When I graduated dental school in 2003 (man, I’m old), I knew 2 absolute truths in this world. The first was that biologic width is 2.04 mm and the second was that perfect Class I canine guidance could cure cancer.
Therefore, when one of my favorite patients walked in one day with the chief complaint of “my crown catches food,” I freaked out when
I saw that, not only did she have an open contact, but she had a bilateral posterior open bite. How could this have happened? I knew I didn’t seat that perfect crown on No. 3 with an open contact. What I found out was that some dentist had the gall to make MY patient an oral appliance for sleep apnea. I immediately referred her to an orthodontist. You could see how mad I was based on my handwriting on the referral. Wait…my handwriting is always that bad. The orthodontist, in all of his wisdom, wrote back, “No orthodontic treatment needed at this time.” Why would he let this go even though she had a posterior open bite? The answer: Because she was breathing and sleeping at night. Oxygen trumps bite every time. Open bite or open casket? The best part of this was that the patient didn’t even know her bite was changed. She never missed a meal. The only person who had a problem with it was me. Once I got over my brainwashing, I could treat sleep apnea. We might change bites, but we are also changing lives.
Sleep apnea is certainly a hot topic right now. It is inspiring to screen patients, to treat patients, and to help patients; however, there is a learning curve. It’s medicine, not dentistry. Making the appliance is easy, but navigating the referral pathway, mastering a new language, billing medical insurance, and managing the side effects is outside of our comfortable dental world. I always get asked right away, “What appliance do you use?” Honestly, that is the last question that should be asked. If your team isn’t able to talk to patients and raise patient awareness, then you will have no patients to even decide which appliance to put them in. Dental sleep medicine is so much more than taking impressions and delivering a piece of plastic. My advice? Get trained and get trained now. Never make a “snoreguard,” which basically means you don’t do a sleep study on the patient first. That is a liability nightmare if you make someone quiet but don’t treat the underlying disease. It’s like doing a prophy and no x-rays on a severe periodontal patient. It’s a Band-Aid on a gushing wound.
As dentists, we always think about the pitfalls as opposed to the possibilities. I challenge you to overcome the roadblocks in our heads and get started on this journey. Do it right, and do it well, and you’ll improve the lives of many patients. But make sure you have a destination and a road map (or GPS, for you Millennials) to get you there safely.
Dr. Erin Elliott is a general dentist with a private practice in Post Falls, ID. She focuses on many aspects of dentistry, including general and cosmetic dentistry as well as orthodontics and dental sleep apnea. A past president of the American Sleep and Breathing Academy, Dr. Elliott has authored several articles on dental sleep medicine, and is considered a national expert in this growing field.
Contact Dr. Elliott at erinelliottdds@gmail.com