Is Wild West Dental Sleep Medicine About To Be Wrangled In?
Is Wild West Dental Sleep Medicine about to be wrangled in?
In recent years, with all the dentists dipping their toes into the dental sleep arena, it seems there is becoming a shift in the idea of what exactly the dentist's role is, or should be. Should they test...should they diagnose, and on and on.
While it all seems so exciting, one fact that seems to be escaping us most is this...you're a DME! If, in all this excitement, you lose direction, here's a reminder!
While this may not sit well with some of you, in the world of dental sleep medicine, that's your role as a dentist! With all the recent pontification about residencies, exhaustive training, years of experience, she was previously owned by a little old lady in Pasadena...it all still boils down to one thing; your job as a dentist is to fabricate the appliance! And, why not? I mean, our dental clients love the idea that they are tasked with creating the appliance, billing insurance and allowing the medical doctor to assume the role of treating physician! Are you being restricted financially?? Well, Endeavor Health has a dental client in California who has CONSISTENTLY delivered over one-hundred appliances per month, for the past five plus years, at an average of $3,200 each!
We routinely see dentists promoting their voodoo medicine...supine CBCT to look at the airway, rhinometry to view the dimensional aspect of the airway. WOW!!! That all seems so fancy, "Stu"! But fact is, that's all useless data, for a few reasons!
First, if one wishes to needlessly expose the patient to the radiation of a CBCT to view the airway...well, that looks really great when the patient lays back on the dentist's shiny new $250k New Tom 5G Supine CBCT. BUT...that data is useless for this diagnosis!! And, when the dentist pulls out his/her acoustic rhinometer (Even in the hands of a qualified medical doctor, this is experimental when it comes to most all health insurance companies, btw) and starts probing the patient..."WOW, that's high-tech equipment!!! But, again...useless data!!!
The challenge here...there is one factor, one essential factor that need be present whenever PROPERLY evaluating a patient for obstructive sleep apnea. Wait for it...THE PATIENT NEEDS TO BE ASLEEP! If you doubt or question that, here is the forth grade level math unpacking...do you or do you know someone who snores? Does that person snore when they are awake? There you go! The easy math equation to conclude that there is in fact a change in the dimensional aspect of the airway from a state of sleep and wakefulness! You are now a dental sleep expert!!!
But, wait...there's more!! Dental Sleep Medicine really is NOT rocket science! For all the pontification about "mini-residencies" (we just recently watched a long-time practicing sleep dentist stand-up and proclaim that two cases he saw were performed by dentists who were educated by a two-day dental sleep program when, in fact, those two cases were performed by his colleague, a 30+ year local sleep dentist...everybody's an expert!), the fantastic data, the numerous conferences, seminars, CE's, certificates on the wall, YEARS of experience and the knowledge of the multitude of comorbid issues and secondary diagnosis'...RLS, Polycythemia, Retinal Vein Occlusion, Drug Resistant Hypertension, et al...you can NOT identify, diagnose, treat, evaluate, prescribe, or even glove up!!! REMINDER
Dental Sleep Medicine is an evolving field! If you fail to evolve, you WILL become obsolete! And, there is a litany of programs designed to make you think this is the most difficult part of your practice. Fact is, it's not! However, it may absolutely be one of the most important, from a patient health perspective. And, we agree that, as a dentist, you should ABSOLUTELY be screening every patient who walks into your office!! When proper protocols are in place, our dental clients routinely discover things about their patients they never knew! Most common; 23-25% of their patient mix is either currently on PAP therapy or has been at one time and fallen off! But, be careful...it is a negligent dentist who suggests to a CPAP compliant patient that OAT is a better choice over the gold standard! And, for those of you who say, "My sleep physician doesn't have an 82% compliance amongst his CPAP patients...perhaps you need a new sleep doc?!
In any case, I digress! Point being, as a dentist, you are presented with groundbreaking opportunity here! For those patients shuffling thru life like The Walking Dead, on an aimless destination from point A to point B, you can be the awakening for them all (see what I did there?!)! Screen, educate and, for God's sake, get them to a physician and collaborate to provide the patient with the best treatment option(s) for their life and lifestyle! I promise the money will follow!
But, if it is your goal to pursue patients for the all-mighty dollar, to screen, test, "treat" and do it all in your office, the potential harmful ramifications WILL eventually catch up to you! And, it will likely be at the patient's expense!
For those of you who mope around with the "We live in Mayberry and there are no sleep physicians"; you are part of the problem! There are COUNTLESS IDTF organizations across the United States who will either personally deliver or drop-ship an FDA approved testing device to your patient's front door!!! And, the beauty, they will take care of the insurance verification and billing for the test, provide you a study read by a Board certified sleep physician all inside an average of five to eleven days! And, another YUGE bonus...again...wait for it...protect you from the disservice of placing your patient in financial harm's way when insurance discovers that the DME dispensed the testing equipment and the claim is denied!
We now know that the Colorado Dental Board is going to table current hearings for guideline devo until the Medical Board is able to review current questions about the dentists role in diagnostic testing!
Dental Sleep Medicine...there's a change a brewin'! Mount your steed! Yee Haw!