Most people who seek help for a sleep breathing disorder like snoring or sleep apnea are diagnosed by a sleep doctor and given a pressure mask, or CPAP. Millions of these are sold every year. For World Sleep Day 2021, Phillips, one of the two biggest CPAP manufacturers, surveyed 13,000 people in 13 countries around the world. Of the people who were prescribed CPAP, only 18% of them were using it. Of the people who were at risk, 27% said they would not take a sleep test because they did not want a CPAP.

It gets worse. The US Agency for Healthcare Research and Quality released a draft report about the use of CPAP for obstructive sleep apnea that concludes there is low evidence that CPAP has any long-term positive health effects. Any such report is debatable, but it is clear that CPAP is not the universal therapy that cures everyone some physicians believe it is.

The reasons people won’t use the simple device that helps them feel better during the day and, as far as they’ve been told, helps them live longer, healthier lives are as varied as any group of people can be. Common reasons they tell me include:

• I can’t stand anything on my face.
• The mask moves around and blows air into my eyes.
• I swallow air.
• It leaves marks on my face. (More of a problem when people actually went to work!)
• My spouse hates it.
• I want to travel, camp, RV, boat, etc., and it’s too inconvenient.

It is a wonderful time to be a dentist involved in airway therapy – providing good solutions to manage and resolve your patient’s sleep breathing problems. Oral appliances are better accepted by patients in every head-to-head study that has ever been done. While many people go to bed with their CPAP on, by morning, it’s off. Oral appliances are still in their mouths. Research points out that many hours of therapy is better than fewer hours of it, so the health effects are the same.

How do you talk with your patients about their therapy? It isn’t productive to bash CPAP – believe me, they’ll do that themselves. I tell people I love CPAP – when it is used, it’s great. CPAP is the treatment of choice for my father and brother. As you scan through your patient population with questions about sleep and breathing (you are using a screener, right?) you will find plenty of folks who want a CPAP alternative.

If you want to be a provider of oral appliance therapy, there is much to learn. The device portion is straightforward, but there are medical concerns, TMJ joint issues, finance, and office systems to sort out. The challenge is well worth the effort, of course. Dr. Pankey always puts rewards at the center of the philosophy. Nothing I’ve done in dentistry is more rewarding than helping people breathe.

Not every dentist will foray into providing dental sleep medicine but becoming well informed and adding airway conversations to your consultations will impact the lives of many. If you would like to dive deeper and develop your knowledge about dental sleep medicine and learn about the realities of introducing it into your practice, I recommend the Pankey Institute’s 5-day immersive Dental Sleep Medicine course.

Dentists make thousands of choices during their careers. From practice style to how to shape retirement plans, we get to decide how to do things. No matter what style of practice the dentist chooses, the mix of services the involved dentist gets to pick from is ever expanding. Dental sleep medicine is one of the newest services we have added to the list and many dentists are curious about adding it into what they already do.

Practicing Dental Sleep Medicine

Dental sleep medicine may be the closest thing to practicing medicine any non-oral surgeon dentist will get. Managing a chronic disease – sleep disordered breathing – is much like managing another one, periodontal disease. More and more dentists every day are taking up the challenge of helping their patients breathe better during sleep.

Membership in Dental Sleep Medicine organizations, like American Sleep and Breathing Academy, has grown by double digits each year. The calendar is crowded with courses on how to make oral appliances. Dentists are finding the rewards that come with this area of practice energizing and fun. Whole office teams are being reshaped to learn new skills.

Dentists are taught some medical basics during professional school, but years of concentrating on what we do for oral health can dilute the attention paid to patient health history, pharmacology, and medical comorbidities.  

Since every sleep disorder is a medical diagnosis, collaboration with medical professionals requires the dentist to revisit whole body health and recover the ability to communicate with physicians with appropriate detail. Patients certainly expect their dentist to understand their diagnosis and treatment strategies.

Once the person is diagnosed with sleep disordered breathing, treatment choices include positive air pressure masks, surgery, and oral appliances (mostly mandibular advancement devices). Dentists must have a working knowledge of each of these strategies, especially as we are relied upon for expert application of the third choice. Advancing the mandible to open the airway is the description of what we do, but the implications of that choice involve every bit of scientific based health knowledge dentists know. Incorporating sleep dentistry into your practice can bring new learning and new energy to your practice at the same time that you significantly improve the health and quality of life of your patients.

For more information join Steve at the Dental Sleep course.

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. Integrating dental sleep medicine into your practice can be a great way to engage your self and your team and serve your patients in a powerful way that will improve their overall health.

Dental Sleep Medicine Involves the Whole Team

Adding dental sleep medicine to your mix of services requires the entire team to gain new knowledge of the role of sleep and the diagnosis of a sleep breathing disorder, as well as how we can utilize dental devices as an adjunctive therapy. This has to be combined with ‘dental’  concerns such as muscle pain, temporomandibular joint disorders, missing or loose teeth to finalize a treatment recommendation. Working through complex multi-factorial diagnostic and treatment planning decisions is part of practicing dentistry, and we simply apply these skills to the additional medical information that is pertinent for patients with a sleep breathing disorder.

When any new service or technique is added to our daily repertoire in a busy dental practice it can cause disruptions, stress, and challenges that some dental teams won’t be able to see past to get the rewards that come from all the hard work. In addition to acquiring the technical expertise make sure you have prepared your team, and you may benefit from expert advice and finding meaningful mentors that can assist you.

A complicating factor for many offices is the choice to submit sleep therapy to medical insurance. Most dental offices are not equipped for medical billing and many financial administrators, perfectly comfortable with dental claim forms, find themselves mystified at the nuances of submitting to a host of unfamiliar payers. Fortunately, professional medical billers have stepped up to help, but even making this agreement requires dentists to stretch their knowledge and get expert advice in new areas of healthcare.   

Choosing Dental Sleep Medicine

Why do this? While dentists often improve people’s lives in fantastic ways with pain relief, reducing infection and inflammation, and beautifying smiles, rarely do we have the opportunity to give them a chance to live longer. Obstructive sleep apnea left untreated is proven to shorten life expectancy.

Treating the disease will enable people with persistent hypertension to reduce their blood pressure. Bed partners of snorers whose airways are opened improve their quality of life. Often married partners who had chosen to sleep separately reconcile into one bedroom. When someone sits with our team and tells us how much better they enjoy dreaming again after years of missing it, our days are brighter!

Are you trying to decide if treating sleep-disordered breathing is right for you? Dental continuing education provides plenty of introductory courses. I’m honored to be the editor of Dental Sleep Practice Magazine, dedicated to practical education.

There are academies and associations dedicated to supporting every member of the dental team as we expand our medical involvement to provide a service that only dentists are capable of performing. Mini-residencies are forming at leading educational institutions to provide in-depth, multi-disciplinary learning.

Is it worth the effort?

The first time your team celebrates together after a happy patient gives everyone a hug because of how much better they feel now that they’ve used your oral appliance, I think you’ll know the answer.