Archives for posts with tag: DSM

#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.
 
 
 
   

                                  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?   

WHY WOMEN ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

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 ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

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.

WHY ARE WOMEN LESS LIKELY TO BE DIAGNOSED 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.

COMMON SLEEP APNEA MISDIAGNOSES
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 atHopkins’ 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.

A dentist asked me, “ How do I find sleep apnea patients that I can treat?“

Here’s how I answered him, “They will find you.“
If you saw the award winning movie “Field of Dreams” you will remember Ray Kinsella (Kevin Costner) being told, “Build a field and they will come.”   He did build a baseball field in a Kansas corn field and sure enough the great legends of the game came to play there.
After you have been trained and become confident in your screening and treatment skills you’ll be pleasantly surprised at the vast number of sleep apnea patient resources.  Build your field and they will come.
These are just a few of the sources available to you:
  • word gets around that you are the sleep doctor and new patients will seek you out
  • your patient base will produce enough candidates to keep your schedule filled  
  • you will be developing a network of healthcare professionals that will send you patients
  • patients you have treated will be referring their family and friends
Success in Dental Sleep Medicine, unlike in other ventures, does not have to be long and drawn out. If you focus on all the “little things“ and stay dedicated you will reach your objective in a few months.
Studies reveal OSA is prevalent. 
-A 2015 study in Switzerland reported 50% of men and 23% of women had at least moderate OSA.1
-In 2002, the Sleep Heart Health study found that 24% of men and 9% of women have at least mild OSA.2

-In the Wisconsin Sleep Study Cohort, it was reported that 10% of men and 3% of women age 30 to 49 have at least moderate OSA, while 17% of men and 9% of women age 50 to 70 have at least moderate OSA.

-Over 50% of children diagnosed with ADHD suffer from sleep apnea
-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). 
-OSA is highly underrecognized, and it is estimated that 82% of men and 93% of women in the United States with OSA are undiagnosed.4
Is there any better opportunity today in dentistry?
Are you ready to build your field of dreams?
Write me with any questions at cskdoc@aol.com.
References
  1. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
  2. Young T, Shahar E, Nieto FJ, et al; for the Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults. Arch Intern Med. 2002;162(8):893-900.
  3. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.
  4. Young T, Evans L, Finn L, Palta M. Estimation of clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-706.

                                                                                     

                                                                                          ‘it’s THE START that STOPS most People’

We know you are interested in developing a strong presence in the exciting and profitable world of Dental Sleep Medicine.    Here are answers to the most frequently asked questions.
  1. “Are there enough patients who need my DSM Service?”

If  you did not get one new patient coming to your office because of your new magnet (DSM) you could keep a schedule filled with your existing patients. 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 (IN ADDITION TO those new patients that hear about you), are there for you to help.

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). Is there any better opportunity today in dentistry?

  1. “Why is THIS the best time for me to learn DSM?

Dental Sleep Medicine is the hottest button in dentistry today.
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 the brain and to other organs. Strokes. Heart attacks. Diabetes. Dementia. People are recognizing that they have the symptoms and are asking their Dentists about it. Some Dentists have the solutions. Every Dentist would like to be “The Sleep Dentist.

  1. “How would I get paid? Do Insurances cover the Services?”

With training in Dental Sleep Medicine you will learn the answers to these often asked questions about reimbursement:

-What is the difference between dental and medical codes?
-What is Durable Medical Equipment and how does that apply to us, as dentists?
-How some dentists leave thousands of dollars of medical reimbursement on the table and lose case acceptance in the process    -What  are the deductibles?
-What documents do I need for successful medical insurance processing?
-What do I need to know about Medicare?

-The number one medical billing error you should not make

 4.  “How do I get Started?”

If you are interested enough to have read this far, you have already started. To succeed in DSM you must have passion for helping people and excitement for being at the forefront of a new medical/dental science. With only 4% of dental practices qualified to offer these services, you can be proud to be a medical/dental pioneer.

The first step in your education is to attend a DSM training seminar. There you will learn all the basics. Sleep Group Solutions presents two-day seminars every weekend in two different cities. The “Introduction to Dental Sleep Medicine” covers all aspects “from A to Pay”. You will learn the mysteries of the science of sleep, a functional protocol for screening and treating patients, how to find patients who need your services, the various intra-oral appliances and how to monitor their efficacy. and billing benefits with medical codes.

Oral appliance therapy (OAT) is the most convenient and preferred therapy for the mild and moderate cases and for those patients who cannot tolerate the CPAP device. Fortunately, this is where The Dentist rides in on a white horse to the rescue. We dentists like to say we are on the front line of the battle against sleep apnea. Dentists are in the optimum position to see the signs and symptoms and can offer the most preferred solutions to the problem..
In the words of the Great Master Yoda, in the classic Star Wars movies, “There is no ‘try’; there is only ‘do’ or ‘do not’.”

                                                                                                                                                                                     “It’s the Start that Stops Most People”

WHAT IS MISSING IN YOUR COMPREHENSIVE DENTAL EXAM?

A truly professional comprehensive dental exam examination (D0150 or D0180) should include much more than what the CDT codes delineate.
What is essential?
Beyond the obvious FMX, charting of existing and needed dental and periodontal conditions, and an oral cancer screening, there are many other evaluations which are directly related to our services and are within our authority and responsibility.
The Comprehensive Exam should also include measurement of vitals such as blood pressure, etc. and a sleep dysfunction screening with a sleep questionnaire and a careful discussion of any notable items (alerts) in the patient’s med and sleep history. These things don’t need to be spelled out in the CDT code. They come with our desire to do what we know is right.

MALLAMPATI EXAM

TMJ exam, facial muscle palpation, Mallampati classification  (correlates tongue size to pharyngeal size) and an oxygen saturation test will provide critical information.  Any dentist/hygienist/team will chose how extensive they wish their dental exams to be and what should be included.

Would we be “spending too much time” in a dental exam visit?

Not if we care about our patient’s total well being, our conscience, and our dental license.

And is this “nearly always accepted by patients with huge value and appreciation”? YES, it is when the dental team shows their patients how much passion, care and skill they have. I see it in many dental offices. The really successful ones.

5-20-12 HUMAN PYR

Do you want to do more?
Here’s your opportunity to increase your service to your community, to create your “niche”, and  to stand out in your community as a complete care-giver. Your rewards will be enormous!
It is reported that 34% of the population has sleep breathing symptoms. One of the next three patients that walk thru your doors is your candidate.

Are you able to help them?

Does your New Patient Exam include a screening for Sleep Apnea?1-21-13 LOGO DENTAL PROS SHARING

 

Interested? Then check this out: http://sleepgroupsolutions.com

or ask me:  cskdoc@aol.com

Getting tired of the nasty weather, yet?

Come down to sunny, warm Florida and escape the mean cold winter while learning a valuable service to help your patients.

Dr. John Carollo presents his Dental Sleep Medicine seminar in Jacksonville and offers you 16 CE credits.

DATE/TIME
April (04/05/2019 – 04/06/2019)
8:00 am – 5:00 pm

 

LOCATION
DPC Technology
7845 Baymeadows Way Suite A
Jacksonville, FL, 32256

Phone: 904) 443-0095 (for hotel reservations only)

While your family is running around spending your money in Florida you will be learning a valuable new dental service. But let them spend because when you get back home you’ll quickly recover your total weekend costs as a Sleep Medicine Dentist.

Sleep Apnea victims are looking for a dental professional like you to treat their symptoms. One of every three patients that walk through your door has a sleep breathing dysfunction. Your patients need your help

See the course content and register here: https://join.sleepgroupsolutions.com/seminars/jacksonville-fl-3/#axzz5gnE9eOJY

It is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed.

If we accept the reports that a minimum of 80% of Sleep Apnea is undiagnosed, then only 20% is actually addressed in any fashion.

The undiagnosed may fit into these categories:

1. Patients have no idea that such a thing as Sleep Apnea exists.

        Hard to believe it but there are such people.
2. They know about, but have no idea that they suffer from, Sleep Apnea .
        “Isn’t snoring normal?”  “Doesn’t everyone wake up 4-6 times a night?”
3. They know they have the symptoms of Sleep Apnea but are in denial.
        A “smart lawyer” who insists sleep apnea does not exist. He tells me that I am “just as bad as [his] wife” who listens to him snore and gasp for breath every night.
4. They know they have problems but refuse to do anything about it.
       Some have heard horror stories about CPAP machines and simply do not want to take action. They need to learn about the oral appliance therapy (OAT).
5. Misdiagnosed Sleep Apnea.
        There is a lack of knowledge of sleep apnea among many health professionals. Physicians are alerted only to the stereotypes but Sleep Apnea is a non-discriminating attacker- it effects people of all genders and ages.It is often misdiagnosed as ADHD.
It is sometimes very difficult to get these people to want to be screened and diagnosed by just telling them their symptoms are evidence of a serious disease.    It is necessary for them to “see” it for themselves and for them to adopt a top down approach – of their own volition.The best way to do this is to educate them in the most simple, effective, non intimidating and cost effective way – we can show them films of OSA victims having sleep breathing events.  We must find a way to get them screened and filmed and then show them their results. This is an massive education deficit issue.  Learn how to help them: SleepGS.com

Sources

American Sleep Apnea Association  http://www.sleepapnea.org/i-am-a-health-care-professional.html

Indy Star, Lauran Neergaard, http://www.indystar.com/articles/9/186972-5719-052.html

Detroit Free Press, Bill Dow, http://www.freep.com/news/health/sleep2e_20041102.htm

We know you are interested in developing a strong presence in the exciting and profitable world of Dental Sleep Medicine. Here are answers to the most frequently asked questions.

  1. “Are there enough patients who need my DSM Service?”

If  you did not get one new patient coming to your office because of your new magnet (DSM) you could keep a schedule filled with your existing patients. 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 (aside from those new patients that hear about you), are there for you to help.

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). Is there any better opportunity today in dentistry?

  1. “Why is THIS the best time for me to learn DSM?

Dental Sleep Medicine is the hottest button in dentistry today.
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 the brain and to other organs. Strokes. Heart attacks. Diabetes. Dementia. People are recognizing that they have the symptoms and are asking their Dentists about it. Some Dentists have the solutions. Every Dentist would like to be “The Sleep Dentist.

  1. “How would I get paid? Do Insurances cover the Services?”

With training in Dental Sleep Medicine you will learn the answers to these often asked questions about reimbursement:

-What is the difference between dental and medical codes?
-What is Durable Medical Equipment and how does that apply to us, as dentists?
-How some dentists leave thousands of dollars of medical reimbursement on the table and lose case acceptance in the process
-What documents do I need for successful medical insurance processing?
-What do I need to know about Medicare?

-The number one medical billing error you should not make

-What  are the deductibles?

-An easy way to help your entire team eliminate any problems with Medical Billing

 4.  “How do I get Started?”

If you are interested enough to have read this far, you have already started. To succeed in DSM you must have passion for helping people and excitement for being at the forefront of a new medical/dental science. With only 4% of dental practices qualified to offer these services, you can be proud to be a medical/dental pioneer.

The first step in your education is to attend a DSM training seminar. There you will learn all the basics. Sleep Group Solutions presents two-day seminars every weekend in two different cities. The “Introduction to Dental Sleep Medicine” covers all aspects “from A to Pay”. You will learn the mysteries of the science of sleep, a functional protocol for screening and treating patients, how to find patients who need your services, the various intra-oral appliances and how to monitor their efficacy. and billing benefits with medical codes.

Oral appliance therapy (OAT) is the most convenient and preferred therapy for the mild and moderate cases and for those patients who cannot tolerate the CPAP device. Fortunately, this is where The Dentist rides in on a white horse to the rescue. We dentists, like to say, we are on the front line of the battle against sleep apnea. Dentists are in the optimum position to see the signs and symptoms and can offer the most preferred solutions to the problem..
In the words of the Great Master Yoda, in the classic Star Wars movies, “There is no ‘try’; there is only ‘do’ or ‘do not’.”

Beginning with the seminar training, the dentist must be 1000% committed to success. (Anything we endeavor will be more likely to be achieved when we are positive that we will win.) The seminar training is only the beginning of the learning process. We must retain what we have learned, continue to study, to research all new ideas and to practice our treatment plan presentations with our teams. Everyone on the team must be skilled and committed.

Sleep Apnea training, although essential, is not the end of the education. It is, as Winston Churchill said in 1942 during WWII,  “…this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

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: cskdoc@aol.com