DENTAL SLEEP MEDICINE
Insider January 2015
THE CLINICAL CORNER
10 Seconds or10 Minutes?
With Dr. Gy Yatros
Have you ever had a patient in a TAP device need more protrusion than the device permits? Did you send it back to the lab, incurring repair fees & leaving your patient without their device? I used to do the same thing, but there is a simple way to reposition the hook within 10 minutes & an even simpler way to do it in less than 10 seconds. The key to a successful Dental Sleep Medicine practice is efficiency & dedicating a few minutes to watching this video will save you a ton of time during your Dental Sleep career. Grab some popcorn, a handpiece, and enjoy‌.
Watch:
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Keller’s ClearDream Clear Improvements on an Old Design
Dr. Tarun Agarwal Raleigh Dental Arts Raleigh, NC
In recent years, the dental sleep medicine community has seen myriad new appliances enter the market, often claiming to revolutionize how you approach oral appliance therapy (OAT). These claims are almost always unfounded and can lead to uncertainty among clinicians about what’s real and what is mere hype. That’s why I was skeptical about Keller’s newest product, the ClearDream, from the outset. I mean, a dorsal is a dorsal is a dorsal, right? Whether it’s blue or pink or green, who cares. However, with little hype or baseless claims, the ClearDream speaks for itself by taking the familiar, proven concepts and adding several significant improvements. I found there to be three key differentiators when compared with other similar devices. Just by looking at the ClearDream, the first difference is immediately apparent. It is made using a clear material, not colored acrylic like all other dorsals. This is important not for esthetic purposes but because the device is fabricated using Keller’s proprietary clear, clinically unbreakable, nonporous Crystal Clear 450 material. As a result, the
increases comfort and may increase patient compliance. A reduction in overall bulk isn’t limited to the anterior either. The lingual surfaces of the ClearDream are contoured to the teeth; a design feature that maximizes tongue space.
device won’t absorb stain and odor, nor will the fins break as can occur with many other appliances. Constant repairs or remakes eat into profits quickly, so durability is paramount. I know this claim about durability is true because it’s the same material they use for NTI Plus splints. Another benefit of the Crystal Clear material is its highly retentive nature, avoiding the need for ball clasps in all but the most extreme situations. This means I don’t incur a bunch of charges for additional ball clasps just to ensure the trays don’t dislodge. At the other end of the spectrum, there is an option for a heat-activated Thermofit liner for patients with deep undercuts or for additional com-
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fort. When I’ve used this option, they drop right in and usually require zero adjustments. Chairtime is valuable and with the ClearDream I don’t have to block out extra time because I know I won’t be grinding on acrylic all afternoon. Now, if only my crowns dropped in this easily. The second major difference seems to be a key feature of ClearDream’s design philosophy; less material and increased patient comfort. Utilizing the Crystal Clear material allows for a slimmer, more streamlined, and more comfortable device without compromising durability. There is significantly less acrylic in the anterior than other dorsals with no facial coverage on the maxillary arch and only slight incisal overlap on the mandibular segment which creates an anterior opening. The opening also reduces bulk which
The ClearDream allows for 5.5mm of advancement from the initial set position. Like with any dorsal device, it’s imperative you capture an accurate George Gauge bite. Along with the bite, I send VPS impressions but Keller can also make them with models or digital scans (something I find useful, since I’m currently digitizing my entire process). Occasionally, I have notches added when I need to use elastics. The last key differentiator is the price. At only $299 for the hard acrylic version and $319 for the Thermofit-lined ClearDream, you’re getting the best dorsal device on the market for the lowest price point. To paraphrase Gordon Christensen, for a product to be worth using, it has to be better, faster, cheaper, and easier. The ClearDream meets all of these criteria. To prescribe a ClearDream for your patient, schedule a pickup, or learn more, click here or call 888-919-7577. www.KellerLab.com
As a clinician and educator for over two dec-
HST in my Practice with Dr. Payam Ataii
ades, I have had the pleasure of witnessing the astonishing evolution of the Sleep Medicine field. For many, dental sleep medicine is a new opportunity for them to change the way their practice treats patents. I’m just one dentist, but for me, the ability to screen and offer patients oral devices broadens my experience while greatly improving my career satisfaction. It’s not often that a patient comes in and says, “Hey Doc, I need a mandibular advancement device” BUT about 10% of your adult patients of record would probably benefit from one. This is precisely why I stress the importance of proper screening and testing. Until just a few years ago, medicine saw limited use of home sleep test devices on a large scale but today, a Polysomnography (PSG) is seldom considered to be the ‘gold standard’ test for OSA. The industry is experiencing a continued increase in the use of home sleep testing with utilization surpassing traditional in-laboratory PSG soon. With new companies constantly entering to the market, it can be difficult to determine what makes sense for the practice and who delivers on their commitments to you and your patients .
PSG vs. HST The first of the testing methods I’ll touch on is the Polysomnography (PSG), the traditional ‘gold standard’ according to many in the industry (O’Brien, 2012), is a sleep study that is usually performed in a sleep lab or a hospital and is ‘attended’ or observed by a Registered Polysomnogram Technician (RPSGT). A PSG, is used to diagnose sleep apnea among other sleep disorders including bruxism, parasomnias such as REM sleep behavior disorder, periodic limb movements, and abnormal brain waves indicating nocturnal seizures. Some of these disorders cannot be detected by typical Home Sleep Tests (HST). Patients must complete testing inside the facilities of a lab or hospital and in some instances there is medical reason to have the patient monitored in the lab/hospital setting i.e. Patient requires oxygen and bi-level PAP therapy. Unfortunately, the costs associated with PSG are rather high, patients in outlying areas may experience difficulty locating a facility nearby, and patient acceptance is rather low due to the high number of leads and unfamiliar setting. The second method of testing is the Home Sleep Test. The HST is a sleep study that can be performed in the patient’s home and is used to diagnose obstructive sleep apnea. Home sleep studies have been used for years overseas, but the United States have considered HST experimental and required attended in-lab PSG to diagnose Obstructive Sleep Apnea. In 2008, Medicare changed their stance on HST and shortly after, private insurance companies followed suit. This has resulted in increased access to care for patients and lower costs for payers. One of the palpable advantages that Home Sleep Tests have over a traditional Polysomnography is patient convenience. Incorporating HST into my practice has been met with very favorable feedback from my patients because of the comfort and ease of the process. The accuracy has been fine and I have not experienced the need for re-
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testing. In a 2012 study, results displayed that HST results were not inferior to the standard PSG (Rosen, Auckley, Benca, 2012). HSTs are also interpreted by a medical health professional as a PSG. For sufferers of sleep apnea who may live in remote areas and do not have easy access to sleep labs, this means increased access to sleep testing. Depending on which path you choose, you may be able to dispense the tests from your office but much simpler, companies such as EZ Sleep, ship HST devices to any home within the company’s reach and they help provide instructions and care for my patients. Lastly, with the changing medical/dental cost environment, a HST is a more cost effective option than the PSG, as it is estimated to be less than half the price of a traditional PSG. For this reason, many are making the move to HSTs in order to cut costs. It’s important to note that reimbursement for HST varies among payers and even the various Medicare coverage areas. These policies can seem to be a moving target and this is another benefit of working with EZ Sleep. I don’t have to dedicate a team member to figuring all of this out. Instead, they provide the insurance pre-authorization for HST and ensure that I have all of the necessary documentation. This allows me and my team to focus on other matters.
Adding Dental Sleep Medicine to My Practice There are many services that can help a practice get set up with HST but not all are created equally. I have had the benefit of working with a national company based out of Los Angeles called EZ Sleep. They offered the relationship with a sleep physician, set me up with the screening and testing assets for my practice, as well as offered training that myself and the staff used to learn how to screen patients and get them tested appropriately. One of the things that new dentist find it difficult to do is enter the dental sleep medicine arena. They do not know where or how to start a relationship with a medical doctor that can interpret the sleep results and diagnose if the patient has obstructive sleep apnea (OSA). This was one area that was an added benefit that came with the EZ Sleep package and product. For my practice we Contact Info submit the screening, if a test www.EzSleeptest.com is needed, it is scheduled with 310 North Westlake Boulevard, Suite 110 the patient, and once the test is completed, the results are Westlake Village, CA 91362 sent to me with an easily unPhone: (888) 240-7735 derstood page describing the report and results of my patients’ sleep test. This allows me to provide my patients with life-saving treatment while also increasing productivity and setting my practice apart from the multitude of other practices nearby.
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LETTER OF MEDICAL NECESSITY: WHAT, WHY, & THE BIGGEST QUESTION:
“HOW DO I GET ONE?” LOMN. These four ominous letters have been the road block for many dental offices, including my own….
Let’s face it, we know how dental insurance works. The tooth was broken, I diagnosed it, then I fixed it, now pay me, please. Send in a claim with an X-ray and a short narrative and it’s paid. Dental plans have $750 to $3000 yearly maximums so the gate keepers work hard to not pay claims, but they know the faucet will turn off at some point.
Lesia Crawford, CEO, GoGo Billing 877-874-4646 ext. 1 info@gogobilling.com
GoGo Tip of the Month: Send the letter and LOMN to the primary care physician, the sleep doctor, heart specialist or any other specialist who has had any involvement with the patient’s diagnosis and/or treatment. Whomever sends it back signed first - wins! You only need one to give to the insurance gate keeper. Contact me with any questions & have a happy & productive 2015!
Medical plans are completely different from dental plans. They have million dollar maximums or frequently, no maximum at all. Gate keepers are guarding that pile of cash with their lives! Considering UHC is currently holding 84th place at $80.96 Billion on the Forbes Global List, it’s obvious they are doing a stellar job protecting that gold like a dragon in a fairy tale. Now, if every policy holder was running around getting 3D imaging and blood panels drawn for every tummy ache they assumed was a tumor, UHC might not even get onto the prestigious Forbes list. To stop patients from deciding what treatment they need based on Google and WebMD, medical plans use preauthorizations to decide if the treatment or testing is “medically necessary”. By getting the prescription for treatment and Letter of Medical Necessity (LOMN) proof is provided to the plan that the patient needs the oral appliance, and we are playing by the rules. Pre-authorizations are not a luxury, they are a necessity and the LOMN is the most important piece of the puzzle for an approval.
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This magical letter is the key to unlock the safe and get payment for the treatment you are delivering. But wait! There is more! This act of correspondence not only gets you paid by the insurance companies, but also gives you credibility and opens communication with primary care doctors, sleep doctors, and pulmonary specialists. You want as many physicians aware of how easy you are to work with and you want them to know their patients will be treated with the utmost care, compassion, and professionalism. Utilizing patients’ benefits and minimizing out of pocket costs can be more important. You want the patient to get the root canal done so you can fit the crown, right? So you refer to the office that gets your patient treated and sent back to you. The DDS who treats sleep apnea for cash and doesn't play the medical insurance game is equivalent to the specialist who costs so much that your patient actually gets mad at you for sending them. While medical offices are as familiar with the LOMN as we are with referrals for 3rd molar extractions, they still want it to be easy and take as little time as possible. DS3 gives you the tools to send letters introducing yourself as a skilled dentist treating sleep apnea with an interest in treating mutual patients. It’s simple and with a couple mouse clicks, it can be printed for mailing or transmitted via digital fax. Medical offices appreciate that the LOMN is already filled out just sign here and send back please.
To Tripod or Not to Tripod. By. Dr. Richard Drake
One of my mentors has been Dr. Keith Thornton, inventor of the TAP devices for obstructive sleep apnea (OSA). I made my first TAP over 13 years ago and estimate that I have delivered more than 1,000 TAPs since then, and it remains a key part of my armamentarium. I don’t use it for every patient, but I find it is almost always at the top of my list. It does a fabulous job of treating moderate to severe apnea. We have multiple case studies now where with the TAP we have reduced Apnea Hypopnea Indexes (AHI) from 100 to below 10. Regardless of efficacy, wearing
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a Mandibular Repositioning Device (MRD) can be a challenge for some patients, and part of that challenge is overcoming side-effects. One potential side-effect is ongoing TM Joint issues. Sometimes it is muscle, sometimes the joint itself, sometimes both. Here are a few clinical tips to address ongoing joint pain and generalized achiness in the joint area.
three planes, NOT just the anterior posterior.
Unilateral Pain Make sure the TAP hits only in the anterior area. Frequently, pain on just one side is caused by an imbalance from the device hitting on only one side in the posterior area. Typically the side that is hitting is the side that is hurting. Simply reduce the posterior First, determine if the pain is thickness on unilateral or bilateral, acute or that side until chronic. Remember that doc- it no longer touchumenting joint and TMJ dyses. You’ll see function in DS3 beforehand is this happen ALWAYS a good idea! Also, more in paremember that we work in
tients with a steep Curve of Spee. Also check that the advancement mechanism is not misaligned, pulling the patient too far to the right or left as they protrude. Again, the joint that is being restricted from moving is usually the one that hurts. Lastly, sleeping only on one side with a hand under the face can cause unilateral joint issues. Consider tripod in all of these cases as discussed below. Bilateral Pain Most often, pain on both sides is caused from titrating too far forward too fast. Slow down. Back up a bit. Utilize the Cl II hook on the TAP 3 Elite. Check to make sure there are no posterior interferences as the patient moves forward (just like above). Consider adding posterior stops so that you “tripod” the TAP. It hits in front on the advancement mechanism as well as the posterior R and L all at the same time. You’ll want to wait until you get close to your treatment position to do this, because further adjustment forward means you’ll have to adjust the posterior segments every so often as you titrate the MRD forward.
12 Steps to tripod: 1) Place TAP in mouth and determine approximate amount to add to posterior segments to create tripod effect 2) Roughen outside areas on lower posterior above first molar on both sides 3) Vaseline occluding surface of MAX only posterior area 4) Create acrylic ball approximating thickness you will need (pea to small marble sized) 5) Lute acrylic balls to posterior of LOWER arch 6) Insert MAX device on patient (Don’t forget the Vaseline!) 7) Hook LOWER into upper, and while you support the lower, have the patient slowly close into occlusion; help the patient bite into device withOUT completely flattening the acrylic stops you created 8) Have the patient move side to side while you ensure adequate height of the posterior stops (If needed, pinch the sides in to raise them up 9) Let it set up for at least a few minutes 10) Remove, making sure not to change the height of posterior. 11) Pressure pot for 8-10 minutes 12) Re-seat TAP on patient and make sure anterior and both posterior segments hit simultaneously
SUMMARY The joys of treating OSA successfully far outweigh the speed bumps, or side effects, along the way. Having a few tricks up your sleeve to help patients get over the speed bumps makes you a better doctor and helps patients wear their devices and treat their apnea more successfully.
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The D.I.S.H. on the Oral-Systemic
The D.I.S.H. on the Dawson Institute of Systemic Health changes. Dr. Roizen pointed out that a large study showed that 89% of people with adult, type 2 diabetes can lower their blood sugar levels to within normal limits, without the use of medications, by implementing a few simple lifestyle changes. Recent DNA studies have also proven that lifestyle is more important to longevity and quality of life than is our genetic predispostion. He challenged dental teams to be on the frontlines fighting this battle that is destroying our nation, Dawson Academy pointing out that we spend more By Dr. DeWitt Wilkerson time with our patients than any othThe Dawson Academy is pleased to er health professionals. We left the bring the Total Wellness Dental Pracconference with an enlarged vision tice seminar series to Brentwood, TN of Dentistry. beginning in April, 2015. In 2012, we In April, 2015 The Dawson Academy attended the second annual conferwill bring scholars, researchers, and ence of the American Academy for clinicians, to the Mountain West Oral Systemic Health (AAOSH). It was Institute, personally training dental held at the Cleveland Clinic, featuring some of the top medical clinicians and teams to expand their practice mission to include total wellness researchers in the world on the subscreening, coaching, and therapy. ject of total wellness. The meeting Our newest course series, The Total completely altered the way we view Wellness Dental Practice, will assist Dentistry. Michael Roizen M.D., Medidental teams to become patient adcal Director of the Cleveland Clinic vocates for total health and gateWellness Institute, shared evidence keepers of systemic inflammation. proving that our nation will soon be bankrupt due to increasing healthcare Systemic inflammation is the fire within that feeds accelerated aging, costs, especially the cost of managing lowered energy levels, poor chronic diseases associated with metmemory, chronic pain, and disease. abolic syndrome/obesity, diabetes, Common causes are oral pathogenic heart disease, dementia, physical inbacteria in the bloodstream, sleep activity, smoking, and stress. Accordapnea, a pro-inflammatory western ing to Dr. Roizen, there will only be diet, physical inactivity, smoking, two options to manage this growing and stress. Dental teams can effeccrisis: rationing of health care by the tively address all these sources of federal government and insurance chronic inflammation. companies, or the public gets smart, and we start taking responsibility for The participants in this course series own health through personal lifestyle will learn from noted authorities
including Bradley Bale MD, Steven Masley MD, DeWitt Wilkerson DMD, Tom Nabors DDS, Tony Iacopino DMD, Susan Maples DDS, David Seaman DC,MS, Stephanie Lodding RDH, and Gy Yatros DMD Just some of the topics covered in the continuum include how to use salivary testing to guide antimicrobial periodontal/systemic therapy; home sleep studies to guide screening and monitoring of treatment of obstructive sleep apnea; principles of prevention of diabetes, heart attacks, and strokes; exercise physiology; stress management techniques; nutritional principles; smoking cessation counseling; networking within the medical community, and many other principles of Dental Medicine. For more information contact the Dawson Academy, www.TheDawsonAcademy.com. You are urged to accept the challenge to create The Total Wellness Dental Practice in your own office. Wouldn’t it be wonderful, if in addition to saving teeth, you could also save lives? We would be thrilled to help you! Dr. Wilkerson is Senior Faculty/ Director of Dental Medicine for the Dawson Academy for Advanced Dental Study, in St. Petersburg, Florida. He is Past President of the American Equilibration Society and serves on the Board of Directors for the American Academy for Oral Systemic Health (AAOSH). He can be contacted at dwilkerson@thedawsonacademy.com.
BY DS3 SUPPORT SPECIALIST CINDY HERBERT
DS3 Members ask and want to know: “How can we get more sleep patients?” It’s a common question we hear at Dental Sleep Solutions, and we spend a fair bit of our time brainstorming ideas to help you get more patients. The lowest hanging fruit is your existing patient base who walk through your doors every day. You are screening your patients with the DS3 screener, right? Beyond that, we recommend that you cultivate relationships withFrom localOSA, physiLSAT, & AHI to RDI, cians. Office visits from a staff memRERA, & OAT, DSM has an ber who delivers business cards, acronym for it. Two that dentistry practice brochures, and even referral has become increasingly conforms are a great start. Even better if cerned with are HIPAA (Health the Doctor will follow up with a visit Insurance Portability & Accountahimself. I recommend thatHITECH you visit bility Act) and (Health two offices every single week. year Information TechnologyA for Ecolater, 100 local nomic physicians will at least and Clinical Health Act) know who you are. Quitehow often, after which govern patients’ doing this, I would a call the healthget records arefrom protected, office manager maintained, whom I had handed and transmitted. Are my brochures to. thinkHIPAA you you “Do awareyou that every could help my husband not snore violation is punishable by so fines of much?” Absolutely! From humble $50k - $250k?!?! A recent Denbeginnings I have seen doctors cretalTown article states, “These ate significant and referral laws consistent translate to a very real consources. It is not rocket science cern because the simplebut fact is you have to putthat in the workaccount and rest your Gmail isn’t assured, it will pay securehandsomely. and Dropbox is a joke. Many physician offices are open to
51 DENTALSLEEPSOLUTIONS.COM www.DentalSleepSolutions.com
lunch and learns. Dr. Drake recently did one in San Antonio for a rather large ENT group. Their practice has seven physicians and a staff of 32. We brought box lunches from a local deli and presented a 30 minute power point about how we could work together while they ate their sandwiches. Two docs showed up and 29 staff members. Cost me less than $500 and a couple hours’ of time. take to start Every timeHow we uselong thesedid freeitand getting referrals? Less easy services to innocently com-than 24 hours! municate with each other about anything having to do with a patient Sleep Solutions or aDental case, we’re in violation. Every has prepared power points for single time we send or receive our Members to utilize. You’ll need information is a new potential fine to customize them with your because of how the informationpersonal is information, of course, transmitted.” Fortunately, for DS3as well as to the specific Members, this is notaudience, a concern. but these power points can a powerful DS3 is indeed a HIPAA &beHITECH tool to help you get more compliant EMR. It is the only dedi- patients. Start conversation with cated dental sleepthe medicine softhow that particular specialist can ware that meets these criteria. Stay help ENT’s, example, we ahead you. of the curve, avoidfor hefty implore to help our topatients fines, & contact me today ensure breathe better through that your DSM patient data is se-their nose. cure with Once DS3. they know that you
to you. Customize each one to the type of physician you are visiting.
PCP: Treating OSA will make patient’s healthier. Period. Across the board. ENT: I need someone I can refer to who can increase nasal patency, treat GERD, allergies Cardiologist: We can help control hypertension, A fib, V fib, coronary artery disease Gastro / Endocrine / Nutritionists: We can help patients lose weight, better control GERD, better control glucose and insulin levels Rheumatology: Patients who sleep better feel better and complain less Sleep docs / pulmonologists: Just throw me a bone, a crumb, a patient who refuses to wear PAP after a dozen different masks!
Screen your patient base Office visits to physicians (two per week, 100 per year) Lunch & Learns (one per quarter, increase to one per month)
Contact:
Brandie Cindy Herbert Havell 877.95.SNORE
understand the referral process is Contact me for a sample PowerPoint a two way street, they are much that you can use when giving cindy@dentalsleepsolutions.com more receptive to your messagebrandie@dentalsleepsolutions.com Lunch & Learns and more willing to refer patients
We need an ad
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MEMBER WHO’s WHO With DS3 Support Specialist Staci Holbrook
faculty at Wash U. teaching general dentistry for 2 years before I went into private practice in St. Louis about 1990. 25 years now, gosh where has the time gone?
What sparked your interest in Dental Sleep Medicine?
of Metro Dental Sleep Medicine
Dr. Khalil, how long have you been practicing & have you always been in the St. Louis metropolitan area? I was actually born & raised in Ethiopia & lived there until I finished high school. Then I emigrated to the U.S. & attended Wheaton in IL for some undergrad courses & finished with a bachelors in chemistry at Indiana State. I got a master’s of public health (MPH) at University of IllinoisChicago & then got my DMD at Washington University in 1983.
So, then after graduating from Wash U, you went into private practice? Not exactly. I did a general practice residency at the VA in STL from ’83-’84 & then practiced in Austin, TX for 1 year. I worked with the Elks Mobile Dental Clinic for about 3 years treating handicapped kids & teenagers out of a mobile van all across the eastern half of Missouri. Then I was on
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4 years ago I was diagnosed with OSA. My physician told me I had moderate OSA & didn’t need CPAP & suggested that a dental device might be a good idea. He asked if I could make one myself & I said yes. I began attending a lot of sleep CE. The MD said he needed a dentist nearby so I agreed to open a dedicated sleep office in the same plaza. He also encouraged me to continue building my own referral network & I started looking at DSM in a much more comprehensive way. I recognized there were 3 major hurdles to overcome. The first is the technical part of making devices which was actually relatively easy. Secondly, was medical billing which required a deep level of learning & persistence, & finally, building relationships with the gateway entry point of OSA which is the diagnosing physicians.
Of the 3 hurdles you mentioned, which do you think is most significant? First of all, you can’t treat without a diagnosis but like all of us, most physicians are very busy treating their patients with tons of issues that may or may not be sleep-related. The first hurdle is getting the MD’s to recognize the importance of identifying & treating sleep disordered breathing, particularly OSA. Secondly, they need to recognize that dentists can provide a legitimate, acceptable, & effective treatment option. Lastly, it’s important to establish enough rapport & confidence with MD’s to get them to regularly refer their OSA patients to dentists for treatment with OAT.
How did you overcome this hurdle? To address the issue of awareness, I began treating some of my existing dental patients & showed the few referring MD’s what outcomes of treatments were. The more they saw positive results, the more confidence they had to continue referring. This also built my confidence to begin going to other physicians & sharing these results. I started going to MD’s with no sleep experience. I’d ask them if they have ever heard from a patient that they weren’t wearing their CPAP’s. Their ears would perk up & they’d say, “I don’t know what to do, but I would sure love to have an alternative.” I would suggest a ‘lunch and learn’ for their staff & I’d pick up their favorite
breakfast or lunch from wherever they’d want. I went into a 4 physician group practice after having this discussion with them. I brought bagels and coffee for a ‘breakfast and learn.’ One doctor immediately recognized in their patient base that people needed this & within 24 hours he began referring patients. Then another MD in that same office began referring shortly after. Secondly, I regularly send reports to MD’s regarding pre/post treatment stats to show improvement. I use the DS3 system because it keeps them informed about our shared patients. This is one more way to stay at the front of their mind. Lastly, I meet with them to continue building rapport. I visit with them for 5-10 minutes to discuss patient outcomes via conference call, text, whatever. One MD I visited over holidays told me ‘you almost killed 1 of my pts.’ I was taken aback & asked why. He said, “Your device helped him so much that he decided on his own to stop taking his insomnia meds so even though he was breathing well, he still had insomnia. He fell asleep at the wheel & his wife had to grab the steering wheel. You stopped his snoring & treated his OSA but his insomnia persists.” To me, this highlights importance of multidisciplinary approach & ongoing communication. As dentists, we tend to focus so much on OSA and forget that it is merely one of dozens of SDB classifications.
What tools can you not practice Dental Sleep Medicine without? A diagnosis of OSA Clinical dental & TMJ screening which I use DS3 for George Gauge & impressions Good software. DS3 is the best to do it. I’ve used others but it is far and above superior. It addresses the biggest hurdle which is dealing with referring MD’s with the well-written letters. Without that, you are dead in the water. No SIGNIFICANT businessperson can live without their relationship with the bank. The bank doesn’t care if you make or lose money as long as you communicate with them. If you keep them apprised of what is going on, good or bad, they will work with you. It is frequently the same with referring physicians. DS3 allows me to do this by mailing or digitally faxing correspondence directly from my software.
your stature within the medico-dental community? Speaking opportunities? Over past 4 years, I’ve gone from just beginning & that year I treated about 40 patients. By the end of 2013, I made 60 devices. In 2014, I made 163 devices, nearly a 300% growth rate. This has had a huge personal & professional impact on me. I have made a huge positive impact on many patients’ lives. Professionally, I’ve tripled the income in my sleep practice. We’ve grown exponentially & this has created confidence that allows me to approach even more MD’s to help treat this epidemic. In this time, I’ve been asked to speak to several study clubs and other groups. I started the Midwest Dental Sleep Medicine Study Club with some colleagues and learn more every day about emerging research and how we can better improve patients’ lives.
Describe your DSM experience in 5 words? Enjoyable. Rewarding. Meaningful. Profitable. Fulfilling.
How can others replicate your success? You have to make a paradigm shift from treating teeth to the connection of three seemingly disparate spheres. Teeth, TMJ, & the airway. As dentists, we are well trained in teeth, marginally well trained in evaluating & treating the joints but the airway is foreign to us. We write it off as something that ENTs & MD’s deal with. We have to focus on airway first, TMJ second, & teeth last. Until you make that shift, you are unlikely to grow. We’ve been saving teeth, now we must save lives.
To Contact Dr. Khalil Dr. Saba Khalil 314.740.1395 drsabak@gmail.com
What impact has DSM had on your practice, on your professional satisfaction, & 1.877.95.SNORE
The DS3 Team would like to wish you all a Happy & Fulfilling...
STAY TUNED FOR OUR FEBRUARY EDITION
Devices Too Tight or Too Loose? Simple Techniques You Can Use to Avoid Sending It Back to the Lab Do You Really Need to Keep Your DSM Patient Records Separate from Your Dental Records? Medicare; To Be or Not to Be? We'll Answer the Question... DS3 Member Who's Who with Dr. Stacey Layman & Much, Much More!!!