Your Role in Dental Sleep Medicine
2013
see the video: http://vimeo.com/57383873
Dr. Lavine:
Well, we’re going to go ahead and get started. Welcome, everyone. This is Lorne Lavine. Most of you know me as the digital dentist. I wanted to welcome you all to tonight’s webinar. As of this morning, we have almost 450 people that were registered for the webinar. I think it really the interest in this topic, and a good chunk of you are already here. I’m only going to spend a couple of minutes talking so that we make sure that Dr. Elliott could speak as long as she’d like. We also want to make sure that we leave time for any questions.
All of you, on your screen, should have a little “Go to Webinar” control panel. Go ahead and type in your questions as you think about them. Depending on where we’re at in the presentation, we may not be able to get to them until the very end, but as you think about them, just go ahead and type them in. I’ll do my best to make sure we get to all those questions before the evening’s done. By the next week, you should all get a number of things. When log out tonight, indicate if you would like Dr. Elliott to follow up with you or whether you want me to follow up with you. That will just be a short, little two-question survey there. Also, many of you know what I do record these webinars. So, within a day or two, you are going to get an e-mail with a link where you can download the entire presentation. So, don’t worry if you have to take a phone call or the kids are screaming. We’re going to give you the whole presentation to listen to when you’d like.
I also want to thank our sponsor tonight, Golden Dental Solutions. They have graciously agreed to provide an hour and a half of continuing education credits for everyone. Many of you are probably familiar with Golden Dental because we’ve done a lot of webinars with them in the past, the Physics Forceps and other products. They’re going to be coming on later tonight, and they’ll offer a special deal for everyone as well.
So, many of you already know me. I am known as the Digital Dentist. I did practice as a periodontist for 10 years. What I’ve been doing for the last few years is to present webinars that are topics of interest even if they’re not necessarily in my area of expertise, which is technology. Really, the goal of these courses is to provide concepts that I think are interesting and stimulating, maybe a little controversial but hopefully beneficial, and I think we’re going to hit on all those topics tonight.
As dentists, we are constantly looking for ways that we can improve our practices, looking at new things that we can do, and this is really the focus of webinars I’ve done over the last year or so. Many of you have been on some of my previous webinars where we talked about Physics Forceps where general dentists are now handling tough extractions or Six-month Smiles where dentists are now doing short term ortho. I think sleep apnea, sleep medicine really falls into that area because dentists can definitely play a role.
As many of you probably know, if left untreated, it can cause all kinds of problems, heart failure, stroke, high blood pressure, diabetes. So, I really think this is a great tool, a great service we can provide our patients as long as we have the training and the knowledge to be able to do that.
Now, as much as I’d love to talk about sleep apnea until the cows come home, the fact is I don’t know much about it. My role, really, is a as a moderator tonight. It’s interesting that as a speaker, as a consultant, I’m out there a lot, and I talk to a lot of other dentists, other consultants. So, we get to hear when there are new rising stars in our field, and Dr. Elliott, I hear about her for a few months. I had the pleasure of meeting her at a social event at the Greater New York Meeting back in the end of November.
I was just so impressed with the passion that she brings to this topic and how she has helped so many of her patients with it, and I said to her that this would be a great webinar topic. She graciously agreed to come on. She is a practicing general dentist with a private practice. She’s in Post Falls, Idaho. She does a lot of things other than sleep apnea. She practices general dentistry, cosmetic dentistry, ortho, but, definitely, sleep apnea is where she’s becoming a real expert. She’s an active member of the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine.
She’s authored several articles on dental sleep medicine, including her latest article which was in the October issue of Dental Economics. It was called “Take the Time to Check for Sleep Apnea”. She is considered a national expert in this growing field of dentistry, and she’s lectured extensively, educating dentists on how to incorporate sleep dentistry medicine into their practices.
So, without further ado, I’m going to turn the microphone and the screen over to her, and welcome Erin. It’s a pleasure to have you tonight, and we’re really looking forward to the presentation.
Dr. Elliott:
Thank you, Dr. Lavine. I’m looking forward to sharing with everybody the passion I have for not only helping my patients but in helping other dentists help their patients as well. Like you said, I practice in Post Falls, Idaho, which actually has a population of 27,000. So, like many of you, I don’t practice in a big metropolis with thousands and thousands of patients around. Our county actually has about 125,000, and two [05:11] physicians that I work with very closely, and it didn’t happen overnight.
It’s something that I started about three and a half years ago, and, since then, have really taken it as a whole other part of my practice. Within Post Falls Family Dental, I have Sleep Better Northwest and a dental sleep medicine coordinator that actually handles a lot of the administrative staff as well as the follow-up appointments while I’m still practicing general dentistry. In fact, today I did occlusions on a four year old and an extraction on a 60 year old using the Physics Forceps, and I just do everything to help serve the families in the county.
Dr. Lavine:
We’re not seeing your screen, yet, Erin. So, I don’t know if you’ve clicked the button yet.
Dr. Elliott:
Oh, okay. Alright.
Dr. Lavine:
The presentation always goes better when we can see the screen. There we go. Perfect.
Dr. Elliott:
Sorry about that. There’s my practice in Post Falls. So, recently, we’ve seen in the news. This was actually when I traveled to the Greater New York Meeting. On the way there, I took Delta, and there was an article in the inflight magazine about sleep. On the way home, I took Alaska, and there was an article about sleep. It affects a lot of Americans because, really, we don’t get enough sleep with all the electronics we use and caffeinated beverages and sleep aids. There’s so much that we’re missing in our sleep.
Now, even in the news, every week I see different press releases about obstructive sleep apnea and the effects it has on our health. This one just came out this summer in which patients are more likely to die from cancer, and it really affects a lot of us. It’s really important because there are four stages to our sleep. That includes deep sleep and REM sleep that we know about where we dream. If it is interrupted, we don’t get the restful sleep we need, and with already surviving on so little sleep, we aren’t getting the hormone regulation. Our body’s not resting. Our cells aren’t regenerating and healing, and it has a hug economic impact as far as untreated sleep apnics using twice the amount of health care dollar.
So, there are about 84 different sleep disorders, and the once that the dentists concentrate on, of course, are sleep disorder breathing category. Other categories include sleep walking, sleep talking, something called REM behavior disorder. My patient actually just got diagnosed disorder in which she was acting out her dreams. So, fortunately, she’s safe and her husband’s safe. She was actually going after him in her dreams.
With the snoring, we all know about snoring, and it’s not really a joke. We all know we like to joke about it. Upper airway resistance syndrome is when patients are snoring, and they’re consistently getting interrupted because of the snoring, whether it be an arousal from their life or an arousal from a deep sleep into a lighter stage of sleep. These are people that wake up unrested. Central sleep apnea is a category of sleep apnea that’s actually pretty rare. That’s when our brain tells us not to breathe. So, we have two different types of sleep apnea that we deal with, and obstructive is the one the dentist can treat because there’s an actual physical blockage affecting our sleep pattern.
We’re going into snoring. I guess, recently, due to my cold, I have been snoring more lately, and my husband sent this to me on our Facebook account with love. He has resorted to this occasionally, the pillow technique, and like I said, we see it on the cartoons, in articles, in the news. A lot of the population snores, but many people tell me they don’t snore. When I talk to their wives or husbands, I hear the real truth. Most of the time when I ask if somebody snores, they say, “No, I don’t. I sleep just fine. I don’t snore, but my wife tells me I do.”
I thought it was interesting that a lot of the custom built homes that are being built actually going to have two separate master bedrooms, and that’s already started in Europe. They’re called snore rooms. So, it has become a pretty common thing, and snoring occurs when there is a narrowing of the airway and vibration of the soft tissue. That can be in the nasal component or the back of the throat.
As we sleep, there can be a continuum of snoring, especially as we age or start gaining weight. As we age, we lose muscle tone. So, our normal sleeping becomes a non-sleepy snore, and, like I said, that upper airway resistance is when we’re interrupted enough that we don’t get enough sleep. We become a sleepy snorer, and eventually obstructive sleep apnea is diagnosed.
Obstructive sleep apnea is where there’s repetitive episodes of apnea, insufficient airflow or without rest, and the difference between obstructive sleep apnea and central sleep apnea is actually when there’s ventilatory effort. It’s when we’re trying to breathe, but we can’t because there’s blockage.
So, as you can see, when we lay down supine on our back, we normally maintain an airway with the soft palette and uvula allowing us to breathe. Now, with snoring, there’s a partial obstruction of the airway, and the nasal cavity and the soft tissue there could be vibrating. There could be a narrowing there or the soft tissue and uvula area. Then, apnea occurs. Obstructive sleep apnea occurs when there is a complete blockage, and our oxygen desaturates.
So, as we become increasingly obstructed, that is called hypopnea. Hypopnea means that basically there’s a little kink in the hose. The airway is narrowed enough that our oxygen desaturates 4% or more. Now, with apnea, we have a complete obstruction for 10 seconds or more, and our oxygen desaturates. So, we get into this continuum, this pattern where we fall sometimes pretty easily. Sometimes it takes us a while. As our muscle relaxes, the soft tissue relaxes. The tissue vibrates, and the tissue actually relaxes. Snoring is the vibration. Then, it narrows enough to the point it collapses, and we have an apnea.