Helping dentists navigate the waters of dental sleep medicine
Among the clinicians, innovators, and scientists who help establish dental sleep medicine are the laboratory professionals who have stood with the clinicians from the first days. Christina LaJoie and her company Great Lakes Orthodontics have been there from the beginning.
When I reflect back over my 24 years since I began my career in dental sleep medicine, I had no idea how many people suffered from sleep-related disorders. I could have never envisioned the growth of or my involvement in this field. During the early years of my career, snoring was often considered just a nuisance to be dealt with. Today, we now know that snoring is a symptom of a potentially serious health problem. In fact, snoring and sleep-related disorders affect a significant percentage of the adult population.
My foray into the world of sleep began at Great Lakes Orthodontics, when a doctor named Harry Tepper approached the company with his snoring device, the Tepper Oral Proprioceptive Stimulator (TOPS). The year was 1989 and I was intrigued. At that time, the only snoring device on the market was an appliance called the Snore Guard. It wasn’t long before more sleep appliances were introduced. Dr. Peter George, an orthodontist, invented an appliance named the NAPA (Nocturnal Airway Patency Appliance), a single-positioned mandibular repositioner that is still being prescribed today. The hugely popular George Gauge™ was also developed. This device enables the clinician to have an actual recordable start position, without relying on the patient and the guess work to obtain the interincisal clearance between the upper and lower anteriors.
In 1994, orthodontist Dr. Alan Lowe, one of the most influential clinicians and sought-after authorities in the medical and dental field, took me under his wing. Dr. Lowe, Professor and Chair, Division of Orthodontics in the Department of Oral Health Sciences, University of British Columbia, Vancouver, Canada, had been involved in government funded cross-country clinical trials that bolstered the importance of the Klearway®, an adjustable mandibular device. Under his tutelage, I gained a wealth of knowledge that prepared me to educate dentists on how to get started helping their patients with sleep-disordered breathing.
More than two decades later, I now have the satisfying role of coordinating sleep physicians with dentists, further perpetuating the two specialties for the co-management of their patients. My goal is to spread the word about sleep, lecturing with key clinicians on oral appliance therapy and the procedures and suggested devices to enhance and raise the level of care in their practices. I also believe it is critical to stay involved with the Academy of Dental Sleep Medicine, the Associated Professional Sleep Society, the American Thoracic Society, and many study clubs. This presence in the sleep community has allowed dentists to familiarize themselves with our laboratory and sleep-related products.
So, how does a dentist get started treating sleep?
Frequently, a dentist will be prompted into treating sleep-disordered breathing by their sleep-deprived patients who are looking for help. Commercials about snoring and treatment devices have flooded the media and have driven consumers to seek relief from their dentists.
Today, Great Lakes has become the “go to” resource for thousands of dentists looking to get started treating sleep. Our team can provide guidance with: records, selecting the best appliances for their patients, insurance and Medicare information, patient maintenance, and what to observe as they titrate patients to their therapeutic position.
When a dentist contacts Great Lakes, we will first explain how the dentist and physician relationship works and what their role is. We will also provide patient and professional information, as well as educational resources. The American Academy of Dental Sleep Medicine (AADSM) offers essential/beginner courses twice a year and is an excellent place to hone skills and keep up to date on the latest trends. The AADSM (at this writing) is the only institution where a dentist can become board certified in dental sleep medicine.
The proper bite is critical
Once a patient has been has been medically evaluated and found to be a candidate for an oral appliance, it is then up to the dentist to choose the appropriate appliance based on what the patient presents dentally and anatomically. Great Lakes will work with the dentist to determine which appliance to prescribe. From a laboratory perspective, we also advise dentists on how to take the proper bite for their specific sleep appliance—a crucial step for successful treatment. Although dentists are familiar with bite registrations, if the bite is not in a protrusive and accurate alignment of the midlines, it will be an issue when receiving and seating the appliance. Natural deviations in the midline should also be noted. An improper bite can ultimately affect appliance durability. Also, vertical opening between the upper and lower incisors is key in the overall fit and efficacy of the appliance. We recommend the George Gauge as a highly effective tool in obtaining a precise record. Once we receive the bite registration and models, we will evaluate the case and consult with the dentist as needed.
Motivating the Patient
Treatment doesn’t stop once a patient is provided with a sleep appliance. Patient encouragement and education is important for treatment success. Dentists can explain which habits to adopt, for instance, sleeping on their side–or to avoid, such as refraining from alcohol or caffeine a few hours prior to bedtime. It is important to know about medications the patient is taking or other physical conditions, such as a deviated septum—variables that can affect the overall progress with the appliance.
Improving Quality of Life
It is truly an amazing feeling when I look around a room at an annual sleep meeting, and see all the doctors who are now helping their patients. To know that Great Lakes has and will continue to play an integral role in this evolution makes me proud. With the right guidance, it is easy to begin treating sleep-ordered breathing and improving the lives of thousands of patients.