Alright! And Welcome back!

Today we are going to answer a question regarding Sleep Apnea in the diagnosis of Obstructive Sleep Apnea.

I had a question submitted by Michael, it says:

Hi T-Bone! It was a pleasure hearing you speak and learning from you at my Galileo’s training in San Diego last November. You went off on a tangent -Which quite honestly it’s not unusual- and started talking about treating sleep apnea. You mention that you don’t refer your patients directly over to the MD anymore to get a sleep study done because they never return to you. So what are you doing to keep the patient in your office to do the oral appliance and still get a diagnosis from the MD.

So, let’s talk about that, I maybe I miscommunicated a little bit on that and I want to clarify. I don’t think I miscommunicated but I want to clarify on this.

First and foremost the diagnosis of Obstructive Sleep Apnea (OSA) can only be done by a Physician. As a Dentist we are not able to make this type of diagnosis. No Cone Beam, nothing will make a dentist be able to create that diagnosis.

Now, next is that the diagnosis of OSA must come from either and in-lab polysomnogram PSG sleep study or and at-home HST Home Sleep Test. Now again, those two devices can be used and then the diagnosis, again with the scoring the reading and interpretation being done by the physician can then make the official diagnosis of obstructive sleep apnea. Now based on the diagnosis, based on your personal philosophy then you can decide how you would like to treat that person with Obstructive Sleep Apnea.

So now, let me kind of clarified how I’m doing it in our practice.

First and foremost, we firmly believe in Co-coordinated care. In other words we like to work very closely with our patient’s physicians. That being said, I don’t allow the physicians to stand in my way. Now typically what I am referring to is the primary care, that cardiologists and not that, they absolutely they know what they are doing, but more about it’s about the patient and it’s about barriers to the patients. So we, in the state of North Carolina where I live and practice, are allowed to own home sleep testing devices and we are allowed to order a home sleep testing test to be done. So again, I can order the test, I can dispense the test, I cannot read the test because that is outside the scope of my license. So what we are doing in our practice is we are helping patients get screened and helping them get tested for the presence of Obstructive Sleep Apnea. And then working with either a local sleep physician or a remote sleep physician to do the scoring and to do the official diagnosis from that home sleep testing.

Now again, co-coordinated care, we always let our physicians know the primary care, what we know the primary care, the sleep physician, So that way we can co-coordinated care, so that the doctor knows what treatment is going on for the patient. That also being said, when we get Home Sleep Test results that come back and will not comfortable with results, we are not comfortable with treating a patient for an appliance right away, we work closely with our physicians in the community specifically a neurologist or Sleep Physician to allow us to get the patient to the right place, to make sure that a CPAP isn’t the best choice or to make sure that there isn’t signs of Central Sleep Apnea, to make sure that there aren’t other conditions. We also even work with this local group of psychiatrist as well for other areas in terms of sleep. Because sometimes sleep is not just about the lack of breathing, certainly that’s a big component, but there is also insomnia, there is anxiety, there are so many different things as you more more explorer sleep that come into this.

So we believe, and again in the state of North Carolina we are allowed to own Home Sleep Testing Appliances we do dispense this to our patient, we do help them in getting the test and then we do work with either a local Physician Community or remote Physician Services to read, interpret, score and properly diagnose our patient. And then from there, depending on the results from that physician, if oral appliance is first line of defense we will provide oral Appliance therapy, in Oral Appliance is not the first line of defense or they recommend a more comprehensive In-lab PSG, we will then work with an In-lab PSG.

An area that we have found difficulty in, is what I call the all in one treatment Sleep Centers.

And that’s where they sell and service a CPAP Machines. That is where I think most dentist are finding that our trouble is when a patient goes into that service route that they sometimes, or very often don’t return because they are getting it in the CPAP right away, and then we never hear communication back and we know that 60% of those patients fail CPAP and they  maybe not be for 6 months or a year before we have the patient back and then we can even ask them again if they’re using the CPAP or, you know again, things get in the way you just kind of forget what’s going on there.

So I like the quarterback care, I like to certainly co-coordinate care and I like to work with our local physician community.

So I do apologize if I did not make that clear, or if I mislead anybody that we are circumventing the physician community, that is not the case. So we need the Physician Community to obtain the diagnosis, we are just using a Home Sleep Testing devices through the office to help screen patients and help patients make it easy for them to get tested and I would encourage you to do so, but do check with your state laws. Some states for example do not allow Dentist to own these machines, not allows dentist to prescribe these machines, so do check with that.

Again, thank you so much for tuning in. If you have questions that you would like answer please don’t hesitate, as you can see in the bottom left of your screen, just visit and I will be happy to answer your questions. And if I may, I would love to put in a plug for our wonderful Hands-On Workshops on Sleep Apnea. If you’re looking to get into Sleep Apnea and need some additional training and you want to focus on getting a good implementable workflow that works in your practice please do consider coming out to Raleigh for a Hands-On program. I do think that we do a wonderful job of giving you some wonderful actionable education.

Thank you very much!


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