Recently I received a call from a dentist I met at a national convention a year or so ago. He has been struggling trying to get his team on track delivering sleep apnea care in his dental office. He’s committed to providing care at the very highest level. As it turns out, he has a busy practice and a large team. He has completed several weekend training programs and owns a NOX-T3 home sleep testing device that he uses to titrate oral appliances. I suggested the following two-step process as a way to improve engagement with his team and improve the way he understands the sleep disordered breathing risk in his own practice.
Step One
I suggested that reception provide an Epworth Sleepiness Scale for every patient through the door for a period of one week. This is a survey of the practice so information should be anonymous at this point. At the end of the week, the questionnaires should be sorted into three groups, slight, moderate and high risk of dozing throughout the day. This will give an excellent snapshot of how much, if any, unmet sleep care there is in the dental practice.
The last time I did this we had almost 100 completed questionnaires total. Twenty-seven patients suggested that they were at high risk of dozing when they did not want to. This is a much higher rate than the risk of severe sleepiness in the general population, pointing to increased need for sleep therapy in that dental office.
In addition to evaluating the business opportunity, this technique will begin the process of starting team discussions around sleep apnea. In comparison to classroom learning, this kind of patient-centered needs analysis will bring the team together and start internal discussions around treatment and diagnostic options. This will give the dentist the opportunity to answer specific questions and help raise the educational bar for the team regarding sleep apnea.
I like this step because it is inexpensive and it gives the owner of the practice the ability to reset his messaging to his patients and staff.
Step Two
The second phase of the program requires that we shatter the concept that obstructive sleep apnea is only a disease of obese males. In fact, some of the worst sleep-disordered breathing patients I have seen are women and children with extremely narrow airways or who suffer from partial airway collapse resulting in snoring.
At the same time, we need to build confidence in the screening capabilities and communication skills of the dental team. This is the time to start using the NOX-T3 or similar full-featured type 3 device to test everyone in the practice as well friends and family. This is a noninvasive test with a cost of about $10 per patient, so this kind of testing is a great training tool that pays huge dividends in helping the dental team gain confidence. The NOX-T3 is intended to test patients from 2 years of age to adult which makes it ideal for use in a family dental practice.
The dental office tends to treat patients who are otherwise healthy and may not understand that their snoring or daytime sleepiness can be putting them at risk of diabetes, stroke and car accidents. Pediatric patients can be put at risk of poor school performance and behavioral issues. The key to all of this is an informed and aware dental team prepared to engage in discussions that on their face do not appear to have a place in the dental office.
It can be hard to launch a new program in a working practice. It is particularly difficult if new office practices, patient messaging and clinical techniques are required. Sleep apnea therapy in a dental office can be very rewarding. The ability of a practice to deliver on its goals requires training, focus and most importantly, a clear understanding of what success looks like. This reboot does all of these things and in this case, there was no additional investment to achieve the goal.
Randy Clare is Senior Sleep Therapy Brand Manager at Glidewell Dental Lab based in Newport Beach, California. He has been involved with the development and distribution of sleep therapy products including Mandibular advancement devices, CPAP supplies and sleep diagnostic devices for over 20 years. He can be reached at randy.clare@glidewelldental.com for more information, follow thesleepandrespiratoryscholar.com.
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