ANY WONDER WHY DENTAL SLEEP MEDICINE IS NOT GAINING TRACTION WITH MDs?

This was published in the Science section of the New York Times on May 2, 2011.

To the Editor:

I am correctly cited in Ms. Brody’s article stating that I would not get routine dental X-rays, as there is little evidence to support them in asymptomatic patients. The situation for mammography is completely different. Randomized clinical studies have shown mammography saves lives. It is unlikely to impact thyroid cancer, and the benefits of mammography clearly outweigh any risks. So, the message is clear: Get your mammogram and skip the “routine” dental X-ray if you do not have symptoms.

Carolyn D. Runowicz, M.D.

Miami

I contend we have a real problem here. Any comments?

The $20,000 Phone Call

I don't even have to write today's blog ' Seth Godin did it for me:

The $20,000 phone call

When a homeowner decides to put his house on sale and calls a broker...

When he calls the moving company...

When a family arrives in town and calls someone recommended as the family doctor...

When a wealthy couple calls their favorite fancy restaurant looking for a reservation...

Go down the list. Stockbrokers, even hairdressers. And not just people who recently moved. When a new referral shows up, all that work and expense, and then the phone rings and it gets answered by your annoyed, overworked, burned out, never very good at it anyway receptionist, it all falls apart.

What is the doctor thinking when she allows her neither pleasant nor interested in new patients receptionist to answer the phone?

Snoring Isn't Sexy provides telephone conversation recording so members can listen to (and act on) phone calls that are costing them patients.

Beating a dead horse and other exercises in futility

There was an ad for paper and actual books at the bottom of the Business Section in today's New York Times (Apr. 29, 2011).

Sure the Gutenberg Press was remarkable in its time but the Internet reaches many times more people, faster and more efficiently than the word printed on paper could ever do. Imagine what would happen in medicine and dentistry today if all medical journals were available on the Internet at minimal cost instead of having to wait a year or more for the printed version and then having to pay upwards of $40 an article if you don't subscribe.

This ad is an an advertisement out of desperation much like buggy whip manufacturers must have done when the car was introduced or by ice house owners when the refrigerator came into being.

In dentistry, we are doing the same thing today, especially in dental sleep medicine. We advertise in the newspapers, in magazines and even on the web. People do inquire about dental sleep medicine but few, if any, convert to patients despite the fact that, for the most part, treatment will be covered by medical insurance or Medicare. There is a reason this is happening!

Do you want to know what our problem is in the conversion of patients? Dental sleep medicine has been marginalized in the public press. For example, today Michael Breus PhD (the "sleep doctor" who writes for the Huffington Post who also shills for Sleepy's and has his own bed for sale) wrote another article on obstructive sleep apnea and snoring (Apr. 29, 2011).

http://www.huffingtonpost.com/dr-michael-j-breus/learning-something-new-th_b_846366.html

Not one word about oral appliances, not one. So when a patient who may be interested in oral appliances for his/her mild to moderate sleep apnea reads this, they immediately dismiss OAT.

The sad part is that we, both as individuals and as an organization, do little or nothing to combat this omission. Until we call Dr. Breus and others on this, we will never get patients to accept oral appliance therapy as legitimate therapy.

Comment on Dr. Breus' articles publicly on

twitter: @thesleepdoctor
Facebook: www.facebook.com/thesleepdoctor

I did.

But until we ALL comment, there will be no change and patients who cannot tolerate CPAP will get no treatment. There is no better time to make your voice heard, the Internet makes it possible but only if you have the courage to use it. Otherwise just keep sitting on the tack and crying about lack of patient flow and lack of patient conversion. Believe me, no one gives a damn about your radio commercial or your printed advertisement, or what I do or what any other group marketing dental sleep medicine does until people like Michael Breus, Mehmet Oz and Oprah start talking about the benefits of OAT.

The public just doesn't care what you say about yourself, they only care about what others say about what you say about yourself.

What would happen if...

You absolutely must, MUST watch this. Eric Whitacre said it so much better than I ever could. Even the name of his piece is appropriate. Imagine if we had a world-wide network of dentists providing oral appliance therapy all working together - singing their individual practices but TOGETHER rather than singly.





Let's develop a "virtual choir" of dentists providing oral appliance therapy in the United States, Canada and around the world? Why not? Just think what would happen to your individual practices if we could actually pull this off.

PUBLIC INTEREST IN TREATING SNORING AND SLEEP APNEA

Despite the fact that we, as health care professionals, understand that snoring and sleep apnea are life-threatening, cardiovascular-related conditions, the public seemingly does not. This is yet another illustration of the 80:20 rule in action.

20% of the estimated 20 - 40 million people who suffer with sleep apnea in the United States have been diagnosed and treated (successfully or not). The other 80% have no doubt heard of sleep apnea and know about the problems of snoring but yet do not seek treatment or follow through when they find a source of treatment.

In dental sleep medicine, it is relatively easy to get patients to call a dental office and inquire about options for treatment and yet the conversion rate from inquiry to treatment is exceptionally low despite the fact that both private medical insurance and Medicare often cover the cost of care.

If cost is removed from the equation, we could assume that a reason for patient hesitancy is concern about the treatment itself. Yet neither CPAP nor oral appliances are invasive and getting fitted for either is not an ordeal in itself. So what is the answer?

The only answer that I can see is patient apathy. 80% of the public does not perceive the problem of snoring and sleep apnea to be significant enough to bother spending the time involved in diagnosis and ultimate treatment. Most of the time, a CPAP unit requires an overnight stay in a hospital environment wired to a PSG. Even the home sleep study requires patient involvement for diagnosis. And then there's the nightly nuisance of the CPAP itself, for a disease state most patients do not perceive as important.

In the case of oral appliance, a sleep study is also needed and then there is the succession of dental appointments to get a device that the patient again has to insert and care for - all for a condition that 80% of patients do not perceive as important. After all - there is no pain, no bleeding, no swelling - "sure it may cause a problem down the road but right now I've got other things to do."

We live in a "give-me-a-pill-for-that" society where immediacy is the answer. We do not yet have that answer. The diagnosis and treatment of snoring and sleep apnea require a degree of patient involvement that they are reluctant to commit to. We need to do a better job of public education, we need to do a helluva lot less intra-specialty squabbling, we need to do far less condemnation of the other specialty's therapeutic regimen. In other words, if we are ever to get the public to accept care for this serious medical syndrome; we need to present a unified approach. Early diagnosis and treatment of sleep apnea could save the American health care system millions (if not billions) of dollars in the treatment of associated diseases but despite this we continually pit CPAP against oral appliances against surgery.

Do patients perceive care of sleep apnea as a necessity? Do physicians really think that dentists are a valuable source of alternative treatment? Do dentists advertise a sure-fire "cure" for snoring and apnea? Do vendors claim that their procedure, device, surgical approach is the only treatment that works?

We are all guilty, we are all responsible. The public is suffering!

Seth Godin just wrote "The worst voice of the brand *is* the brand"

One sentence stood out:

When a doctor rips off Medicare, all doctors are less trustworthy.

Interesting comment that can be applied directly to those of us who practice dental sleep medicine.

How well do we represent the profession in dealing with patients who snore and have obstructive sleep apnea? Do we claim to have a unique appliance that no one else has? Do we advocate over-the-counter appliances that research has proven ineffective? Have we taken sufficient continuing education to actually know what we are doing when we treat sleep apnea? Do we present ourselves to sleep physicians in a way that is beneficial to ALL dentists who work in this field? Do we deal honestly with Medicare?

Is dental sleep medicine just a "profit center" to replace cosmetic patients lost to the recession or are we seriously approaching the field in order to help people?

I can't answer any of these questions for you, you can only do that yourself. But remember your actions reflect on ALL dentists in the field and on dentistry in general.

Larry

WTF? Twitter and Snoring and Sleep Apnea

There are a number of well-meaning folks on Twitter who purport to be experts on snoring and sleep apnea. These people seem to Tweet about every article that has either the word "snoring" or "sleep apnea" in the headline.

This morning there were between 5 and 10 tweets about an article located at http://bitURL.net/bcd2.

This article contained sentences like

Buying this inexpensive device is a very good way to tell if this device helps you rattle when it is right for you by your dentist is taken into account.

Have you tried your dentist know ? that it is quite possible that the snoring problem is due to your jaw placement rather than some loose tissue or an enlarged uvula is this?

Questions and Answers Ask the experts your health related questions here … Ask 200 characters AV8 have this damn virus! Once you finally get to be able to scan the super anti-spyware, stopping my computer twice! It is capable of 120 pieces, then find out * Phew *. Now what?

It's pretty obvious that this is a computer-generated link farm page.

To those Tweeters that repeat this stuff and promote it - PLEASE READ THE ARTICLES BEFORE YOU TWEET ABOUT THEM... unless you too are just computer-generated programs.

No wonder serious dental sleep medicine is having a problem

An article just came across the wires this AM at a site called articlesbase.com. The site is, of course, the kind of trash that Google is trying to get rid of with its new algorithm but its potentially dangerous to those who practice dental sleep medicine seriously. The article is designed to garner ad links without any regard for the validity of content.

The title of the article is "How Cosmetic Dentists Can Help You to Get a Good Night's Sleep...Literally." The article goes to to describe three methods of how a cosmetic dentist can help:(1) CPAP (2) Pillar procedure (3) Surgical excision. While a dentist can perform the Pillar procedure and an oral surgeon can excise excessive tissue - CPAP is outside dental licensure. There are also few, if any, cosmetic dentists who will undertake surgery on the soft palate or pharyngeal area.

The article is bogus but potential patients are able to read this.

The article goes on to state:

However, not every kind of treatment can be good for every patient. If your neighbor underwent surgery, for instance, you may be better off getting a CPAP machine. Make it a point to consult with your cosmetic dentist about suitable options before you go ahead with any kind of treatment.

Finally, choose the cosmetic dentist carefully and only after extensive research. Check out the reputation he (or she) has online prior discovering their attitude towards you during you initial in office examination. Additionally, make it a point to discuss the expenses before you decide to go ahead with the treatment. Procedures in cosmetic dentistry can be expensive, but will never burn a hole in your wallet. If a particular treatment package seems to be a little too expensive, ask for alternative options.

You are in luck if you live in or around Carrollton, TX. Cosmetic dentists here are some of the best in the entire state of Texas. Schedule an appointment with one of the reputable dentists in your area and those sleepless nights will soon be a thing of the past.

We've all got to become aware of what's going on in order to protect our patients and the field of dental sleep medicine.

Now here's something really scary about where dentistry is heading

On the web page of TheWealthyDentist.com ( a group whose name distresses me anyhow especially in an era of foreclosures and unemployment) there's a survey " Do you consider oral cancer screenings to be an important part of your job?"

The survey responses that are offered are:

Do you consider oral cancer screenings to be an important part of your job?
Yes! This is an essential role for dentists.
I offer screening, but other services I offer are more important to me.
No, oral cancer screening is not a regular part of the dental care I offer.

This scares me on several levels.

First, even asking the question whose answer should obviously be "yes" indicates that even performing a screening as basic to a patient's well-being as an oral cancer screen is open to question in today's dental environment is a sign of a declining professionalism.

Second, use of the word "job" rather than "profession" connotes a lowering opinion of dentists themselves as part of a health care team.

Finally, if oral cancer screening is open to question what chance do we have to convince dentists to perform the very essential screening for sleep apnea?

For years, I have fought a losing battle over the use of the terminology "doctors and dentists" rather than "physicians and dentists" since we are, or least used to be, doctors. The survey convinces me that I will never win this battle and that dentistry will continue to decline as a valuable profession in the minds of the public.

How sad!

The Borgias and Dental Sleep Medicine

There was a half page advertisement in today's New York Times Dining section. The ad read

MACY'S CULINARY CHEF TODD ENGLISH PREPARES AN ORIGINAL DISH INSPIRED BY THE SHOWTIME ORIGINAL SERIES THE BORGIAS!

Now correct me if I'm wrong but wasn't Lucretia the chick with the ring that flipped open to dispense poison? Is it really a good marketing ploy to prepare an original dish based on a family that chose poison as a signature statement?

What does this have to do with dental sleep medicine? Well, there's one company marketing dentists who provide oral appliance therapy for snoring and sleep apnea by using a boil-and-bite appliance that anyone can buy over-the-counter for $9.95 as a "trial" appliance.

Those of us in the field know full well that while these devices may reduce or eliminate snoring they are far from medically acceptable therapeutic devices for treating sleep apnea. And, in addition, may have a whole range of side effects including:

This is a temporary device; it is not intended for use for more than the time determined by the prescribing Provider or if complications occur. Some complications may include soreness in the teeth, soreness in the jaws, tooth damage, existing restoration damage, facial muscle and TMJ pain, TMJ dysfunction and temporary and/or permanent bite changes. These specified complications are not intended to include all possible complications that may occur. By agreeing to participate as a patient in the [name removed] program you are agreeing that you will not hold the prescribing Provider , [names removed] liable or responsible to you, to your spouse or to any other person for physical or emotional injury, or for monetary damages, in the event one or more complications occur as a result of your participating in the[name removed] program and your use of the non-custom anti-snoring dental device provided to you as part of your participation in the [name removed] program.

(Quotation from that company's disclaimer - name of company removed intentionally)

Is subjecting medically ill patients to a device that can actually cause harm not the same marketing concept as using the Borgias to promote an original recipe? Will an OTC device really be able to predict success or failure with a well-designed, custom appliance?

It's up to you, it's your practice...