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Keys to Success in Sleep Dentistry

Managing snoring and obstructive sleep apnea is both a medical and dental discipline involving screening, diagnosis and treatment.

uncover the patients in need

Uncover the patients in need

There are 70 million undiagnosed OSA patients in USA.2,4 That means a screening process could uncover OSA risk in ~20% of your current patient base, many of whom will be candidates for OAT. Many more will be problem snorers looking for a professional solution.

Panthera Dental’s Patient Screening Assessment tool (coming soon) will help you identify those that snore and that are at risk of OSA, and determine their treatment pathway.

Potential candidates for OAT are:

  1. Patients who snore.
  2. Patients at risk of OSA and who, when tested, are diagnosed with mild or moderate OSA.
  3. Patients with severe OSA who are contraindicated for or can’t tolerate CPAP.

Note that insurers are likely to reimburse OAT for 2 and 3. But treatment for snoring will likely be paid for by the patient.

Test those at risk of OSA

Get patients at risk of OSA diagnosed

At risk patients must be diagnosed by a qualified sleep physician before they can be treated. They should be referred to a sleep clinic or sleep physician for adequate sleep testing. Suitable candidates can then be referred back to you for OAT.

Test OAT candidates

Treat OAT candidates

Those diagnosed as simple snorers, or as having mild or moderate OSA are potential candidates for OAT. Patients diagnosed with severe OSA should be treated by a physician but if they are contraindicated for CPAP or if they can’t tolerate it, they can be treated with OAT instead. Discover Panthera solutions.

Patients receiving OAT should be assessed periodically to check that the treatment is effective and to manage any dental side effects.

The Pillars of Success

Training

Every patient is unique, and a dentist needs access to a variety of mandibular advancement devices . Training is necessary to help navigate the complexities of SRDBs and dentistry. Typically, a national professional society can provide training, accreditation and CPD – see AADSM for the United States.
Panthera Dental also provides training courses – contact your local rep for details.

Training should cover patient screening and selection, referral and diagnosis, appliance selection and titration, billing and follow-up. Include support staff in the training to ensure the service works efficiently when put into practice.

Promotion

Use screening and patient information to start the conversation about snoring and OSA, for example with leaflets and posters in your office waiting room.

An engaging website is important to help build your brand and increase the visibility of your practice in search engines. Your site should:

  • Encourage patients to be educated about snoring and obstructive sleep apnea.
  • Promote the expertise and capabilities of your practice – patient testimonials and reviews can be compelling.
  • Include a clear call-to-action with an incentive to encourage new appointments and enquiries, for example a free consultation.
  • Include information about costs and payment options to ensure that prospective patients understand the affordability of diagnosis and treatment.

Multi-Disciplinary Teams

It is advantageous to build strong relationships with local sleep physicians or home sleep testing providers so that when at-risk patients are referred for testing, the MAD candidates are referred back for treatment. A sleep physician may also want to periodically check treatment outcomes for the patient.

As a medical condition, OSA treatment claims are filed through a patient’s medical insurance provider. It may be useful to set up ‘in-network’ with the same insurance plans as physicians.

Keep in touch with the physician throughout the patient journey. Be organized and efficient in communications, making sure that the patient’s progress is clear and documented for all parties.

Medical Billing in the USA

Medical billing involves working with two types of billing code: Procedure Codes (CPT) and corresponding Diagnostic Description Codes (ICDA9). Many dentists work with medical billing specialists to get this working smoothly. AADSM has published a Reimbursement Guide to help dentists navigate this process.

Many practitioners keep things simple initially, focusing on self-paying patients and then setting up reimbursement infrastructure over time.

A third-party financing program could be introduced as a way to help self-paying patients meet the costs – this can be preferable to credit card funding and benefits the practice by avoiding the risk and expense of billing and collections.

The Opportunity

The scale of the opportunity to improve lives with oral appliance therapy (OAT) is considerable:

80 million Americans

Nearly 80 million Americans have mild to severe OSA2 but only ~6 million (7.5%) have been diagnosed.4

CPAP non-compliant

50% of patients receiving CPAP treatment for OSA are non-compliant after 6 months and 83% are non-compliant after 5 years.5

Half of adults snore

Around half of adults snore, many of them habitually.1 Untreated snorers often develop OSA.

Untreated OSA

Untreated OSA causes daytime drowsiness and increases risk of high blood pressure, atrial fibrillation, heart failure, stroke and type 2 diabetes.3

Oral appliances opportunity

Oral appliances are a first-line treatment for snoring and mild to moderate OSA and a second-line treatment for severe OSA when CPAP is contraindicated or can’t be tolerated.8,9

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Sleep-disordered breathing (SDB) describe a group of disorders characterized by abnormalities of the respiratory pattern or ventilation during sleep.

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Sleep bruxism is a parafunction in which the masticatory muscle activates involuntarily during sleep. Sleep bruxism can be diagnosed in a number of ways.

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