Sleep Medicine’s Seismic Shift to Dentists – Are You Ready?
by Charles F. Collins, CEO – Airway Management
For years, many members of the dental sleep medicine community have been predicting that this segment of dentistry is poised for exponential growth. It’s right around the corner…
As the CEO of Airway Management, I’ve been fortunate to serve clinicians on the front line for the last 16 years. To effectively support the community, we constantly evaluate the big picture of dental sleep medicine and look for evidence of future growth and market direction. It involves thinking like a business, too. The Dallas Business Journal included Dr. Thornton’s original vision: “I am trying to develop a disease management approach that is more USER friendly, has more options for the patient and is much less expensive.”
There are several significant signs that indicate the Dental Sleep Medicine segment is in fact poised to become main stream. This will radically increase the number of patients treated with oral appliance therapy, good for my company but, far more importantly, good for our population health.
1. The current medical approach is not working.
Most professionals would agree that a huge percentage of our population is afflicted with some level of sleep disordered breathing. It has been reported that the CDC considers Sleep Apnea to be an epidemic. The numbers range from 25 – 40 million undiagnosed sleep apnea patients. The full sleep disordered breathing range, including snoring puts the number at close to 90 million, and that’s just in the United States.
Getting a patient diagnosed has changed from only clinic-based, overnight events to home-based, portable studies. They can still be difficult to access because of the need to see a physician with special training. These doctors are often scheduled for weeks ahead and, in many communities, very few in number.
Not only are people not getting diagnosed, but the most common treatment, utilizing a CPAP machine, has very poor compliance. It doesn’t really matter how good the treatment is if the patients don’t use it. A recent publication from Stanford stated: “Approximately 1% of all obstructive sleep apnea patients are receiving treatment at the present time.”
A diagnostic protocol that is expensive with numerous barriers has proven to be ineffective in diagnosing large numbers of patients. A treatment protocol that is expensive and difficult to achieve compliance is ineffective for the majority of patients that need help.
But, I think you already know that… What is new is the rapidly shifting mindset of a growing number of physicians, like Dr. Barbara Phillips, the president of the American College of Chest Physicians, who said “The diagnosis and management of sleep apnea to this point, has been, in my view, too complicated, too time consuming, too expensive, too patient unfriendly, too test-oriented and not nearly enough follow-up, chronic management, oriented.” Drs. David Gozal and Atul Malhotra, both past presidents of the American Thoracic Society, agree. Furthermore, Dr. David White, Chief Medical Officer at Respironics, Inc., said that “CPAP was not great to begin with and “there are great opportunities for new therapies”
2. The ADA recommends that all Dentists should screen patients for Sleep Disordered Breathing.
For the first time, the ADA has taken a leadership role to finding a new path. Enlisting the 150,000-strong army of Dentists in the fight against sleep apnea will absolutely improve health care in America. These dedicated professionals are perfectly suited to getting patients diagnosed and properly treated. If our health care system has any chance of helping the millions of patients breathe better at night, getting oxygen in the bloodstream and avoiding all the related medical conditions, we unequivocally need dentists in the lead.
Having the ADA support this cause will make a big difference. Pioneering Dentists can now count on a very large lobbying entity to change the political environment and support their membership in the quest to help their fellow citizen.
3. The FDA has cleared simple, low cost, oral appliances for over the counter sales.
In most countries, these appliances are already sold at pharmacies and online stores, without a required prescription. Because of the massive number of people afflicted with sleep disordered breathing, removing this regulation will allow people to become knowledgeable about oral appliance therapy.
We live in a capitalistic society and the invisible hand will guide investments to satisfy this enormous market. The entrepreneurial spirit will be unleashed to make sure everyone knows that advancing your mandible forward a few millimeters makes a big difference in your life expectancy.
This will eliminate one of the biggest obstacles to treating the population: Knowledge that oral appliance treatment exists and works. Don’t be fooled that cheap over the counter products will ruin the professional market. They actually support the professional market by doing the hard job of educating the general population. People can brush their teeth and floss on their own. But, they still go to the Dentist for professional cleaning and proper maintenance of dental health. And they will also go to the Dentist for professional sleep disordered breathing care.
4. Large multinational and Private Equity companies have recognized the opportunity.
In the last couple years, large multi-billion dollar organizations have decided to invest in this segment. Here’s a few examples:
- ResMed has operations in 72 countries. In 2009, it introduced the Narval oral appliance. Since then, they have invested tremendous sums of money to perfect and market the device. As the founder of CPAP and leader in the multi-billion-dollar market, it would appear that this investment would cannibalize their CPAP market and lower overall revenues. Unless they expect the oral appliance market to be much bigger than the CPAP market.
- In 2016, a large private equity fund named Health Point Capital sold MicroDental Laboratories. They spun out a new company from MicroDental just prior to selling, named ProSomnus Sleep Technologies. Selling a profitable, large dental laboratory and investing in a start-up oral appliance business would seem like a foolish move, unless they projected huge market opportunities in the oral appliance market.
- SomnoMed, a leader in the oral appliance segment, licensed a direct to consumer model. Frustrated that the oral appliance business is not reaching significant market share, they decided to go direct to the public. Employing their own medical and dental professionals in a DSO, they are investing significantly in the business-to-consumer model. Even at the risk of alienating their core clients by competing directly against them. Why would they make such a risky strategic move, unless they projected it would eventually increase their unit volume way beyond the established lab-to-professional model?
What does this mean for me?
As you contemplate the signs that the DSM world is changing, the next thought is, “What do I need to do to ready myself and my practice?” If the approximately 5,000 DSM dentists in the US treated the 90 million patients, each dentist would need to treat 18,000 patients. We need all hands on deck!
Fortunately, the cottage industry has grown since Dr. Thornton first introduced the TAP 1 in 1996. We now have very good companies to help Dentists learn about DSM and oral appliance therapy. This includes several trade groups that offer certificates and diplomas. We have companies that support dental practices with the necessary practice management techniques and tools.
We have excellent companies that help the dentist get paid for their services. We have great media organizations, like Dental Sleep Practice, to serve as a rally point for the industry and share the latest information.
The educational and practice management services are readily available to provide the skills and knowledge for any dentist to participate in this critical community medical service. Your friends, colleagues and neighbors need your help.
The treatment provided by Dentists most commonly involve oral appliances, referred to as Mandibular Advancement Devices (MAD). The FDA has cleared over 100 appliances to be used to treat obstructive sleep apnea. Although many appear to be similar, the choices can be a bit overwhelming. Mastering the delivery and adjustments for multiple devices can become an obstacle for the Clinician.
The investment to master the devices can be simplified by using the TAP system. Dr. Thornton’s TAP devices, the Thornton Adjustable Positioner, has proven to be a simple and effective tool. Here’s some of the reasons most DSM Dentists have chosen to use the TAP appliances every day.
• It works
Since 1996, the TAP devices have been used in over 36 peer reviewed studies. These studies compare the effectiveness of oral appliance therapy, many studies are compared to CPAP. For mild to moderate OSA, the TAP devices indisputably work. No other appliance has been studied to this level.
• It’s Simple
The single point of adjustment eliminates any concern about changing the midline that is a potential negative issue with all bi-lateral adjustment devices. Over-adjust one side and TMJ issues flare up.
• It can treat the widest range of Sleep Disordered Breathing
Snoring and Upper Airway Resistance – myTAP / dreamTAP
Mild to Moderate OSA – myTAP / dreamTAP
Severe OSA – dreamTAP + TAP PAP CS
• It has the most options and features – customize for any patient
15mm protrusion range – biggest in industry, by double.
– Establishing the initial protrusion is not crucial. It will always work.
Multiple tray systems
– TAP Classic – Urethane lined or ThermAcryl lined
– Many custom trays from lab partners
– Glidewell – 5 colors with Urethane lined trays
– National Dentex – Crystal Clear® Thermoplastic
– Great Lakes – Rhea® custom fit trays
All hardware made in the USA from Cr-Co alloy.
– The most bio-compatible alloy for the oral environment
10 mm of lateral excursion with no posterior obstructions
– Perfect for lateral bruxers – the majority of OSA patients.
Every case comes with a free AM Aligner
the industry standard to treat the most common side effect
• Work with your most trusted lab partner
The TAP appliance can be ordered from over 150 authorized dental labs in North America.
Work with the technicians you know and trust.
Our family company, Airway Management, has been around long enough to have developed a full suite of products that offer treatment at all levels of sleep disordered breathing and assist each patient in various life stages/diagnosis. Our lead product, the dreamTAP, is now the 5th generation of the TAP appliance. We continue to reinvest in research and development. You can expect more innovations from Airway Management.
For 2018, we are launching an online educational and training platform for how to use the TAP system and how to build TAP appliances. Always up to date and accessible from any device with a web: browser, desktops, laptops, tablets and phones.
• www.TAP.wiki is a free site that shows how to use the suite of products. Drill down quickly for specific topics like “how to change hooks”, “appliance design options” or “seating a ThermAcryl lined dreamTAP”.
There are over 30 guides, which can be downloaded and printed. Complete with lots of images, documents and videos.
Great for Dentists & staff, Lab representatives and technicians.
• www.TAPlab.wiki is a free site that has all our work instructions for dental laboratories.
This is for authorized TAP manufacturing partners only
Can only access via invitation from Airway Management.
Great for training, always up to date.
To my friends in the Dental Sleep Medicine business: Our time is nearly at hand. By offering increased treatment options that are far less invasive, we will get more people treating their SDB. Instead of 10% getting treatment with CPAP only, we can move the needle and make it 90% with oral appliances. Together we can make a significant contribution to our communities and improve the lives of millions of our neighbors.
As Anne Frank said: “How wonderful it is that nobody need wait a single moment before starting to improve the world.”
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