Book Review

by Pat Mc Bride, MA, RDA, CCSH

The Clinicians Handbook for Dental Sleep Medicine
by Ken Berley, DDS, JD, DABDSM, and Steve Carstensen, DDS, DABDSM

Clinician’s HandbookAs a practitioner who has been “doing” and involved in dental sleep medicine for more than twenty years I have been waiting a very long time for a publication specific to the dental sleep medicine practitioner. Read cover to cover in one cross country flight – I literally could not put it down – The Clinicians Handbook for Dental Sleep Medicine will in this author’s opinion be hailed as the seminal text on the subject for decades to come. Did I wait impatiently for this book? You bet ya! Is there something in here for everyone, even the folks who have been “into” dental sleep medicine for donkey years and think they have it dialed in? Yes, without a doubt! No one who reads this book will walk away without garnering invaluable and priceless nuggets for their practice and their patients who suffer from any myriad of breathing disordered sleep conditions. Of special note, this book is loaded with excellent illustrations and provides a large number of citations for additional reading and further education while paying homage to giants in the field such as John Remmers, MD, and Keith Thornton, DDS, along the way.

If we conservatively estimate the numbers of affected people with IFL, UARS, and OSA to be 20+ million, practitioners are facing a pandemic, especially when the “gold standard” of therapy CPAP has a documented longitudinal compliance rate of anywhere from 25-50%. Truth be told, it’s more like 25% tops. As the fastest growing discipline in dentistry, dental sleep medicine offers the dental practitioner the opportunity to ethically screen and treat patients with alternate and adjunctive therapies such as oral appliances (OAT) that will drastically improve overall health trajectories for patients while adding significantly to the source of income for the dental practice.

The book is thoughtfully laid out with an introductory overview of sleep and sleep disorders providing a sound foundation for each incremental step up the ladder through protocols, implementation and practice while offering solid “how to” guidance every step along the way. It closes with frank discussions regarding legal, ethical and policy issues and pulls back the curtain on a subject close to all of our hearts, pediatric sleep and breathing disorders.

Refreshing and engaging in it’s Marcus Welbyish presentation, this book packs a wallop when it comes to presenting the reality of how wading in at the shallow end without a full understanding of the depth of the pool can undermine even the best intentioned DSM providers. Yogi Berra’s quote, “If you don’t know where you are going, you might end up somewhere else” could not be more applicable. Interdisciplinary cooperation in developing relationships with physicians and specialists whether they refer or not is instrumental and lies at the very heart of success for all parties concerned; especially since the dental sleep medicine practitioner cannot actually diagnose sleep disorders and cannot prescribe treatment for them.

Information on records taking, comprehensive examinations and staging therapy are critical and useful to those who may still be using outdated forms that inadequately document the full scope of a patient’s health status and individual issues. The examination process is outlined with a state-of-the-art precision medicine technique to aid the dentist in making better therapy decisions while mitigating complications and issues that may come up legally later. The EHR, no longer far away on the horizon, is explained in detail with sound caveat emptor advice regarding computer programs, billing systems, etc. to keep providers from falling into a financial pit when getting their program up to speed.

Practical matters such as treatment decision making and appliance selection are handled comprehensively, listing pros and cons of many temporary and permanent appliances without bias, as many providers really don’t understand why one appliance may be better for a patient than another. Fabrication, delivery, follow up,
compliance and complication issues are soundly outlined with emphasis on collaboration between dentist and medical providers to serve the patients’ best interests as treatment progresses.

Legal issues and policy statements are fully reviewed by Dr. Berley who gives sage advice coupled with a strong dose of what’s what in the current and future legal landscape of the profession. Some of this detailed information may be a real eye opener to many to folks who thought a turn key operation managed by others without MD involvement was strictly within the standard of care and practice guidelines. Many of the updated policies and insurance guidelines presented may find providers unaware. For example, the requirement that DME providers must carry an insurance Surety Bond as mandated by Medicare. Failure to have this in place could mean disaster for a practice that cares for many Medicare patients.

These 210 pages are not meant to be “blown” through. This is a Bible, go out and buy it, highlight sections and then make up your own action items. Dog ear pages or whatever works for you so that it becomes the hub of your wheel. Then, refer to it again and again as you raise the level of your craft and improve the lives of your patients. We’ve all waited for a long time for a solid, practical and well written guide for the dental sleep medicine practice. Now we have it. There are no more excuses not to get it right from here on out.

Besides publishing his Clinician’s Handbook for Dental Sleep Medicine, Dr. Carstensen is also the talented and knowledgeable Editor in Chief for Dental Sleep Practice. Read Publisher Lisa Moler’s thoughts and visions for the future of all of the MedMark publications here.

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