An interview with Gy Yatros, DMD, and Richard Drake, DDS, ABDSM, by Payam Ataii, DMD, MBA

Dr. Ataii: Between the two of you, you have over 25 years of experience treating patients that suffer from snoring, upper airway resistance or sleep apnea conditions. What’s been your greatest take away from that journey so far?

Dr. Yatros: In the years of dedicating our time to these treatment modalities, our greatest take away is the positive impact on our patients’ lives in a way that no other aspect of dentistry can provide. Sure, a full mouth rehab or a new smile with eight veneers is a wonderful feeling. However, when treating sleep patients, it’s much more. We help restore marriages, save lives, give grandparents back to their grandchildren. It’s an amazing feeling and an awesome responsibility.

Dr. Drake: I would add that we have an obligation to our patients. As dentists, we are obligated to ensure the patient’s wellbeing. Since we have a front row seat to the airway at the very least all dentists should ensure their patients are screened and, when appropriate, tested for sleep disordered breathing (SDB). It’s unfortunate these simple but important tasks are not being performed more frequently.

Dr. Drake: We lecture dozens of times each year around the country and encounter the same thing. It’s alarming. When considering the published prevalence statistics, we see that approximately 20% of the adult population suffers from some degree of sleep disorders; whether it’s obstructive sleep apnea, RERAs, or periodic limb movement disorders. What other health care provider is in a better position to help identify these patients? I feel it should be our obligation as dentists, at the very least, to help identify these potential patients.

Dr. Yatros: Think about that. If you screened 100 of your adult patients today, at least 20 of them would be at risk of suffering from sleep disorders and warrant a diagnostic test.¹ Of those 20, according to the prevalence stats, approximately 14 of them would likely suffer from an obstructive airway and would benefit from a dental device. Dentists are regularly foregoing an opportunity to dramatically improve their patients’ quality of life while also missing an opportunity to add revenue to their practice. It’s really a win-win situation.

Dr. Drake: We think that this is a no-brainer. Gy and I talk about this frequently. We simply can’t understand why every dentist is not considering getting involved.

Dr. Ataii: When I speak with colleagues they express concerns about ‘not having the patients’ or they cite the hurdles inherent to sending patients to the sleep lab.

Dr. Drake: Here’s the issue I have with that. The process is actually not as diffcult as it may appear to be and when utilizing a proven system, practices will learn to incorporate this seamlessly into their practice. For instance, integrating a simple screening form into the practice’s standard intake paperwork will address the issue of ‘not having the patients.’ They are already there in the practice. It’s likely that no other health care provider is talking to them about the quality of their sleep and we have that opportunity. These screening forms help identify existing patients of record so we can begin a dialogue about the quality of their sleep and their degree of sleepiness.

Dr. Yatros: Agreed. The process is not that complex. It requires almost no time for the staff and even less time for the dentist. These days, when patients present with a risk of some sleeping disorder, ruling out sleep apnea or upper airway resistance is simple. Concerns regarding patients going to sleep labs and disappearing into the ‘CPAP black hole’ become a non-issue. When appropriate, a home sleep test is an excellent means to diagnose patients. There are different ways to do this but we opt to work with EZ Sleep because they are a dedicated home sleep testing company. They understand the needs of the dental practice, they are responsive, and the process is simple.

Dr. Drake: It should be noted that the regulatory and payer environments have changed so dramatically over the past 5 years regarding home sleep testing. Many payers now mandate that home tests are used over a sleep lab, except in certain circumstances. On that note, the use of oral devices to treat patients that suffer from sleep apnea or snoring has increased since the medical community has begun to understand the benefits that the dental practitioner offers in this arena. Even the CPAP manufacturing companies are recognizing this benefit – so much so, that the largest manufacturer of CPAP machines, ResMed, bought a dental lab and markets an oral appliance to treat sleep apnea.

Dr. Ataii: You bring up a good point Dr. Drake, this industry is evolving. More and more, patients and physicians alike are beginning to understand the benefits of oral devices when addressing sleep apnea. There seems to be more discussion in traditional media and trade journals about sleep disorders and the benefits of oral appliances. However, as a dental and medical community, we are not doing enough to identify patients that suffer from these conditions. Numbers are as high as 90% of the population that has a sleeping disorder remains undiagnosed.

Dr. Yatros: Exactly, that is why we educate practices to screen their entire adult population. Of those 100 patients, as we mentioned before, 20 – at minimum – will statistically have some sort of insuffcient sleep.

Dr. Drake: By screening every adult in your practice, you remove stereotypical assumptions about who may or may not have a condition. The truth is that you will not know until the patient is tested. That is the only definitive way to rule out a possible condition. But there are plenty of clues: snoring, high vaulted arches, scalloped tongues…

Dr. Yatros: Visually impaired airways, bruxism, and a whole sleuth of cranial-facial deficiencies. The point is not to assume that just because you see an obese patient in his 40s, that those are the only people your practice should screen.

Dr. Ataii: No. Everyone gets tested. And trust me, you will be surprised.