I RECENTLY MET A DENTIST at a mini-residency program about dental sleep
medicine. His practice was less than an hour’s drive from my office, so we decided
to stay in touch as we continued to study and understand what interested both of
us: the connections between airway, the value of sleep, keeping teeth in occlusion,
and what’s in the rest of the mouth.
From the occlusion viewpoint, we know there are times
that restorations fail even though we have followed all of the
guidelines for joint position and occlusal harmony. Patients
continue to brux, suffer from GERD, and have uncontrollable
tongues that wreak havoc on their teeth. A simple home
sleep test can now be used by dentists in most states to
evaluate a patient’s airway as part of the treatment plan. In
doing so, dentists are able to identify patients with sleep
disordered breathing, refer them to a physician for a diagnosis,
and sync the medical and dental plan for patient care.
The concept made sense; however, the dentist and I both
knew the top two reasons for failure when implementing
airway focus into the dental practice—getting the staff to
buy into the concept and mastering medical insurance billing.
To address the first one, we used the following guidelines
when we met with the dentist’s team.
Start at the beginning and share the basics—After six
days of intense training on airway issues during sleep, it was
easy for us to see how dentists could incorporate airway into
the current practice protocol. However, everything relating to
airway was new to the staff, and to them it seemed like the
dentist was starting a totally different business venture. Their
practice was already very busy, and they wondered where they
would find time for the new patients. We were starting with
current patients in the practice, so the goal was to develop a
protocol to address both dental and airway concerns.
Be ready for questions—The already-busy atmosphere
in the dental practice was very apparent as soon as I walked
in. Questions such as, “How are we going to handle all these
new patients?” and “Are we going to have to increase our office
exam time?” were asked before I could inquire about how
much the team already knew about sleep apnea dentistry.
Work together on the plan—To answer the staff ’s many
operational questions, we walked through the entire process
for how add airway screening could be added into their cur-
rent structure. We created a checklist for them to follow:
• Use a questionnaire to identify patients with potential
sleep disordered breathing.
• Review four signs and symptoms during the exam that
could be completed in two minutes.
• Test with a home sleep monitoring system, such as the
Nox T3 ( figure 1), unit for objective data.
• Create a referral process for partnering with the medical
• Understand how to charge for the new services.
Download a copy of this checklist from
Choose how many patients you want to start screening— While most dental offices screen patients for airway
claim to see at least one person a day who should have a follow-up airway study, the team can implement this additional
service at their own pace.
Be prepared for conflicts—We thought it would be a
great learning experience to have one or two staff members
use the Nox T3 home sleep monitoring system. When the
results revealed that one of the staff members had moderate
sleep apnea, it turned into our first encounter with patient
denial. This was good practice for additional education and
Appreciate team efforts—The respect between the
dentist and his team members has been very apparent
throughout this new learning process. It is important that the
dentist continues to show that he values the team’s efforts as
Keep your team breathing:
Screening for airway issues
Figure 1: Nox T3