Dental Sleep Medicine Insider

DENTAL SLEEPInsiderMEDICINE 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 protrusionthan the device permits? Did you send it back to the lab, incurring repairfees & leaving your patient without their device? I used to do the samething, 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 success-ful Dental Sleep Medicine practice is efficiency & dedicating a fewminutes to watching this video will save you a ton of time during your Den-tal Sleep career. Grab some popcorn, a handpiece, and enjoy…. Watch: on YouTubewww.DentalSleepSolutions.com

877.95.SNORE

Keller’s ClearDreamClear Improvements on an Old Design Dr. Tarun Agarwal Raleigh Dental Arts Raleigh, NCIn recent years, the dental device won’t absorb stain and fort. When I’ve used this option, increases comfort and maysleep medicine community odor, nor will the fins break they drop right in and usually re- increase patient compliance. Ahas seen myriad new appli- as can occur with many other quire zero adjustments. Chairtime reduction in overall bulk isn’tances enter the market, appliances. Constant repairs is valuable and with the Clear- limited to the anterior either.often claiming to revolu- or remakes eat into profits Dream I don’t have to block out The lingual surfaces of thetionize how you approach quickly, so durability is para- extra time because I know I won’t ClearDream are contoured tooral appliance therapy mount. I know this claim be grinding on acrylic all after- the teeth; a design feature that(OAT). These claims are al- about durability is true be- noon. Now, if only my crowns maximizes tongue space.most always unfounded cause it’s the same material dropped in this easily.and can lead to uncertainty they use for NTI Plus splints. The ClearDream allows foramong clinicians about The second major difference 5.5mm of advancement fromwhat’s real and what is Another benefit of the Crystal seems to be a key feature of the initial set position. Likemere hype. That’s why I Clear material is its highly ClearDream’s design philosophy; with any dorsal device, it’s im-was skeptical about Keller’s retentive nature, avoiding the less material and increased pa- perative you capture an accu-newest product, the Clear- need for ball clasps in all but tient comfort. Utilizing the Crystal rate George Gauge bite. AlongDream, from the outset. I the most extreme situations. Clear material allows for a slim- with the bite, I send VPS im-mean, a dorsal is a dorsal is This means I don’t incur a mer, more streamlined, and more pressions but Keller can alsoa dorsal, right? Whether it’s bunch of charges for addi- comfortable device without com- make them with models orblue or pink or green, who tional ball clasps just to en- promising durability. There is sig- digital scans (something I findcares. However, with little sure the trays don’t dislodge. nificantly less acrylic in the anteri- useful, since I’m currently dig-hype or baseless claims, the At the other end of the spec- or than other dorsals with no faci- itizing my entire process). Oc-ClearDream speaks for itself trum, there is an option for a al coverage on the maxillary arch casionally, I have notches add-by taking the familiar, prov- heat-activated Thermofit lin- and only slight incisal overlap on ed when I need to use elastics.en concepts and adding er for patients with deep un- the mandibular segment whichseveral significant improve- dercuts or for additional com- creates an anterior opening. The The last key differentiator isments. I found there to be opening also reduces bulk which the price. At only $299 for thethree key differentiators hard acrylic version and $319when compared with other for the Thermofit-lined Clear-similar devices. Dream, you’re getting the best dorsal device on the market forJust by looking at the Clear- the lowest price point. To para-Dream, the first difference phrase Gordon Christensen, foris immediately apparent. It a product to be worth using, itis made using a clear mate- has to be better, faster, cheap-rial, not colored acrylic like er, and easier. The ClearDreamall other dorsals. This is im- meets all of these criteria.portant not for estheticpurposes but because the To prescribe a ClearDreamdevice is fabricated using for your patient, scheduleKeller’s proprietary clear, a pickup, or learn more,clinically unbreakable, non-porous Crystal Clear 450 click here or callmaterial. As a result, the 888-919-7577. www.KellerLab.comwww.DentalSleepSolution.com



HST in my As a clinician and educator for over two dec- ades, I have had the pleasure of witness-Practice ing the astonishing evolution of the with Dr. Payam Ataii 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 de- vices 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 ad- vancement device” BUT about 10% of your adult patients of rec- ord would probably benefit from one. This is precisely why I stress the importance of proper screen- ing 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 experienc- ing a continued increase in the use of home sleep testing with utilization surpas- sing traditional in-laboratory PSG soon. With new companies constantly en- tering to the market, it can be difficult to determine what makes sense for the prac- tice and who delivers on their commit- ments to you and your patients .PSG vs. HSTThe first of the testing methods I’ll touch on is the Polysomnogra-phy (PSG), the traditional ‘gold standard’ according to many in the in-dustry (O’Brien, 2012), is a sleep study that is usually performed in a sleeplab or a hospital and is ‘attended’ or observed by a Registered PolysomnogramTechnician (RPSGT). A PSG, is used to diagnose sleep apnea among other sleep disordersincluding bruxism, parasomnias such as REM sleep behav- ior disorder, peri-odic limb movements, and abnormal brain waves indicating nocturnal sei- zures. Some ofthese disorders cannot be detected by typical Home Sleep Tests (HST). Pa- tients must com-plete testing inside the facilities of a lab or hospital and in some instances there is medicalreason to have the patient monitored in the lab/hospital setting i.e. Patient requires oxygenand bi-level PAP therapy. Unfortunately, the costs associated with PSG are rather high, pa-tients in outlying areas may experience difficulty locating a facility nearby, and patient ac-ceptance 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 beperformed in the patient’s home and is used to diagnose obstructive sleep apnea. Homesleep studies have been used for years overseas, but the United States have considered HSTexperimental and required attended in-lab PSG to diagnose Obstructive Sleep Apnea. In2008, Medicare changed their stance on HST and shortly after, private in- surance compa-nies followed suit. This has resulted in increased access to care for patients and lower costsfor payers. One of the palpable advantages that Home Sleep Tests have over a traditional Polysomnography is patientconvenience. Incorporating HST into my practice has been met with very favorable feedback from my patients be-cause of the comfort and ease of the process. The accuracy has been fine and I have not experienced the need for re-

877.95.SNORE

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 apneawho may live in remote areas and do not have easy access to sleep labs, this means increased access to sleeptesting. Depending on which path you choose, you may be able to dispense the tests from your office but muchsimpler, companies such as EZ Sleep, ship HST devices to any home within the company’s reach and they helpprovide instructions and care for my patients. Lastly, with the changing medical/dental cost environment, a HST isa more cost effective option than the PSG, as it is estimated to be less than half the price of a traditional PSG. Forthis 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 coverageareas. These policies can seem to be a moving target and this is another benefit of working with EZ Sleep. I don’thave to dedicate a team member to figuring all of this out. Instead, they provide the insurance pre-authorizationfor HST and ensure that I have all of the necessary documentation. This allows me and my team to focus on othermatters.Adding Dental Sleep Medicine to My PracticeThere are many services that can help a practice get set up with HST butnot all are created equally. I have had the benefit of working with anational company based out of Los Angeles called EZ Sleep.They offered the relationship with a sleep physician, setme up with the screening and testing assets for mypractice, as well as offered training that myself andthe staff used to learn how to screen patientsand get them tested appropriately. One of thethings that new dentist find it difficult to dois enter the dental sleep medicine arena.They do not know where or how tostart a relationship with a medicaldoctor that can interpret the sleepresults and diagnose if the patienthas obstructive sleep apnea(OSA). This was one area thatwas an added benefit that camewith the EZ Sleep package andproduct. For my practice we Contact Infosubmit the screening, if a test www.EzSleeptest.comis needed, it is scheduled with 310 North Westlake Boulevard, Suite 110the patient, and once the testis completed, the results are Westlake Village, CA 91362sent to me with an easily un- Phone: (888) 240-7735derstood page describing thereport and results of my pa-tients’ sleep test.This allows me to provide mypatients with life-saving treat-ment while also increasingproductivity and setting my prac-tice apart from the multitude ofother practices nearby. 877.95.SNORE

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…. Lesia Crawford, Let’s face it, we know how dental insur- This magical letter is the key to unlock the CEO, GoGo Billing ance works. The tooth was broken, I diag- safe and get payment for the treatment you 877-874-4646 ext. 1 nosed it, then I fixed it, now pay me, please. are delivering. But wait! There is more! This [email protected] Send in a claim with an X-ray and a short act of correspondence not only gets you paid narrative and it’s paid. Dental plans have by the insurance companies, but also gives GoGo Tip of the Month: $750 to $3000 yearly maximums so the gate you credibility and opens communication Send the letter and LOMN to keepers work hard to not pay claims, but with primary care doctors, sleep doctors, andthe primary care physician, the they know the faucet will turn off at some pulmonary specialists. You want as manysleep doctor, heart specialist or point. physicians aware of how easy you are to any other specialist who has work with and you want them to know their had any involvement with the Medical plans are completely different patients will be treated with the utmost care,patient’s diagnosis and/or treat- from dental plans. They have million dollar compassion, and professionalism. Utilizingment. Whomever sends it back maximums or frequently, no maximum at patients’ benefits and minimizing out of signed first - wins! You only all. Gate keepers are guarding that pile of pocket costs can be more important. You need one to give to the insur- cash with their lives! Considering UHC is want the patient to get the root canal done so ance gate keeper. Contact me currently holding 84th place at $80.96 Bil- you can fit the crown, right? So you refer to with any questions & have a lion on the Forbes Global List, it’s obvious the office that gets your patient treated and they are doing a stellar job protecting that sent back to you. The DDS who treats sleep happy & productive 2015! gold like a dragon in a fairy tale. Now, if apnea for cash and doesn't play the medical every policy holder was running around get- insurance game is equivalent to the specialist ting 3D imaging and blood panels drawn for who costs so much that your patient actually every tummy ache they assumed was a tu- gets mad at you for sending them. mor, UHC might not even get onto the pres- tigious Forbes list. To stop patients from While medical offices are as familiar with deciding what treatment they need based on the LOMN as we are with referrals for 3rd Google and WebMD, medical plans use pre- molar extractions, they still want it to be authorizations to decide if the treatment or easy and take as little time as possible. DS3 testing is “medically necessary”. By getting gives you the tools to send letters introduc- the prescription for treatment and Letter of ing yourself as a skilled dentist treating sleep Medical Necessity (LOMN) proof is provid- apnea with an interest in treating mutual pa- ed to the plan that the patient needs the oral tients. It’s simple and with a couple mouse appliance, and we are playing by the rules. clicks, it can be printed for mailing or trans- Pre-authorizations are not a luxury, they are mitted via digital fax. Medical offices appre- a necessity and the LOMN is the most im- ciate that the LOMN is already filled out - portant piece of the puzzle for an approval. just sign here and send back please.www.DentalSleepSolutions.com

To Tripod orNot to Tripod. By. Dr. Richard Drake One of my mentors has a Mandibular Repositioning three planes, NOT just the an- been Dr. Keith Thornton, inven- Device (MRD) can be a chal- terior posterior. tor of the TAP devices for ob- lenge for some patients, and structive sleep apnea (OSA). I part of that challenge is over- Unilateral Pain made my first TAP over 13 years coming side-effects. One po- Make sure the TAP hits on- ago and estimate that I have tential side-effect is ongoing delivered more than 1,000 TAPs TM Joint issues. Sometimes it is ly in the anterior ar- since then, and it remains a key muscle, sometimes the joint ea. Frequently, pain on just part of my armamentarium. I itself, sometimes both. Here one side is caused by an im- don’t use it for every patient, are a few clinical tips to ad- balance from the device hit- but I find it is almost always at dress ongoing joint pain and ting on only one side in the the top of my list. It does a generalized achiness in the posterior area. Typically the fabulous job of treating moder- joint area. side that is hitting is the side ate to severe apnea. We have that is hurting. Simply reduce multiple case studies now First, determine if the pain is the posterior where with the TAP we have unilateral or bilateral, acute or thickness on reduced Apnea Hypopnea In- chronic. Remember that doc- that side until dexes (AHI) from 100 to below umenting joint and TMJ dys- it no longer 10. function in DS3 beforehand is touch- ALWAYS a good idea! Also, es. You’ll see Regardless of efficacy, wearing remember that we work in this happen more in pa-w1ww.DentalSleepSolutions.com

tients with a steep Curve of 12 Steps to tripod:Spee. Also check that theadvancement mechanism is 1) Place TAP in mouth and determine approximate amount to addnot misaligned, pulling the to posterior segments to create tripod effectpatient too far to the right orleft as they protrude. Again, 2) Roughen outside areas on lower posterior above first molar onthe joint that is being restrict- both sidesed from moving is usually theone that hurts. Lastly, sleep- 3) Vaseline occluding surface of MAX only posterior areaing only on one side with a 4) Create acrylic ball approximating thickness you will need (pea tohand under the face cancause unilateral joint is- small marble sized)sues. Consider tripod in all 5) Lute acrylic balls to posterior of LOWER archof these cases as discussed 6) Insert MAX device on patient (Don’t forget the Vaseline!)below. 7) Hook LOWER into upper, and while you support the lower, haveBilateral Pain the patient slowly close into occlusion; help the patient bite into Most often, pain on both device withOUT completely flattening the acrylic stops you cre- atedsides is caused from titrating 8) Have the patient move side to side while you ensure adequatetoo far forward too height of the posterior stops (If needed, pinch the sides in tofast. Slow down. Back up a raise them upbit. Utilize the Cl II hook on 9) Let it set up for at least a few minutesthe TAP 3 Elite. Check to 10) Remove, making sure not to change the height of posterior.make sure there are no pos- 11) Pressure pot for 8-10 minutesterior interferences as the 12) Re-seat TAP on patient and make sure anterior and both poste-patient moves forward (just rior segments hit simultaneouslylike above). Consider add-ing posterior stops so thatyou “tripod” the TAP. It hits infront on the advancementmechanism as well as theposterior R and L all at thesame time. You’ll want towait until you get close toyour treatment position to dothis, because further adjust-ment forward means you’llhave to adjust the posteriorsegments every so often asyou titrate the MRD forward. SUMMARYThe joys of treating OSA successfully far outweigh the speed bumps, or side effects, along the way. Having a few tricks up your sleeve to helppatients get over the speed bumps makes you a better doctor and helps patients wear their devices and treat their apnea more successfully. 1.877.95.SNORE

The D.I.S.H. on the Oral-SystemicThe D.I.S.H. on the Dawson Institute of Systemic Health changes. Dr. Roizen pointed out that including Bradley Bale MD, Steven Masley MD, DeWitt Wilkerson a large study showed that 89% of DMD, Tom Nabors DDS, Tony Iacopino DMD, Susan Maples DDS, people with adult, type 2 diabetes David Seaman DC,MS, Stephanie Lodding RDH, and Gy Yatros DMD can lower their blood sugar levels to Just some of the topics covered in within normal limits, without the the continuum include how to use salivary testing to guide antimicro- use of medications, by imple- bial periodontal/systemic therapy; home sleep studies to guide menting a few simple lifestyle screening and monitoring of treat- ment of obstructive sleep apnea; changes. Recent DNA studies have principles of prevention of diabe- tes, heart attacks, and strokes; ex- also proven that lifestyle is more ercise physiology; stress manage- ment techniques; nutritional princi- important to longevity and quality ples; smoking cessation counseling; networking within the medical of life than is our genetic predispos- community, and many other princi- ples of Dental Medicine. tion. He challenged dental teams to For more information contact the be on the frontlines fighting this Dawson Academy, www.TheDawsonAcademy.com.By Dr. DeWitt Wilkerson DawbpaostiontltenintghAaoctuaitsdtdheeamsttrwyoeyisnpgeonudrmnaotrieon, You are urged to accept the chal-The Dawson Academy is pleased to time with our patients than any oth- lenge to create The Total Wellnessbring the Total Wellness Dental Prac- er health professionals. We left the Dental Practice in your own office.tice seminar series to Brentwood, TN conference with an enlarged vision Wouldn’t it be wonderful, if in ad-beginning in April, 2015. In 2012, we of Dentistry. dition to saving teeth, you couldattended the second annual confer- also save lives? We would beence of the American Academy for In April, 2015 The Dawson Academy will bring scholars, researchers, and thrilled to help you!Oral Systemic Health (AAOSH). It was clinicians, to the Mountain West Dr. Wilkerson is Senior Faculty/ Director of Dental Medicine for theheld at the Cleveland Clinic, featuring Institute, personally training dental Dawson Academy for Advancedsome of the top medical clinicians and teams to expand their practice mis- Dental Study, in St. Petersburg,researchers in the world on the sub- sion to include total wellness Florida. He is Past President of theject of total wellness. The meeting screening, coaching, and therapy. American Equilibration Society and serves on the Board of Directorscompletely altered the way we view Our newest course series, The Total for the American Academy for Oral Systemic Health (AAOSH). He canDentistry. Michael Roizen M.D., Medi- Wellness Dental Practice, will assist be contacted atcal Director of the Cleveland Clinic dental teams to become patient ad-Wellness Institute, shared evidence vocates for total health and gate- [email protected] that our nation will soon be keepers of systemic inflammation.bankrupt due to increasing healthcare Systemic inflammation is the firecosts, especially the cost of managing within that feeds accelerated aging,chronic diseases associated with met- lowered energy levels, poorabolic syndrome/obesity, diabetes, memory, chronic pain, and disease.heart disease, dementia, physical in- Common causes are oral pathogenicactivity, smoking, and stress. Accord- bacteria in the bloodstream, sleeping to Dr. Roizen, there will only be apnea, a pro-inflammatory westerntwo options to manage this growing diet, physical inactivity, smoking,crisis: rationing of health care by the and stress. Dental teams can effec-federal government and insurance tively address all these sources ofcompanies, or the public gets smart, chronic inflammation.and we start taking responsibility for The participants in this course seriesown health through personal lifestyle will learn from noted authorities



BY DS3 SUPPORT SPECIALIST CINDY HERBERT DS3 Members ask and want to lunch and learns. Dr. Drake re- to you. Customize each one to theknow: “How can we get more sleep cently did one in San Antonio for a type of physician you are visiting.patients?” It’s a common questionwe hear at Dental Sleep Solutions, rather large ENT group. Theirand we spend a fair bit of our timebrainstorming ideas to help you get practice has seven physicians and  PCP: Treating OSA will makemore patients. a staff of 32. We brought box lunches from a local deli and pre- patient’s healthier. Period. Across The lowest hanging fruit is your sented a 30 minute power point the board.existing patient base who walk about how we could work togetherthrough your doors every day. You while they ate their sandwich-  ENT: I need someone I can re-are screening your patients with the es. Two docs showed up and 29DS3 screener, right? Beyond that, staff members. Cost me less than fer to who can increase nasal paten-we recommend that you cultivate re- $500 and a couple hours’ of cy, treat GERD, allergies time.tdfloamclmtbbkchaMypsaaohwooointeirfsoeattmyuaerefaouiesuourigimoncncncubsrrwlDsiwoesndhhngy,tcserrii.fogsah?ceeno1wlfhmptafhicne”ovdsihc0c.Oenhrhtieai.h,i0eepofblgsdyoAfiIpnIuicsfsr,tstrtselairboarooycaimIewwilewecssIgiccoengvwcpvsiiioyhahieuatllnretouellvolhealurtnauhormpfitraoucIR$swmhltyctbIanFhvaspsvrowaynthnanutlaiieeeoc5eaioer.orelohEoielwmthnslafalodidetTrrcursrobma0shltylisusfnnotiRslcysacmouosynroklyf“b.rutseniabeotmhyi,tArigthccaDawstbwiAtnchh!ceaydowe-foaerasOnm,naaegoreanilQmciakucrngaee$onaccanioe&tecwroSntdnonrinpunt2ee)reaonalntsciFvisuAemdidmnfesG5I.awdtydOrnoaoudpsheaetlhtdtPa,0ri,erinrastCmprhnohiAtcyshsonotddTDwnoLkssEaeaeedeuwciallrTaisaautsa?seserSicnrrnmoro.tonnethvaeoettv,iH!tcaekdAciitdlhiaoii?oTsostct-pwmscheeectDebrleIearTH!hntwwyohlheaTbftnvtteahsaiaarScnnhnl,tAkiaoalaIoeEaiooteosftpilcPetnunMepa&prnrbsHvclayixr.nlCfromoulrrAyredosatbirnelfoymdsseneaehkeuenoe&gHi,AtAhrvpsmnsmHcegai,Aan.mrtyyevt“fdHafelbeciberylltTAebt,I(aeietnyt(assitcPyrHfnlehIteHtdrthiseocoeleytutsroetfiretfjcsAeetseeaeceafosreatdhiroAntrmuediao’tDtodaAnnnrscekalao-atE’.cnetaue,lteRetselcttrictl-iA-lhsn)s.hinofDtrostrtn-rea-oIy,--f  Cardiologist: We can help con-Dw5E1wNwT.ADLeSnLtEaElSPlSeOeLpUSoTIluOtNioSn.Cs.OcMom trol hypertension, A fib, V fib, coro- nary artery disease  Gastro / Endocrine / Nutrition- Every timeHwoewusleotnhegsedfirdeeitantad ke to start ists: We can help patients lose egaestytisnegrvicreesfetorrinanlosc?entLlyecsoms-than 24 weight, better control GERD, better mhounuicraste! with each other about control glucose and insulin levels anything having to do with a patient or aDceasnet,awleS’releinevpiolSatoiolnu. tEiovenrys has pre-  Rheumatology: Patients who psinagrlee dtimpeowweesernpdooirnrtescefivoer our Mem- binfeorrmsattoionuitsilaiznee.w pYooteunt’ilallnfineeed to cus- sleep better feel better and complain btoecmauizseeotfhheowmthwe iitnhforymoautiornpisersonal less tirnafnosmrmitteadt.i”oFno,rtuonfacteolyu, frosreD,Sa3s well as Sleep docs / pulmonologists: Just tMoemthbeerss, ptheisciisfincotaaucdoinecnercne. , but these throw me a bone, a crumb, a patient who refuses to wear PAP after a dozen different masks! pDSo3wiseirndpeoeidnatsHIcPaAnA &beHITaEpCoHwerful tctcioaoemtoendpltltsidaoe.nnthtSEaeMltlaspRler.teyIpttohismuetehgdceiecooitnnnemlyvsedooerfrtsd-eia- ptiao-n with  Screen your patient base B8CC7rina7ond.9dyn5iHet.SeaHNrcabOvteRer:Eltlimataauwhhncfbihmnuhaonneoraereoteretpwsdwdlesaprya,dleweetooo&mhttiy.urohtarhhrsrfcwoetoeeaOoDttDmuhraancttSSeebn.teoneyaMp3eecccdwp.taEuhsttseprttrmtievatNietltrvhhelttlieeirihecTp,eeenesntatue’ogehtsovtrtdlyoo,dear,cuatiaordtoyfrkfriythetouaenhtsopeorrrrgeoipeirusaayfehaetwef.yrsntelxaiSesctemrpa-uthtrianharermpeyeeotalasiismpsrcttstleiyueeacsoc,ngasuhwtensibescrainnddyiiLpne@ueCc@rnordOecnwtdtahehfaefsaenci&ecettntkeymLat,otoveeL1alusiau0osflclonsri0neatnrclsenehsaptuepep&os(soaerpseLpmnryosehweempoalyhualreplosenrutein)nsPcitrtooigihaqwoin)vnueinssnar.Pgsr(cto.teowcinromo,t m

We need an ad 1.877.95.SNORE

MEMBER WHO’sWHO With DS3 Support Specialist Staci Holbrook of Metro Dental Sleep Medicine faculty at Wash U. teaching general dentistry for 2 years before I went into private practice in St. Louis about 1990. 25 yearsDr. Khalil, how long have you been now, gosh where has the time gone?practicing & have you always been inthe St. Louis metropolitan area? What sparked your interest in Dental Sleep Med- I was actually born & raised in Ethiopia & icine?lived there until I finished high school. Then I em-igrated to the U.S. & attended Wheaton in IL for 4 years ago I was diagnosed with OSA. My physiciansome undergrad courses & finished with a bache- told me I had moderate OSA & didn’t need CPAP & suggestedlors in chemistry at Indiana State. I got a master’s that a dental device might be a good idea. He asked if I couldof public health (MPH) at University of Illinois- make one myself & I said yes. I began attending a lot of sleepChicago & then got my DMD at Washington Uni- CE. The MD said he needed a dentist nearby so I agreed toversity in 1983. open a dedicated sleep office in the same plaza. He also en- couraged me to continue building my own referral network & ISo, then after graduating from Wash U, started looking at DSM in a much more comprehensive way. Iyou went into private practice? recognized there were 3 major hurdles to overcome. The first is the technical part of making devices which was actually rela-Not exactly. I did a general practice residency at tively easy. Secondly, was medical billing which required athe VA in STL from ’83-’84 & then practiced in deep level of learning & persistence, & finally, building rela-Austin, TX for 1 year. I worked with the Elks Mo- tionships with the gateway entry point of OSA which is thebile Dental Clinic for about 3 years treating handi- diagnosing physicians.capped kids & teenagers out of a mobile van allacross the eastern half of Missouri. Then I was on 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 pro- vide 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 refer- ring 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 favoritewww.DentalSleepSolutions.com

breakfast or lunch from wherever they’d want. I went your stature within the medico-dentalinto a 4 physician group practice after having this dis- community? Speaking opportunities?cussion with them. I brought bagels and coffee for a‘breakfast and learn.’ One doctor immediately recog- Over past 4 years, I’ve gone from just begin-nized in their patient base that people needed this & ning & that year I treated about 40 patients. By thewithin 24 hours he began referring patients. Then an- end of 2013, I made 60 devices. In 2014, I made 163other MD in that same office began referring shortly devices, nearly a 300% growth rate. This has had aafter. huge personal & professional impact on me. I have made a huge positive impact on many patients’ lives. Secondly, I regularly send reports to MD’s Professionally, I’ve tripled the income in my sleepregarding pre/post treatment stats to show improve- practice. We’ve grown exponentially & this has creat-ment. I use the DS3 system because it keeps them in- ed confidence that allows me to approach even moreformed about our shared patients. This is one more MD’s to help treat this epidemic.way to stay at the front of their mind. Lastly, I meetwith them to continue building rapport. I visit with In this time, I’ve been asked to speak to sever-them for 5-10 minutes to discuss patient outcomes via al study clubs and other groups. I started the Midwestconference call, text, whatever. One MD I visited Dental Sleep Medicine Study Club with some col-over holidays told me ‘you almost killed 1 of my pts.’ leagues and learn more every day about emerging re-I was taken aback & asked why. He said, “Your de- search and how we can better improve patients’ lives.vice helped him so much that he decided on his ownto stop taking his insomnia Describe your DSM experience in 5meds so even though he was words?breathing well, he still had in-somnia. He fell asleep at the Enjoyable. Rewarding.wheel & his wife had to grab Meaningful. Profitable. Fulfilling.the steering wheel. Youstopped his snoring & How can others replicatetreated his OSA but your success?his insomnia persists.”To me, this highlights importance of multidisciplinary You have toapproach & ongoing communication. As dentists, we make a paradigm shifttend to focus so much on OSA and forget that it is from treating teeth to themerely one of dozens of SDB classifications. connection of three seemingly disparate spheres. Teeth, TMJ, & the airway. As dentists, we are wellWhat tools can you not practice Dental trained in teeth, marginally well trained in evaluating & treating the joints but the airway is foreign to us.Sleep Medicine without? We write it off as something that ENTs & MD’s deal with. We have to focus on airway first, TMJ second, A diagnosis of OSA Clinical dental & TMJ & teeth last. Until you make that shift, you are unlike-screening which I use DS3 for George Gauge & im- ly to grow. We’ve been saving teeth, now we mustpressions Good software. DS3 is the best to do it. I’ve save lives.used others but it is far and above superior. It address-es the biggest hurdle which is dealing with referring To Contact Dr. KhalilMD’s with the well-written letters. Without that, youare dead in the water. No SIGNIFICANT business- Dr. Saba Khalilperson can live without their relationship with the 314.740.1395bank. The bank doesn’t care if you make or lose mon- [email protected] as long as you communicate with them. If youkeep them apprised of what is going on, good or bad, 1.877.95.SNOREthey will work with you. It is frequently the samewith referring physicians. DS3 allows me to do thisby mailing or digitally faxing correspondence directlyfrom my software.What impact has DSM had on your prac-tice, on your professional satisfaction, &

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!!!