3. Sleep-disordered breathing: It’s not just a medical problem
Sleep-disordered breathing: tion that results in maximum patient comfort and efficacy. To learn more, I highly recommend attending the Den-
It’s not just a medical problem It passively allows the tongue to assume a forward posi-
tion conducive to better airway patency.
Sleep dentistry is professionally gratifying and may
tal Sleep Medicine Seminars by Dr. Allen Moses at Wil-
lis Tower (formerly known as Sears Tower) in Chicago.
Dates are August 26-28 and November 11-13. For more
by Dr. John T. Herald be financially rewarding. However, one must always re- information about The Moses or Dr. Moses’ seminars
member that we are treating a potentially deadly medi- visit www.themoses.com or contact Ashley Truitt, Direc-
THE HOTTEST TOPIC IN DENTISTRY at the moment contraction. Clenching of the muscles of mastication po- cal disorder, which happens to have a dental alternative tor of Dental Sleep Medicine for The Moses at ashley@
is Oral Appliance Therapy (OAT) for sleep apnea and tentiates the pharyngeal dilator muscles to help open the therapy. You will be held to the usual medical standard, moderndentalusa.com and (940) 395-4555.
primary snoring. The treatment of sleep apnea is para- non-patent airway. Tremendous forces are placed on the not the dental standard. Diagnosis is paramount. Always
mount to our nation’s health, especially due to its relation- teeth to facilitate this open airway. These forces may be have a diagnosis prior to treatment and verify objectively John T. Herald, D.D.S. lectures nationally and internationally
ship to hypertension, hyperlipidemia elevated A1C (insulin responsible for non-traumatic TMD, loosening of teeth, your results. There is never any excuse for not obtaining a about sleep-related pain and neuromuscular dysfunction. Dr.
resistance), and obesity. Hundreds of research articles year- fracturing of cusps, abfractions, and abnormal wear. The home sleep test that is read and interpreted by a qualified Herald has used oral appliances to treat sleep
ly detail the millions of dollars, if not billions, that could be body will enlist whatever mechanism available to survive. sleep specialist, or referring a patient for a polysomno- disturbances and related dental and medical
saved by the successful treatment of this disorder. It has been my experience that many dental problems and gram (PSG) overnight sleep study. problems since 1982. Dr. Herald is a found-
There are many oral appliance designs FDA cleared restorative failures often occur due to Sleep Disordered Many physicians feel that the dentist is the vanguard ing member of the Academy of Clinical Sleep
for the treatment of snoring and obstructive sleep apnea. Breathing (SDB). for diagnosis and treatment of this disorder. If you’re in- Disorders Disciplines and is also a Member of the
A key attribute to the design of a successful oral appliance Thousands of years ago, man developed the ability to terested, get in the game but know the rules. Your team American Academy of Dental Sleep Medicine.
is allowing maximum intraoral space for tongue posture speak. Residual components of our past still exist. For will also play a large part in the successful implementation Dr. Herald graduated from Case Western
and position, which includes a vertical and protrusive ele- the first 18 to 24 months, babies can breathe and swallow of Dental Sleep Medicine into your practice. I encourage Reserve University and is a member of the American Dental
ment. simultaneously. Afterwards, the uvula migrates cervically you to educate and involve your team as much as possible. Association and Ohio Dental Association.
In Phase 2 sleep, which makes up about 50 percent of and the epiglottis caudally. That short distance becomes
the normal sleep cycle, the brain turns off the highest a collapsible tube where most of our vowel sounds are
functioning recognition because the brain needs its rest. formed. It also is non-cartilaginous and prone to collapse.
Only essential body functions, heart rate, oxygen satura- Our body also provides us with several “hard wired”
tion, CO2 monitoring and other functions generally as- neuromuscular reflexes, the most important being the
sociated with the autonomic nervous system are vigilant. jaw-tongue reflex. Opening the jaw several millimeters
During a partial or full collapse of the airway, the body allows the tongue to reflexively reposition anteriorly. Tak-
produces large amounts of adrenalin to facilitate muscle ing advantage of this reflex is the single-most important
mechanism available to those who treat SDB with OAT.
The tongue is a hydrostat (mostly muscle and water)
that can change form but not mass. If given the oppor-
tunity, the tongue much prefers to be in the oral cavity
and not in the throat. Successful OAT requires that there
be maximum space for the tongue to move forward and
upwards. The key is providing room for the tongue to
reflexively move more forward than the mandible.
The newest and most
unique appliance on the
market that takes ad-
vantage of these reflexes
is The Moses™ device
(right), which perhaps
has the most tongue
space of all. It is designed
to be low-profile lingual- ®
ly, providing adequate
room intraorally, is ti-
tratable (adjustable) and
About the MediByte (above): Dentists can obtain top-down treatment
control of sleep dentistry by combining The Moses with the MediByte allows for full lip seal to
from BRAEBON. The MediByte is a convenient, accurate, and comfortable facilitate nasal breathing.
home sleep test device for patients suffering from snoring and/or sleep Oral appliances provide an exoskeleton to support pro-
apnea. Patients are sent home with the MediByte, they then conduct an trusion and vertical opening, thereby maximizing tongue
overnight home sleep test. Home Sleep Delivered then has one of its board-
certified sleep doctors interpret the results and posture and position. The innovative open anterior de-
send it back to dentists in days. sign of The Moses accommodates a forward tongue posi- DIQSam12h_Dntl_110331 1 3/31/11 2:47 PM
July 2011 | www.dentistryiq.com www.dentistryiq.com | July 2011
5. Sleep apnea and the search for a solution through
dental-medical collaboration
I have had a personal experience with sleep apnea. My fa-
by Larry Twersky
materials that promote sleep apnea treatment such as OAT.
ther was an undiagnosed sufferer. Growing up, I remem- Regarding the educational opportunities he and his staff
ber him coming home from work and going straight to the have taken advantage of with 1-800-Snoring, Dr. Steven
couch to sleep instead of playing with my siblings and me. Greenman, in Westlake Village, Calif., says, “Once my team
Not having quality time every day is hard on a family. I def- and I learned how to identify and talk to the people coming
initely feel as though I missed out on having a stronger re- into the office with snoring and OSA problems, I have begun
lationship with my father because of this condition. Tooth to see dramatic results in both the lives and marriages of the
issues, such as decay, affect only one person, but snoring patients I am helping and the profitability of my practice.”
and sleep apnea affect entire families. Besides health conse- Dr. Eric Johnson, in Torrance, Calif., says, “1-800-Snoring
quences, these conditions can damage marriages, relation- is the best marketing investment we’ve made to date! We’ve
ships, and work performance. My goal is to educate people used many other mediums such as newspaper, health expos,
about sleep apnea and the options available to get help. Internet, but nothing has worked as quickly and as effectively
There are four ways to solve a sleep apnea problem: lose in bringing us new patients as 1-800-Snoring. No doubt about
weight, CPAP therapy, surgery, and oral appliance therapy it ... the business model works ... the experts at 1-800-Snoring
(OAT). For those whose apnea is not weight-related, that really know what they’re doing in terms of targeting our au-
leaves CPAP therapy, which many find to be intolerable, or dience and bringing us qualified patients. And, the additional
surgery, which is painful and only 50% effective. Unfortu- staff education and coaching is above and beyond!”
nately, most ENT specialists and cardiologists are unfamiliar As of today, 77% of those suffering from OSA are un-
with the success of OAT in treating sleep apnea; therefore, diagnosed. To put that number into perspective, 18,000 of
they only recommend CPAP, leaving many patients without the people who attended this year’s Indy 500 have undiag-
a choice. This is why both the general public and the medi- nosed OSA. That is a staggering number. This condition
cal community need to know that oral appliance therapy is can lead to fatal health issues such as high blood pressure,
FDA-approved and has been proven to be highly effective heart failure, stroke, and diabetes.
in cases of mild to moderate and certain cases of severe ob- Many patients don’t think their snoring or sleep apnea
structive sleep apnea (OSA). OAT is the only therapy offered problem is their problem. Treating snoring and sleep apnea
— other than surgery — when CPAP cannot be tolerated. is markedly different than performing standard dental care.
In the beginning, 1-800-Snoring was established with- In “regular” dentistry, patients call because they are in pain or
in the 1-800-DENTIST company to inform people that don’t like something about their teeth. With OSA, patients
OSA is a dangerous disease both physically and emotion- commonly call in because a spouse or significant other is
ally. The company has three distinct goals: bugging them ... because someone else is having a problem.
• To provide patients suffering from sleep apnea access We have to talk to patients who suffer from sleep apnea in
to effective, compassionate, and noninvasive treatment a way that makes them understand that the condition is not
from highly qualified dental sleep medicine providers just annoying to the spouse, but it’s a potentially fatal condi-
• To provide members with the marketing, education, tion — all without scaring them off. My team and I resolved
and support they need to be quality doctors to whom we this issue by adding a more personal touch to how we take
would want to send our friends and family for treatment phone calls. Our operators ask questions about the patient,
• To offer a cooperative marketing program so members find out the nature of his or her condition, and then refer the
can benefit from the full potential of our advertisements in patient to a provider who would be the best fit. By the end
their geographic areas of these types of calls — without dispensing medical advice,
Sleep apnea is a big picture condition, so we search for yet educating them about their condition and assuring them
doctors who are capable of seeing the whole issue and who regarding treatment options — patients will understand that
are willing to work with the medical community to provide a snoring and sleep apnea are dangerous, and that they are do-
total solution. We offer training and educational opportuni- ing the right thing by getting help.
ties for our members both in-person and over the Web. Our I have always found that when you do things exception-
range of continuing-education topics help members of the ally and for the right reason, the rewards are the greatest
dental and medical communities set up their practices to ac- and success comes in abundance. Today, it is about getting
commodate snoring and sleep apnea patients, recognize the things exceptionally right.
signs of these conditions in existing patients, and even how
to do medical billing. Every member of 1-800-Snoring pays Larry Twersky is the former president of 1-800-Dentist and the cur-
a monthly fee. We use that money to run ads and send out rent CEO and founder of 1-800-SleepMed and 1-800-Snoring.
July 2011 | www.dentistryiq.com