• One out of every 5 patients that enter your dental office has undiagnosed and/or untreated Sleep Apnea.  If left untreated the patient is at risk of developing High Blood Pressure, Heart Attack, Diabetes, increase in Mortality and any number of other associated co-morbidities.
     
  • Sleep Bruxism and Sleep Apnea are associated conditions. With an ABi Index™ the clinician can measure that relationship. 
     
  • Under regular circumstances, a person’s teeth make contact for about 20 minutes a day with only 20 to forty pounds of pressure enabling the ability to chew.  With sleep bruxism, the higher and lower teeth come into direct contact in as many as 40 minutes per hour, and with a force of about 250 pounds on the primary molar.  Sleep Bruxism is the third most common sleep problem after sleep talking and snoring.  
     
  • It is estimated that 8-10% of Americans suffer from Sleep Bruxism
     
  • There are three types of sleep apnea; central, obstructive (OSA) and mixed apnea (combination of central and OSA). 
     
  • There are three severities of OSA, mild, moderate and severe.  Oral Appliance therapy is only indicated to treat mild to moderate OSA.
     
  • Central apnea results from delay in the transmission of signals from the brain telling the body to breath.  This can be a very serious condition.  The only way to diagnose central apnea is to accurately detect the absence of patient effort when flow at the mouth ceases.  DDME Online’s HST deploys the same technology used in medical sleep labs to measure patient effort.  This technology consists of two bands, one on the chest and one on the abdomen. These bands are so accurate thoracic volume change can be measured and an accurate flow signal at the mouth can be recreated. This saves the dentist from redoing HST time after time, a common issue with many HST monitors (a common quality problem of HST is loss of the flow sensor because many patients during sleep do not tolerate sensors at the mouth).
     
  • AASM guidelines governing the use of oral appliances state (entire guidelines on side web link) “Diagnosis 3.1.1 The presence or absence of OSA………… The severity of sleep related respiratory problems must be established in order to make an appropriate treatment decision”.    
     
  • DDME Online’s believes the dental community should use state of the art sleep lab technology insuring the dentist’s compliance with these guidelines and that all apneas (central, OSA and mixed) related to respiratory problems are diagnosed prior to Oral Appliance Therapy.  Most HST monitors used in the dental practice today cannot differentiate the various types of apnea with sleep lab precision.
     
  • DDME Online is concerned about the dentist who applies an oral appliance based on a diagnosis from an HST that cannot differentiate mixed apnea from OSA.  After applying oral appliance therapy and eliminating snoring, the dentist might have masked the only visible symptom of apnea and left the patient untreated for central apnea which could have serious outcomes.  
     
  • DDME Online’s HST uses EMG signals from the jaw to measure Sleep Bruxism.  Again, this is the same technology used in the sleep lab.  This is the only objective way of measuring Bruxism and if the test is performed early, onset of bruxism can be diagnosed
     
  • Screening for patients that have sleep bruxism and OSA is easy.  The use of the Epworth sleepiness scale is a validated screening tool selecting those patients that should have a HST performed.  A standard dental practice can predict that one patient a day will have undiagnosed OSA and one patient every two days will have undiagnosed bruxism. 
     
  • There is some confusion in the market as to whether a dentist can order and be reimbursed for a test to determine Sleep Apnea.  Issues of Scope of Practice can cloud reimbursement claims to Medicare and third party payers.  The reimbursement practices can vary region by region within a specific payer.  This can give pause to the dental practitioner relating to their desire to treat patients with oral appliance therapy even though medical guidelines clearly state oral appliance therapy is appropriate for the mild to moderate OSA patient.  Furthermore, with a 30% compliance with patients using nCPAP after 90 days of treatment and a 70% compliance with oral appliance therapy, it could be argued that oral appliance therapy should be the treatment of choice. 
  • The diagnosis of Sleep Bruxism is well within the Scope of Practice of the Dentist and treating Bruxism is important to the dentist.  Any dentist can order and get reimbursed for a Nocturnal Bruxism Study.  With a DDME partnership, the dental practitioner receives a diagnosis from a Board Certified Sleep Physician indicating whether or not both Bruxism and Sleep Apnea are present.  With that diagnosis, the dental practitioner has the information to appropriately treat the patient and receive reimbursement for the treatment. 
  • With DDME Online, the dental practitioner, staying within The Scope of Practice and following Medical Guidelines, can confidently obtain the diagnosis of Bruxism and Sleep Apnea, enabling the treatment of the appropriate patients with oral appliance therapy.

SUMMARY 

  • A typical dental practice has 5 undiagnosed mild OSA patients and 2 undiagnosed sleep bruxism patients every week that should be treated by the dental practice.  Treatment for both is reimbursable.  
  • With a DDME Partnership, the dentist is supplied an HST that can diagnose both mild sleep OSA and bruxism but also safely identifies all other types of apnea that should be referred to a sleep lab.  The dentist receives a comprehensive diagnosis from a Board Certified Physician with clear appropriate treatment options.
     

If the practice aggressively screens  their patients that are at high risk for untreated sleep apnea, early onset of sleep bruxism can be determined and those patients might never develop sleep bruxism symptoms