Table of Contents
Upcoming Course
Upcoming Event Presented by Dr. Jamison Spencer: “Dental Sleep Medicine Done the Right Way” – Boise,
Idaho September 10-12
Learn to work with medical doctors and medical insurance companies. Learn how to treat potential TMJ side-effects. Bring your staff too. Space is limited!
To register for this course, please call 208-376-3600 today! For more information, visit:
http://www.jamisonspencer.com/boise-course.html[
Dr. Jamison Spencer
Treating sleepy patients often brings us those who have jaw discomfort to go along with disordered breathing. Having an ability to address both problems together is key to success. This magazine seeks to bring knowledge closer to you and no educator meets this challenge better than Jamison Spencer. You may have experienced one of his practical, informative lectures; Dental Sleep Practice brings you even more you may not know.
Did you always see yourself as a teacher?
I have taught in various capacities for years. I have always enjoyed public speaking (and have never understood why most people would rather have a root canal without anesthetic than speak in public–literally). In dental school I worked as a tutor for junior high and high school students in math and science. After dental school I developed a head and neck anatomy program, using the cadavers that were being used in the Kinesiology department, for pre-med and pre-dental students at Boise State University (winners of the 2014 Fiesta Bowl). During that time, I also started lecturing to other dentists on the topics of anatomy, TMD, and sleep apnea. I spoke at dental offices, free public community education courses, support groups, and anywhere else that I could. If I’m a good speaker it’s because I’ve worked at it A LOT over the years.
Your teaching style is unique – it seems you put as much emphasis on being entertaining as you do on the data. Is this intentional or just your nature?
I’ve been a bit of a jokester with a quick wit since I was a child. I’ve always enjoyed making people laugh. I personally HATE boring lectures. I try to mix in humor along with the art and science of what we are doing. I am passionate about helping dentists and others learn more about obstructive sleep apnea and TMJ disorders. There are too many boring lectures on these topics, so I try to be a little different. I’m sure my style isn’t for everyone, but I personally learn better from teachers that are engaging and funny, so I try to emulate this in my teaching style. Also, I’m probably not smart enough to fill my lectures with all sorts of scientific references and actually understand what they mean…so I just keep it simple and try to make it enjoyable.
Your training is in TMD and sleep – how do you see these two areas of health care interrelating?
I took over a practice limited to TMD right out of dental school. Crazy, I know! My mentor had never treated sleep apnea…at least not intentionally. I became involved with sleep early on, but for many years separated the two fields. I either saw a patient for TMD or a patient for sleep apnea. About 10 years ago I finally made the connection that TMD and sleep were often related, and sometimes causally related with the sleep apnea driving the jaw pain and dysfunction. After I purchased my cone beam CT machine my eyes were further opened as I started to be able to evaluate the airway as part of my regular examination. I have definitely come to believe that one cannot really understand TMD/craniofacial pain without understanding sleep, and that one cannot be completely comfortable treating sleep apnea without understanding TMD/craniofacial pain.
When a patient seeks your care with both sleep and pain complaints, how do you go about beginning to help them? What comes first?
Obviously if the patient is in acute pain we will address that first. An accurate diagnosis is the most critical component to develop any TMD/craniofacial pain treatment plan. While that may seem like a ridiculously obvious statement, I find that most dentists either have no idea what is going on with the patient’s jaw, or what they think is going on is actually wrong (and often times the opposite of what is really happening). Once you are comfortable with your tentative diagnosis, then the next step is to consider the etiology of the condition. If the jaw pain was caused by being hit in the jaw playing basketball, the patient’s sleep apnea most likely is not directly contributing to the current issue. On the other hand, if the patient has more of a chronic issue, has wear patterns on the teeth consistent with grinding or clenching, has scalloping on the borders of the tongue, temporal headaches and/or temporal tendonitis, or other specific signs and symptoms that are consistent with sleep apnea possibly being an etiology of the jaw problem, then we refer for a sleep evaluation…and HOPE that the patient has sleep apnea. If they do, we treat the sleep apnea (CPAP or oral appliance) and hope that their jaw problem improves. Our experience has been that in specific cases where all these things line up, the patient’s jaw discomfort improving with sleep apnea therapy is very common. Of course there are certain things, like internal derangements for example, that may need to be addressed in addition to sleep therapy.
So in an over simplified nutshell, if we believe that the patient’s TMJ problem (this term, of course, being an over simplification itself) is likely related to an underlying obstructive sleep apnea issue, we refer the patient for evaluation. Depending on their level of pain, in these cases we may perform or recommend palliative therapies while we dial in the diagnosis. From a very practical view point, sometimes we address the sleep apnea first because sleep apnea therapy tends to be covered by the patient’s medical insurance, where therapy and treatment of TMJ problems, at least where I practice, are only rarely covered. When a patient has sleep apnea and we treat them for it, causing an improvement in their TMJ problem, we find it to be a more financially conservative option for the patient…which most people appreciate.
Who has inspired you?
I have been inspired by a lot of people. I’ve had the privilege of getting involved in this field right out of dental school, so I tend to be a bit younger than most of my colleagues. I have stood on the shoulders of giants, starting with my mentor Dr. Ed Matthes. He went through all of the “TMJ battles” of the 70’s and 80’s and I was able to learn from his experience, which compressed decades of learning into days. I have changed my practice paradigm several times, which I attribute to actually applying the things that I have learned along the way. I am a firm believer that there is a huge difference between having 20 years of experience and 1 year of experience that you’ve repeated for 19 years! My practice has changed dramatically from when I first started, always aiming to improve the care that we provide for our patients and make this care more affordable at the same time. My father taught me through his example to always try to help people and be of service. My profession is how I put food on the table, but it’s also my passion to help people and to inspire others to do the same. On an ongoing basis I am inspired by my wife Jennifer and our 6 children.
One thing many people may not know is that you’re an inventor of a mandibular positioning device. How did this happen?
I was working with a company out of California that was helping sleep labs. The owner of this company was from the Philippines. He asked me one day if I had any “inexpensive” options for treating people with oral appliances, because people in the Philippines couldn’t typically afford CPAP or custom oral appliances. I talked to him about the various “boil and bite” appliances that were on the market at the time, but gave him my concerns with these types of appliances. I realized that what I felt was a good, inexpensive, customizable oral appliance option didn’t really exist…so I created one. The Easy Airway, originally called the Silent Sleep, was the result of my attempt to come up with an easy to fit, comfortable, inexpensive, long lasting, non-custom oral appliance that didn’t have the disadvantages I felt the boil and bite appliances had. It was the first device to be fit with a VPS material (GC Reline) rather than a thermoplastic material. Today, for the North American market, I feel that the Easy Airway is just another tool to have in your oral appliance therapy toolbox. However, in areas where patients cannot afford custom fabricated appliances, it provides a needed option.
People who have success at practice, at manufacturing, at education and now at inspiring a whole network of clinics must have deep-seated motivations and a sense of lack of limitations on ability to make an impact. How would you describe that for you?
As I mentioned above, Jenni and I have 6 children. Most people looking at my travel schedule will wonder how we ever had time to have 6 kids! When I lecture I always start out by showing a picture of my family. I do this partly because I’m proud of them, but also to remind myself and impress upon others why I am there. Now you’re probably thinking, “if you have six kids you’re obviously on the road lecturing to get away from home and get some peace and quiet!” But you’d be wrong. I teach, coach, consult and try to inspire others to help more and more patients because I hate the thought of people not getting the care they need. I can only treat so many people myself. I can only pick up on an undiagnosed sleep apnea case in the patients that I see. But if I can spark others to evaluate and diagnose, or participate in the diagnosis and management, of a sleep or TMJ problem my reach is extended to thousands of patients. Over time this will become tens of thousands. With other projects I’m working on this may be extended to even hundreds of thousands or millions. That is what drives me. It’s not a matter of motivation or about me, really; it’s a matter of principle and values.
Please tell us what you think about the future of DSM.
I believe the future of Dental Sleep Medicine is extremely bright…unless we screw it up ourselves. Insurance companies are going to drive more patients toward home sleep testing. Auto-set PAP machines will be used more regularly. This is great as it will likely increase the number of patients being evaluated and treated, and will decrease the expense to do so. However, a natural side effect of this will be more people failing PAP therapies, or being in a position were an oral appliance is the logical first line of therapy. Americans are not getting any thinner…and the rest of the world is following our greasy fingered lead. Sleep apnea is not going to go away; it’s not going to be treated with a pill; and surgeries will only be for a select group of patients. Oral appliance therapy is a logical and efficacious treatment option for many patients. As we become more involved in working with “the medical model” we will also gain the respect of our medical colleagues and learn the needed skills to play the game by the rules that the insurance companies and government have set up. This is the huge advantage that the DME companies have that sell CPAP…they know the rules and have played the game for a long time. We are novices.
The danger lies in us and our sometimes overzealous colleagues inadvertently (or, unfortunately, sometimes on purpose) not playing by the rules and by extension giving every dentist a bad name. I recently had a conversation with a nurse reviewer at a major insurance company about some claims that she had seen. She asked me about a company that mails the patient material to take their own impressions, send them back to the company who then makes them a custom appliance and mails it back for the patient to fit themselves. Imagine this nurse thinking this kind of garbage was what many dentists did! Luckily, she was smart enough to realize that this company is not treating patients at the standard of care that should be expected. I believe that all of us owe it to our patients, our colleagues and our communities to inspire others to do their best work. We should become colleagues with the insurance companies and help them to recognize that oral appliance therapy is an excellent option that can be delivered affordably and with predictable results. We are all in this together, and we should strive for excellence and treat everyone like we would treat our own family.
I believe that someday sleep testing will be part of a regular physical and workup for adults, along with a physical exam, taking blood pressure, blood tests and urinalysis. To receive a home sleep study as a screening exam, starting young, will just be the normal thing to do. Those found to have mild to moderate OSA will be offered an oral appliance or PAP therapy. I hope for a day in the near future where sleep and airway issues are routinely evaluated by the primary care doctors. In the meantime, we dentists are ideally positioned to help in the screening, evaluation and management of adults and children with sleep apnea. These people come in to our offices every day, and it is our responsibility to educate and guide them toward accurate diagnosis and effective management. For children, especially – identifying compromised airways that we as dentists can help grow to normal size – how cool is that? Can you imagine how much money we would save in the US if we were able to diagnosis and treat OSA BEFORE all of the comorbidities developed or worsened! Treating sleep is one of the most cost effective treatments available, with almost no side effects or morbidity.
So what’s current for you?
After coaching dentists for years and leading the Tufts/AACP DSM Mini Residency, I met a North Carolina dentist who owns a large group practice. Dr. Lane wanted to add DSM services but had not found the right match. After meeting him and his team I offered to teach a few of the dentists and consult from a distance. They wanted me full time – which meant moving from Idaho! I eventually agreed to visit every other week for “a few months.” Quickly I realized there was a huge opportunity to do something exceptional. My family wasn’t too happy with me being gone so much so we decided as a family to move to Raleigh. My practice in Boise is in good hands and I spend most of my time now helping the awesome dentists and over 400 staff members of Lane and Associates Family Dentistry. They are literally saving lives and I’m having a blast. My life is blessed and I’m grateful every day.
Upcoming Course
Upcoming Event Presented by Dr. Jamison Spencer: “Dental Sleep Medicine Done the Right Way”
– Boise, Idaho September 10-12
Learn to work with medical doctors and medical insurance companies. Learn how to treat potential TMJ side-effects. Bring your staff too. Space is limited!
To register for this course, please call 208-376-3600 today!
For more information, visit: http://www.jamisonspencer.com/boise-course.html
