The Four Pillars of DSM

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Each week, millions of Americans enter dental offices to get their teeth cleaned or a tooth filled, and unbeknownst to them they have a disease that is literally sucking the life out of them every night. In a previous issue of DSP, my Dental Sleep Solutions partner, Dr. Gy Yatros, referred to Dental Sleep Medicine (DSM) as a mosaic. I would like to use another analogy and highlight the importance of a strong foundation for each of the four pillars of our field. Unless you have a defined protocol in place for each of these, you are not likely to succeed at making DSM a more integral part of your practice. I’ll classify these pillars as:

  1. Screen
  2. Test
  3. Treat
  4. Insurance

Start Screening your patients today!

Are you screening your existing patient population for Sleep Disordered Breathing (SDB)? Once they are screened, do you have a defined, repeatable system in place to get them sleep tested? If you’re not, you’re doing your patients a great disservice, and you are leaving money on the table. We have been teaching dentists how to implement DSM into their practices for several years now and regularly hear novice dentists inquire about how they can acquire new DSM patients.
“Should I run a radio ad?”
What about a billboard?”
pm quoteThe answer again is, “Start SCREENING your patients today!” Look no further than your own waiting room! You can put an Epworth Sleepiness Scale onto your letterhead and start the process of screening every adult patient who walks through your door tomorrow. You can use the STOP BANG or the DS3 Screener. Sounds simple, but it’s not, because you and your team have to be prepared to help your patients take the next step. If they ask ‘What does the screening number mean?’ you have to know how to answer. You and your staff have to believe in what you’re doing, and that you’re doing it for the right reasons. Staff members don’t want to feel like they are selling something. So educate yourself AND your staff.
I have a daughter in law who just loves to cook. And she’s quite the chef. With a little prodding, she revealed her secrets to me: You buy the best cookbook and you simply follow the instructions!  Wow.  What a concept. Create a system, a cookbook, and follow the recipe.
Screening helps to identify at risk patients. Now you have to get the patient to acknowledge that he may indeed have a problem. Sometimes this is easy, and sometimes it is near impossible, but using learned verbal skills can prove quite valuable at getting the patient to move on to the next step, testing.
“Our screening process has identified you as being at high risk for sleep disordered breathing. It’s like a skin lesion that looks very, very suspicious of being cancerous. If I saw that and said you should get it biopsied you would agree. It’s just harder to see sleeping and breathing problems, but they still exist and you need to get tested.”

Make it easy for your patients to get a Sleep Test.

Back in the old days (since I’m an old guy and have been doing DSM for many years), the only sleep testing option I had was to refer the patient to the local sleep doctor who also owned the only sleep lab in town. I would refer ten patients to him a month, and he would call them and beg them to come in and get a sleep lab test done, but only about half would ever go. In-lab polysomnogram (PSGs) are not the only game in town anymore, thank goodness. We now have multiple companies who offer Home Sleep Testing (HST) services, and having an additional service choice means that a greater percentage of the patients we identified through our screening process end up actually getting tested. Which test, a PSG or a HST, should you recommend for your patient? That’s a great question, and the American Academy of Sleep Medicine (AASM) has guidelines to help, but in the end, the one the patient’s insurance will pay for is likely the one the patient will utilize. We’re not here to debate the pros and cons of each sleep test; we just want our patients tested.  Either test is good, but it is very important that you have the test interpreted by a Board Certified sleep physician who will make the diagnosis. Again, verbal skills play an important role in getting patients to the next step. Dental Sleep Solutions teaches our dentists to ask:
“Would you prefer to do a sleep test in the local sleep lab or in your own home?” (Pause, for effect, since the next person who speaks loses.) Consider insurance and cost, of course, but get the patient to acknowledge that he may have a problem and that he needs a test. Then make the appropriate referral, and by this we mean create the referral form, fax it to the entity that will do the test, and create a task for yourself in DS3 to follow up with the patient three days later to make sure they have scheduled the sleep test. And finally, schedule the patient for a consultation four weeks later. Scheduling the patient creates accountability and puts a timeline on everything. Now, get a copy of the patient’s medical insurance card. (You’ll need this for later!) Task yourself for one week before the patient comes back for the consultation to collect and verify his insurance benefits.
Contrast this scenario with what most dentists typically do: identify an at-risk patient and recommend he get a sleep study. Then schedule him for his next six month prophy. Half a year later, do the same thing again since the patient never was tested. Insanity, remember: doing the same thing over and over hoping for a different result. Meanwhile, your patient’s health may be suffering every night the airway closes, over and over and over.
Richard B. Drake

Summary

  • Educate yourself AND your staff
  • Begin screening all adult patients
  • Have systems in place to get patients tested
    Stay tuned for next issue when we’ll highlight treatment and insurance.

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