Hygiene Tribune U.S. No. 7, 2011
The ‘Pros in the Profession’ winners / Flying with Hilda / Snoring and sleep apnea: Are they a nuisance or disease continuum?
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[1] =>
HYGIENE TRIBUNE
The World’s Dental Hygiene Newspaper · U.S. Edition
July 2011
www.dental-tribune.com
Vol. 4, No. 7
Snoring and sleep apnea: Are they
a nuisance or disease continuum?
The hygienist and dental team play a huge role in screening and identifying patients at risk
Two-thirds of partnered adults say their
other half snores, while six out of 10 of all
adults (59 percent) say they snore. Sleep
apnea may be present in 20 to 40 percent of
the adult population that experience snoring.
According to the U.S. Department of
Health and Human Services, more than 45
million Americans suffer from sleep apnea, a
disorder that causes a person to briefly, and
repeatedly, stop breathing during sleep.
Obstructive sleep apnea (OSA) is a debilitating and often life-threatening sleep disorder and an estimated 800,000 patients are
being diagnosed with OSA per year in the
United States while approximately only 10
percent are being treated.
Primary care practices are not actively
screening patients for OSA, which leaves a
large void in the number of patients being
identified with this killer disease. OSA has
directly been linked through numerous
research papers to co-morbidities such as
stroke, heart disease, hypertension, impotence and diabetes.
For those patients who have been diagnosed and have had continuous positive
airway pressure (CPAP) recommended, some
may be intolerant of the therapy and are currently going untreated There are millions of
patients who need treatment, including those
who cannot tolerate their CPAP machines
and are looking for alternatives.
The dental practice is a prime portal to not
only screen and identify patients at risk, but
also to offer clinically proven therapy with
oral appliances.
How to implement oral appliance therapy
It starts with education for the dentist and
the dental team. Currently there are many
continuing education courses available on
the topic of dental sleep medicine and oral
appliance therapy, and these are usually
two- to three-day courses with subsequent
workshops and follow up that is essential. I
must emphasize, in order to be successful
with implementation, the entire team needs
to be involved — dentist, hygienist, assistants
and front desk staff.
Following the education, the implementation process begins, which involves asking
questions, observing, communicating, initiat-
(Photo/Provided by Ashley Truitt)
By Ashley Truitt, RDA, BBA
g HT page 2D
The ‘Pros in the Profession’ winners
The 2010–2011 Pros in the Profession award program has come to
a successful conclusion with Crest
Oral-B recognizing five deserving
dental hygienists who go beyond
the call of duty. These five outstanding professionals were nominated
by their peers and selected from an
overwhelming pool of qualified candidates for truly making an impact
on their patients.
Ann Benson was selected for following her dream to start Mobile
Dentistry of Arizona, a practice that
brings comprehensive dental care
to those with limited transportation.
Mobile Dentistry of Arizona offers
on-site dental care to the residents
and staff members of assisted living
homes, skilled nursing, long-term
care communities and other agequalified communities.
Trudy Meinberg has distinguished
herself for more than 30 years as a
registered dental hygienist in both
private and collegiate practice set-
tings. In addition to teaching clinical periodontics to undergraduate
dental students at the University of
Nebraska Medical Center (UNMC)
College of Dentistry, she has also
contributed to several research studies and has been published in a
number of scholarly journals.
Mary Lynne Murray-Rider has
improved the lives of others both
inside and outside the office. In addition to her 31 years of experience as
a registered dental hygienist, Murray-Rider has served as an ADHA
Delegate, the Maine Dental Hygienists Association (MDHA) president
and on several MDHA councils and
is currently serving as immediate
past president and continuing education council liaison.
Linda Maciel has established a
screening protocol to detect early
signs of oral cancer and has caught
basal-cell carcinoma and detected
early signs of thyroid cancer throughout her 11 years of practice. Maciel
also volunteers with her office at
community events and works to promote having a healthy mouth by discussing the links between periodontal health and systemic concerns.
Sharon Shull is an advocate for
both education and community service. She is dedicated to increasing care for segments of society
that are unable to receive basic oral
health-care services and encourages
dental hygiene students to have a
greater awareness of the true oral
health needs of society. Shull is the
community health coordinator and
program director for both the bachelor of science in dental hygiene
online degree completion program
and study abroad at Old Dominion
University School of Dental Hygiene.
Crest Oral-B is honoring these
five Pros in the Profession winners
with a VIP, all-expense-paid trip to
the American Dental Hygienists’
Association’s 88th Annual Session in
Nashville, Tenn., where they will be
1
2
3
4
5
1: Ann Benson
2: Trudy Meinberg
3: Linda Maciel
4: Sharon Stull
5: Mary Lynne Murray
(Photos/Provided by
P&G)
presented with awards to celebrate
their achievements.
For more information about the
Pros in the Profession award
program, please visit facebook.com/
professionalcrestoralb. HT
[2] =>
2D
Editor’s Letter
Hygiene Tribune | July 2011
Flying with Hilda
Flying can be a wonderful or
stressful situation, and more often
than not I find it brings stress. On
a recent trip, I found myself on the
edge. The first leg of my flight was
delayed due to issues with the plane,
which then cut into my layover time,
which was only 45 minutes to begin
with. When my first flight landed,
there was no one available to drive
the jet bridge next to the plane, so
another 15 minutes ticked off my
connection time. Once I deplaned,
I had exactly 10 minutes to get to
another terminal and, of course, the
gate was the last gate in the corridor.
I walked as fast as I could, pulling
my wheeled bag behind me. I was
not about to run (what a sight that
would be). Images of O.J. Simpson
running through the airport for a
commercial some 35 years ago sped
through my head. I knew I would
never be able to pull off what O.J.
had. As I got to the gate and the
attendant scanned my boarding pass
she said, “Run, we are closing the
door to the plane.” This comment
struck what might have been my last
nerve, and I was upset.
I reached my seat with a second
to spare.
Of course, I always want the window seat so I can sleep by propping
my head against the wall of the
plane, so I disrupted the two women
who were all buckled in and ready
to go. “Ugh,” I thought to myself as I
climbed in, “this is going to prompt
a conversation.” I like to use my air
travel as down time, but it was soon
obvious that was not going to be the
case this time.
The woman next to me said hello,
I responded, and before I knew it,
I was telling her my travel woes of
the day. The conversation continued and I enjoyed every minute of
it. As we talked freely, I realized
this woman was amazing. She was
talking about traveling, buying her
tickets on line, printing off boarding
passes, e-mailing with her friends,
using her cell phone and many other
technically savvy pursuits.
She also shared some of her life
story, which was no less amazing
to me than her technical abilities. I
couldn’t help it, I wanted to know
her age. I thought she was probably
in her late 60s and to hear her speak
of all the modern technological she
used in her daily life was astounding. Finally, I mustered up the courage to ask her age and she proudly
announced, “I am 84 years old.” I
could not believe it.
I have given lectures to dental
hygienists who do not own a cell
phone. I have been in dental offices
that still do not have a computer.
And here I was sitting next to a
woman that has embraced progress
to the fullest extent at age 84.
When we landed, I thanked Hilda
(Photo/Iona Grecu, www.dreamstime.com)
•
•
When a patient is
finally able to get a
good night’s sleep, oral
appliance therapy can
be truly life changing.
f HT page 1D
ing systems and offering solutions.
The questions should start at the
front desk when a patient checks
in for their recall appointment.
The following questions should be
added to your patient history update
form:
• Have you been told you snore?
• Are you excessively tired during the day?
• Have you ever had a sleep
study?
Have you been diagnosed with
sleep apnea?
Do you wear a CPAP?
If a patient answers yes to any
of these questions, the conversation should be picked up by the
hygienist. There are also some telltale clinical signs to look for in
these patients such as wear facets
(bruxing), periodontal disease, a
large neck, obesity, scalloped large
tongue, red and inflamed uvula and
enlarged tonsils.
On identifying any of these
clinical signs, the patient should
be directed to fill in a questionnaire called the Epworth Sleepiness Scale. This will identify how
“sleepy” the patient is in his or her
regular daily routine.
It is likely that patients will tell
you “Oh, I just snore when I am
tired, I do not have sleep apnea.”
However, how would the patient
know this if he or she hasn’t been
tested? Snoring is the beginning of a
disease continuum that will develop
into apnea if therapy is not initiated.
Apnea will get worse with age, bad
diet, weight gain and an unhealthy
stressful, lifestyle, which these days
can be so common. Unfortunately,
many people do not realize that
they suffer from sleep apnea unless
someone else brings it to their
attention.
HYGIENE TRIBUNE
The World’s Dental Hygiene Newspaper · U. S. Edition
Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Hygiene Tribune
Angie Stone, RDH, BS
a.stone@dental-tribune.com
Managing Editor/Designer
Implant, Endo & Lab Tribunes
Sierra Rendon
s.rendon@dental-tribune.com
for the conversation we had. I also
told her she had inspired me to keep
educating people about progress in
technology. As dental professionals,
we are being asked and we are
asking others to take advantage of
technological progress every day.
Even though we may be resistant
to change, we can do it. If a woman
who is 84 years old can do it, so can
we. We have no excuse. We need to
get with the program or we will be
left behind wondering where everyone else went.
I guess there was a reason my
flights were delayed after all. HT
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.
com
Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.com
Best Regards,
C.E. International Sales Manager
Christiane Ferret
c.ferret@dtstudyclub.com
Angie Stone, RDH, BS
Dental Tribune America, LLC
116 West 23rd Street, Suite 500
New York, NY 10011
Tel.: (212) 244-7181
Fax: (212) 244-7185
Following the screening process,
a dentist cannot diagnose OSA. The
gold standard in care is to refer
your patient to a sleep laboratory
for a diagnostic sleep study known
as a polysomnogram (PSG). This
is where you will start to build a
mutual referral relationship with
your local laboratory and reporting
sleep physician.
The multidisciplinary referral
pathway should be that you refer
your patients for a diagnosis and —
providing the results fall within the
American Academy of Sleep Medicine (AASM) guidelines for oral
appliance therapy, mild to moderate apnea with no co-morbidity —
the patient should be referred back
to you with a prescription for an
oral appliance. This is important
for reimbursement too. Oral appliances are also recommended for
severe OSA patients if they cannot
tolerate their CPAP, although they
should always try CPAP first.
Home sleep testing (HST) is
becoming more popular and there
are companies that offer an interpretation service for patients who
will not or cannot to go to a sleep
laboratory. There are a wide range
of HST devices available to the
dental market that can be used
for screening, diagnosis (providing they have a certified physician
interpret the report and sign off
Published by Dental Tribune America
© 2011 Dental Tribune America, LLC
All rights reserved.
Hygiene Tribune strives to maintain
utmost accuracy in its news and clinical
reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.
Hygiene Tribune cannot assume
responsibility for the validity of product
claims or for typographical errors.
The publisher also does not assume
responsibility for product names or
statements made by advertisers. Opinions
expressed by authors are their own and
may not reflect those of Dental Tribune
America.
Tell us what you think!
Do you have general comments or criticism you would like to share? Is there
a particular topic you would like to see
articles about in Hygiene Tribune? Let
us know by e-mailing feedback@dentaltribune.com. We look forward to hearing
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to opt out) please send us an e-mail
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sure to include which publication you are
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to process.
[3] =>
Clinical
Hygiene Tribune | July 2011
on the treatment recommendation)
and the main function in the dental
office where it is used to check the
effectiveness of the oral appliance
therapy and ongoing efficacy.
Once you have a diagnosed
patient who is dentally appropriate for oral appliance therapy,
you are ready to do a full patient
examination, evaluation and work
up, including impressions and a
bite registration incorporating protrusive and vertical dimension. It
would be at this stage that you
check their medical insurance and
benefits to see if they are covered
for this type of treatment.
There are numerous custom fitted oral appliances available on the
market, all with varying degrees of
efficacy, patient comfort and cost.
Consider fabricating and dispensing only FDA-cleared devices when
treating OSA in order to secure
insurance reimbursement because
oral appliance therapy is covered
by medical insurance not dental
insurance.
Medical billing is becoming a
more common necessity in the
dental practice for a variety of
treatments and procedures. The
learning curve and process of medical billing and cross coding can be
somewhat consuming, however,
there are software solutions available and also companies that will
handle the entire process for you
which is very helpful, especially
for those just getting started.
Once a patient is fitted with an
oral appliance, a follow-up protocol is essential in order to ensure
that the appliance is adjusted to the
optimum position whereby snoring
is eliminated and the apnea is
reduced significantly. Initially this
is done with an HST device and
ultimately, when efficacy has been
achieved, refer the patient back
to the sleep laboratory for a sleep
study (PSG).
The HST and PSG results should
correlate well, which gives the
sleep physician confidence that
oral appliances are proving effective, and in some cases a good
alternative, to CPAP.
Oral appliance therapy can
be truly life changing for these
patients and being able to change
the quality of someone’s life is
extremely powerful and rewarding. I have seen many tears and
hugs from grateful patients who
didn’t even realize how bad they
felt until they started to feel the
benefits of their treatment.
In summary, a large part of this
treatment can be performed by the
hygienist working closely with the
dentist and incorporating a multidisciplinary approach. Dental sleep
medicine is a substantially rewarding practice and our country is in
desperate need of more awareness
and treatment options. HT
References
1.
2.
National Sleep Foundation,
2005 Poll.
U.S. National Department of
Health and National Services.
3.
4.
5.
Clinical Guideline for the
Evaluation, Management and
Long-term Care of Obstructive
Sleep Apnea in adults. J Clin
Sleep Med 2009;5(3):263–276;
page 2, Journal of Clinical
Sleep Medicine, Vol.5, No. 3,
2009.
The
Epworth
Sleepiness
Scale,Key 1997 ESS Dr. Murray
Johns.
American Academy of Sleep
Medicine Practice Parameters
— Treatment of Snoring and
Obstructive Sleep Apnea with
Oral Appliance Therapy with
Oral Appliances: Kushida C,
Morgenthaler T, Littner M,
Alessi C, Bailey D, Coleman
J, Friedman L, Hirshkowitz
M, Kapen S, Kramer M, Lee-
Chiong T, Owens J, Pancer J;
American Academy of Sleep
Medicine. SLEEP, 2006 Feb. 1;
29(2):240–243.
6.
3D
The American Academy of
Dental Sleep Medicine, The
Ins and Outs of Oral Appliance
Therapy.
About the author
Ashley Truitt, RDA, BBA, has been in the
dental industry for the past 25 years. She is
the director of Dental Sleep Medicine USA
and owner/director of Dental Sleep Medicine
Worldwide, an education and consulting organization dedicated to the advancement and
awareness of sleep apnea in the dental office.
For additional information on how to implement dental sleep medicine into your practice,
please contact Truitt about dental sleep medicine team training and office implementation at
atruitt@dsmworldwide.com or (940) 395-4555.
AD
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Table of contents
[toc_titles] => The ‘Pros in the Profession’ winners
/ Flying with Hilda
/ Snoring and sleep apnea: Are they a nuisance or disease continuum?
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