Your Role in Dental Sleep Medicine P6
2014
I’ve had two patients whose bites shifted, and I said, “Okay. Well, we can just go back to your CPAP,” and they say, “No. I can live with this. I don’t even notice. It’s only because my dentist pointed it out to me. I didn’t even know.” So, a lot of times, the patient isn’t even aware of it. I think it’s funny that every time the patient leaves the delivery appointment, they’re always saying, “I hope this works.” Then, they come back for their one or two week appointment, based on our schedule because we do have some sleep apnea days that we dedicate straight to sleep apnea.
At that appointment, we ask them, “When you wore it, how did you feel?” They look at us the same, and they say, “Well, I wore it every night. Was I not supposed to?” I’m like, “Perfect. That’s great,” because we just don’t want them to feel that it’s not going to work for them if they didn’t wear it a couple of times. So, we show them how to advance it. We don’t show them how to advance it at the delivery appointment because we want them to get used to it. By advancing it, we can from there. If they feel great, sometimes we keep them there. I ask them to advance it until the pillar hurts. We do have patients that still snore, and we talk about Breathe Right Strips or Nasal Pumps and things like that.
Then, we do a one month follow-up, and this is where it gets really fun because they’re feeling good. They’re rolling along, and we start thinking about doing a sleep study at that point. It takes about three months for that to shrink down for the muscles to get toned again. When they’re getting constantly beat up and battered, the tissue is really edematous and swollen. So, at the three month mark where they’ve been allowed to advance it enough, they’ve gotten over the side effects. If they had any TMJ pain, they’re over that.
So, we do a titration home sleep test. I actually didn’t own a home sleep study for a long time because of money, and I finally did that one because they are finally coming down in price. It’s easier to use. I had sent a patient back for his home sleep study because he feels great, and his wife was as happy as he could be. So, I sent him back for sleep position. He did not advance it at all, and his AHI was almost the same. So, I’m always sure to screen them before I send them back. I don’t use my home sleep study as a screener before treatment or use it to diagnose. I might use it for the titration, and then, we refer them for PSG. Honestly, I’ve only have three patients do that, but I really tried to get them to do that.
So, we’re getting towards the end here. The most important thing about doing this is that it’s so energizing. I love getting hugs after I change people’s smiles, but I love getting hugs from patients after they think I’ve save their lives. I just want to read you this testimonial really quick:
Sleep apnea, not anymore! I feel compelled to add my experience to those testimonials already submitted. This has been truly a life altering experience for me. After being diagnosed with sleep apnea several years ago, I tried to adapt to the CPAP torture regimen. After repeated attempts with several masks and watching me wife’s hair blowing around lying next to me in bed, I finally gave up and jut accepted the fact that it wasn’t for me. So bet it.
Then, last year, I was introduced to an oral appliance by Dr. Elliott and her fine staff. Now, many months have passed and both my wife and I are two happy campers! No more waking up tired, no more falling asleep in the middle of the day, no more snoring… Oh my God! My wife has decided that she will no longer be looking for a new husband, as she has found that she can sleep without waiting for me to start breathing again! It has been a life altering experience I never expected. This simple appliance is the greatest thing since the sliced bread!
That is why I’m so passionate about it because I want to teach others how to help millions of people that are undiagnosed and people that we can help that their primary care physicians aren’t catching. So, I’m doing to hand this over, and we can answer some of your questions.
Dr. Lavine:
Thank you. That was fantastic. There’s two things that I always look at to decide if a webinar was successful or not. Number one is do we have a lot of questions, and yours does not have a lot of questions. The people are so interested in what you’re talking about. They’re not typing them in. we only have four or five questions, but I certainly would encourage people to ask questions now if they think about them. Secondarily, how was the attendance compared to when we first started? We actually have about 50 more people than we did at the beginning of the webinar. So, you definitely kept everyone’s attention. I appreciate that.
I think one of the things you alluded to in the presentation is the fact that the webinar gets people excited and interested in it. It wasn’t something designed to make people experts in sleep apnea and treatment. Of course, it also doesn’t mean that you have to go and get an MD either. You do courses online. I know you’re doing one with the folks at Golden Dental Solutions in the next month or so, and I’ve asked Kurt Loder.
Many of you have heard of Cur Lawler when we talked about Physics Forceps. I’m going to turn it over to him to talk about Erin’s course and a special offer for everyone on tonight’s course. So, Curt, the floor is yours, and tell us what you’ve got to say.
Curt Lawler:
Lorne, I appreciate it. Dr. Elliott, great presentation. I really enjoyed it, and I hope everybody else on the line did also. Like Lorne mentioned, in Golden Dental Solutions, we truly believe that in order for a course to be truly effective and translated into skills implemented in your practices on an immediate basis, it must have a hands-on component. A lot of our courses are live patients courses that we do at the University of Detroit-Mercy School of Dentistry here in Detroit. The reason we do that is because it allows you to practice on live patients, and it’s also a great facility where you actually get a true hands-on experience outside of the classroom.
So, we’re doing a course with Dr. Elliott on February 15th and 16th here in Detroit, and we’d like to offer the attendees of the webinar a discount with a promotional code of SLEEP, which expires on January 18th. To learn more about this course with Dr. Elliott that’s being put on by our company Golden Dental Solutions, you can visit GoldenDentalSolutions.com, and if you click on where I have the arrows indicated here on the slide for the Dental Sleep Medicine section or the alarm clock section that says HELP, that will take you to a different section of the website that goes through, in detail, more information about the course, on the amount of CE credits, the course fee, the general outline of the course.
Again, I just wanted to emphasize that this course is going to be really unique in that in day two of the course, we are going to be spending a portion of the day down in the clinic floor at the University where we’ll be going with Dr. Elliott in detail taking of impressions, bite capturing for dental sleep medicine. We’re going to talk about all kinds of different appliances, bite capturing and impression methods.
We’re note tied to a specific product. We’re going to talk about many different brands and provide information for doctors to learn. So, again, if you want to learn more about this course and take the opportunity to register online, you can give us a call at our office with the phone number indicated on the screen, which is 877-987-2284, or if you click on the section of the website here, I will take you to the dental sleep medicine portion of Golden Dental Solutions. You can click on registration, sign up online, give us a call. We’re more than happy to answer any more of your questions.
So, at this point, I’ll turn it back over to Lorne and Erin to go over the questions that you may have submitted during the webinar. Thanks again. I hope you join us in Detroit.
Dr. Lavine:
Thanks, Curt. I guess one of the questions is for you: I already signed up for the course because Dr. Elliott is awesome. Can I still get the $100 credit? I think Erin should give him the credit for that. That’s a very nice comment.
Curt Lawler:
Yeah. No problem. Just give us a call.
Dr. Lavine:
Okay. I will send you the list of attendees so you’ll know who that was. The other thing is that I know some people were curious. Some people came in late. I just want to remind everyone I did record this entire webinar. You’ll all be sent a link in the next day or two so you can listen to it at your convenience.
Erin, we’ve got a lot of questions. Are you ready?
Dr. Elliott:
I am.
Dr. Lavine:
Okay. We’re going to try to get through as many as we can. I’m going to read them as I see them. For Medicare prescription form in addition to the EO487 insertion form, do you list each of the visits?
Dr. Elliott:
For the Medicare, you actually aren’t allowed to. We’re considered a DME company. That stands for durable medical equipment so they look at us as if we’re a CPAP supplier versus the physician. So, we have to bundle our codes. Medicare reimbursement includes the evaluation. It includes any radiographs. It includes the appliance, and it includes all the visits up to 90 days.
Sometimes, you can actually charge out for repairs or maybe some follow-up appointments after 90 days, but I honestly haven’t done that. You can’t even charge out for the home sleep test or titration study. I hope that answered the question.