Recently I was asked by Jason Tierney and Elias Kalantzis from Transform Dental Sleep to participate in a dental sleep medicine webinar by and for leaders in the oral appliance field. It was a privilege to join this event and share from my experiences at Glidewell, which, by case volume, is the single largest dental lab in the world today.

The thoughtful questions that formed the discussion highlighted the forces that have shaped dental sleep medicine in the general dental practice. This dental blog post will cover the top questions that moderators asked during the webinar. I’ve elaborated on these topics to update Smile Bulletin readers on key areas that impact oral appliance therapy (OAT).

It’s a startling number: 30 million people who have trouble sleeping and breathing at the same time. Sadly, the bulk of these patients are undiagnosed and don’t understand their condition well enough to pursue treatment. The potential health implications are clear: diabetes, stroke, heart disease and early death.

In my day-to-day job, I work with general dentists who predominantly serve a community of healthy people who are proactive in taking care of themselves. According to the CDC, nearly 65% of Americans aged 18 and over saw a dentist in 2019. I believe our mission in the dental industry — as professionals who are mindful of snoring and sleep apnea — is to improve access to care for patients who can benefit from dental sleep medicine. And I hope that as the sleep IQ of the general population of the country improves, we will begin to address the 30 million people who are unaware of or don’t believe they have a problem.

Over our half-century in business, we at Glidewell have been working to improve access to care by using innovation to reduce the cost of dentistry. The Silent Nite^® Sleep Appliance, our device for the treatment of snoring and sleep apnea, is a great example of this mission. The Silent Nite appliance was introduced to the snoring and sleep apnea therapy field in 1996. Over the past 25 years, nearly 500,000 appliances have been delivered to patients.

General dentists have found the Silent Nite appliance to be easy to deliver because the tools and techniques required are the same as those required to make and deliver a standard nightguard or retainer. An upper and lower impression and a comfortable protrusive bite, via digital or VPS impressions, yield a device that fits the teeth and positions the mandible anteriorly.

As treated patients may feel anxiety about losing or breaking their appliance, we have also started offering a $97 discount on a duplicate backup appliance through the Glidewell Clinical Twinpak™. Clinicians can now deliver two appliances made on the same models for a consistent fit and at a reduced cost.

Dentists I have spoken with who do not treat sleep apnea are responding to the nonclinical aspects of this treatment, such as medical insurance and the impact on practice workflows. Diagnosis and management of sleep apnea, a medical condition, requires a physician referral. Payment is often tied to medical insurance, and, for patients aged 65 and older, Medicare and Medicaid are the payers. The additional expense of these changes to administrative workflow and the cost of additional training just doesn’t seem to be worth the disruption to the dental office.

At Glidewell, we have distilled the process of treating dental patients for sleep-disordered breathing, a condition that includes snoring and sleep apnea, and have developed a simplified process of provisional care called PMAD (provisional mandibular advancement device) therapy.

Essentially, the dental team screens the patient for sleep-disordered breathing, initiates treatment with an oral appliance, and refers the patient for medical management by a physician. This process is effective and is not disruptive to the dental practice, and it is scalable enough to address the masses when they visit the dental practice for teeth cleaning or other dental procedures.

We will know we have reached the inflection point when the treatment of the many is no longer in the hands of the few. There is nothing about OAT that the general dentist in any town in the U.S. cannot accomplish with the materials they use every day.

It’s estimated that there are 140,000 general dentists in the U.S. The American Dental Association (ADA) states that 52% of American adults report seeing their dentist every six months. There are more than 255 million adults in the U.S. Dentists will be having conversations with some 125 million of them twice this year. We know that 62 million or so have some form of sleep-disordered breathing. Screening and education is critical to success with this patient population.

I believe that if all dentists screened 100% of their patients for sleep-disordered breathing, the way we understand the condition would be transformed. Simply asking patients if they snore or find themselves feeling excessively sleepy in the afternoon as part of a health history would be a great start. Adding the Epworth Sleepiness Scale or STOP-Bang Questionnaire to new patient and patient recall forms would be ideal.

Also, start treatment as soon as a primary complaint like snoring or bed partner disturbance is identified. The treatment of snoring does not require a physician’s prescription or an objective diagnosis. At Glidewell, we developed the process of provisional mandibular appliance device therapy that lets any dentist treat snoring as a standard offering in the dental office, just like a BruxZir^® Zirconia crown, Simply Natural^™ Dentures or a Comfort H/S^™ Bite Splint.

This process begins with the simple question: “Do you snore, and would you like to stop?” If the answer is yes, then the patient is fitted with a custom mandibular advancement device (MAD), such as a Silent Nite appliance, OASYS Hinge Appliance^™, EMA^® device or dreamTAP^™ appliance. After the patient is advised that snoring is a symptom of apnea, a physician referral is provided and informed consent documents are added to the patient record. (This is very important. Click here for an example.)