Sleep Apnea. They will spread the word – referrals.
            3. They will know their dentist will be able to offer them the most comfortable and popular treatment for OSA- the Oral Appliance Therapy. (OAT). 
              4. They will be delighted that Medicare and their private insurance, in most cases, will pay for the OAT. 
              5. Your patients will sleep better, feel better, be healthier and live longer. 
Contact me to learn more:

By Charles Kravitz, DDS in Women’s Health
Swedish scientist Dr. Karl Franklin and his team set out to find out how prevalent sleep apnea is among women and how often symptoms occur. Out of a population-based random sample of 10,000 women between the ages of 20 and 70 years, they gathered data on 400 of them. The test group were given questionnaires which included several questions regarding their sleeping habits and sleep quality. They also underwent overnight polysomnography.


Women with sleep apnea are less likely to be diagnosed compared to men. In studies of patients registering for evaluation for sleep apnea, the ratio of men to women has sometimes been extremely lopsided, with 8 or 9 men diagnosed with obstructive sleep apnea (OSA) for each woman found to have OSA. However, we know from studies in the general population that the actual ratio is likely to be closer to 2 or 3 men with OSA for each woman who has the condition.  Women make up about 45 percent of sleep study referrals and most sleep studies are still done to screen for sleep apnea.


 First, there is an unfortunate predefined notion of the make-up of a sleep apnea patient. The stereotype is a middle-age, overweight or obese male. Physicians may not be thinking of this OSA diagnosis when the patient is female. Second, women may present with slightly different symptoms than the “classic” symptoms of snoring, witnessed breathing pauses at night and excessive sleepiness during the day.

Instead, women may present with fatigue, insomnia, disrupted sleep, chronic fatigue and depression morning headaches, mood disturbances or other symptoms that may suggest reasons other than OSA for their symptoms. Because these symptoms are not specific for OSA, women may be misdiagnosed and are less likely to be referred to a sleep study for further evaluation. Another problem is that women with sleep apnea have more subtle breathing disturbances and are more likely to have REM-related apneas, so they may be tougher to diagnose.



Women are often diagnosed in error with one of the following conditions, rather than sleep apnea.

  • Anemia
  • Cardiac or pulmonary illnesses
  • Depression
  • Diabetes
  • Fatigue from overwork
  • Fibromyalgia
  • Hypertension
  • Hypochondria
  • Hypothyroidism
  • Insomnia
  • Menopausal changes
  • Obesity
  • Sources
  • Dr. Karl Franklin, European Respiratory Journal
  • Grace W. Pien MD, MS, assistant professor of medicine, divisions of Sleep Medicine and Pulmonary and Critical Care at the University of Pennsylvania School of Medicine.
  • Nancy A. Collop , MD, medical director at Johns Hopkins Hospital Sleep Disorders Center and associate professor of medicine at Hopkins’ Division of Pulmonary and Critical Care Medicine in Baltimore, Md .
  • Fiona C. Baker, PhD, sleep physiologist, Center for Health Sciences, SRI International, in Menlo Park, Calif.
  • Anita L. Blosser, MD, with Duke Primary Care at the Henderson Family Medicine Clinic in Henderson, N.C.

These American war veterans are standing at the WWII Memorial in Normandy, France.