Author: Michael Kelley

S-Force Dental Impression Materials. 10 pack for only $139.00 ASBA DISCOUNT  Silicone impression material consists of a base and catalyst in a putty consistency. Silicone impressions are classified according to their method of polymerisation on setting. They are available in a range of viscosities including light, medium, heavy and very high viscosity (or putty) material. Developing and distributing world class dental PVS impression materials to dental and orthodontic offices, and to sleep apnea and TMJ specialists in all 50 states.  10 pack for only $139.00 ASBA DISCOUNT! Silicone impression material consists of a base and catalyst in a putty consistency. Silicone impressions are classified according to their method of polymerisation on setting. They are available in a range of viscosities including light, medium, heavy and very high viscosity (or putty) material. When taking a putty impression it is usually combined with a low viscosity silicone. This is also known as the putty wash technique. Putties were developed initially to reduce the shrinkage of condensation silicones. There are three ways of recording a putty wash impression: One-stage impression – putty and wash are recorded simultaneously. Two-stage un-spaced impression – putty impression is recorded first and after it has set it is relined with a thin layer of wash material. Two stage spaced impression – a space is created for the wash. This space may be made by: Using a polythene spacer over the teeth prior to making the putty impression. Recording the putty impression before the tooth preparation. Scooping away the putty and providing escape channels for the wash. The most effective way of recording a putty wash impression is to use the one-stage technique in a rigid metal tray. se the app anytime that’s convenient and help maximize your comprehension of dental and medical sleep medicine and how it relates to the dentist’s role. To support my research on impression materials we asked two dentists their opinions on the different impression materials: “Silicones are the most dimensionally stable of all the materials and will keep their shape even if left for long periods. However, silicones work best in a dry environment and may not be ideal if there is a lot of saliva. Alginate is flexible and flows well. This allows the impression material to record fine surface detail. However, alginate does have poor dimensional stability and will distort if left to dry or left in water”. – Dr. Harry Sugg “Alginate is the cheapest and most commonly used impression material. It is versatile and useful for denture work, opposing impressions for crown and bridge work and removable orthodontic appliances. Alginate is not as accurate as silicone and is prone to distortion if not kept damp. Silicone has different grades of thickness and is often used where more accurate work is required. It is commonly used for taking impressions for crowns, bridges, short term braces and fixed retainers. The heavier silicone can be used to record the area approximately and the lighter (‘runnier’) silicone can then be used to record the finer detail, giving a really accurate impression”. – Dr. Paul Serrano The differences between impression materials, as outlined above, are the materials themselves and the purpose they are used for. Each of the materials has advantages and disadvantages, but they are each used for a different purpose and are effective and commonly used products in dentistry today. Don’t miss out on this GREAT PRODUCT!

The ASBA Members Mobile App is designed to reinforce your education about the different components of dental sleep medicine. It enhances your knowledge with questions to test your recall, interpretation and problem-solving skills The App, which is available for both Apple and Android devices includes Self-Study Modules – (Future updates will be eligible for Continuing Education (CE) Credits). Use the app anytime that’s convenient and help maximize your comprehension of dental and medical sleep medicine and how it relates to the dentist’s role. The app also allows for valuable networking opportunities with other American Sleep and Breathing Academy members. If any member wishes to modify their contact information in the App, email alan@myasba.com or cassie@myasba.com The app is free. Use the links below to download it to your device today!

Dr. Kent Smith, D-ABDSM, ASBA has been fighting the good fight for sleep apnea awareness for most of his career. The founding director of Sleep Dallas is a longtime advocate for dental sleep medicine, and a dental sleep practice pioneer. He’s also the president of the American Sleep and Breathing Academy, and the owner and primary facilitator of 21st Century Sleep Seminars, a series of training events that prepares dental professionals to incorporate dental sleep medicine into their practices. During his two decades in dental sleep medicine, Smith has seen his fair share of high-minded statements from sleep-related medical associations, and he views each with gratitude and optimism. He also knows, however, that mere lip service won’t be enough to move the needle in the right direction with regard to sleep dentists’ ability to most efficiently and effectively care for their patients. So, when the American Academy of Dental Sleep Medicine (AADSM) recently took the position that it is within the scope of practice for a qualified dentist (a dentist who treats sleep-related breathing disorders and who commits diligently to their continuing education) to order and administer home sleep apnea tests (HSTs), Smith found himself once again feeling a bit torn on the topic. The following Q&A covers Smith’s perspective on the AADSM statement and the overall state of the dental sleep medicine industry:   Will the AADSM’s statement influence public and/or private payers? How about the physicians in the American Academy of Sleep Medicine (AASM)? Smith: I was happy to see the statement and appreciate that the AADSM is promoting this—I think it is an important addition to the conversation. As for whether the statement will have a tangible impact, I think we have to continue to beat the drum, find prominent platforms for our cause, and insist on change if we’re to see the insurance companies, the state boards, or even the AASM change their policies and/or official positions.  Why don’t insurers pay for tests that dentists order? What are the odds that the AADSM position statement will hold water with insurers?  Smith: Insurance companies are in business to make money and will put up as many coverage roadblocks as they can to maximize profits. Whether or not the AADSM position statement will hold water with insurers remains to be seen. HSTs are becoming more commonly used to diagnose OSA because of their cost-effectiveness and convenience to patients, and while some insurance providers have gotten on board, many have not. With Medicare, for example, sleep studies administered by dentists are not covered. Cigna follows suit—their stance is, ‘We agree with Medicare. We’re not going to pay for home sleep tests if dentists give them out.’ If we can convince Medicare to change its policy on HSTs, we’ll likely be able to influence other insurers. Do you see it as a long-term goal to change Medicare’s policy around HSTs administered by dentists? Smith: The long-term goal is to decrease the roadblocks that stand in the way of sleep apnea patients getting a proper diagnosis and effective treatment of their condition. For dentists treating sleep, insurance coverage is a major obstacle, so yes, I would love for Medicare—and all insurers with similar coverage policies—to change their ruling, change their systems, and cover HSTs administered by dentists. I hope this message from the AADSM is a precursor to change. That would be fantastic. When working for change, how important is it to work with sleep physicians?  Smith: Sleep physicians are paramount to our efforts. As a medical community, we must work together to ensure patients have access to the treatment options they need, and that begins with ensuring those of us on the frontlines for diagnosis aren’t restricted by the kinds of policies we’re encountering with regard to ordering or administering HSTs. How much respect do sleep physicians have for sleep-focused dentists—and oral appliances—these days?  Smith: I’m really hopeful and optimistic about the inroads we’ve made in the last five to 10 years building relationships with and helping educate sleep physicians about oral appliances. Certainly, there is still some misunderstanding, especially as it relates to medical insurance covering the treatment. ResMed released some findings a few years ago that showed that physicians are just unaware that insurance, including Medicare, will pay for an oral appliance. It’s unfortunate because that means that they are less likely to offer an oral appliance as an option to their patients who might really benefit from one. Clearly, we have continued work to do to close that gap with sleep physicians.    What about non-sleep physicians?  Smith: In my experience, non-sleep physicians are often more open to our partnership and collaboration. For sleep physicians, they can be territorial about who they’re willing to allow into their “arena” or trust with their patients’ care. And I understand their reticence—look, they’ve had years of training in their specialty and some dentists begin practicing sleep after a weekend course. That’s not to say that a dentist isn’t qualified, but when you look at it from the sleep physician’s perspective, it’s easy to understand.  What is the level of sleep awareness among general practitioners?  Smith: I recently read an article in Time magazine about the health topics that general practitioners regularly discuss with their patients. One-hundred percent talk to their patients about smoking; 93% talk about diet. Sleep? Forty-three percent talk to their patients about sleep. That’s less than half! We must get general practitioners to fully understand the role that sleep plays in their patients’ health and its association with so many of these chronic conditions we see on the rise in our country.   Kent Smith, DDS – At a Glance Dr. Kent Smith is a Diplomate of both the American Sleep and Breathing Academy and the American Board of Dental Sleep Medicine and is on the Advisory Committee of the Australasian Academy of Dental Sleep Medicine. In 2007, he was asked to start a sleep curriculum at the Las Vegas Institute of Advanced Clinical Studies. In 2011, he started the SKISH Initiative (“School Kids in Safe Hands”), to keep bus drivers and students safe on the roads. In 2012, he was the first in Texas to be awarded a Dental Sleep Medicine Facility Accreditation and is the creator of the “Best Sleep Hygiene” app, which is a free download. That same year, he was asked to host a radio show on sleep disorders, and has been the host of “The Sleep Show” for the last 3 years, heard every Friday at 1PM on KAAM 770 in the Dallas area.  

Valued Friends and Clients: This is David Gergen, Executive Director of The American Sleep and Breathing Academy. President and CEO of Pro Player Health Alliance. President and CEO of Gergen’s Orthodontic Lab. Friends I have not put my name on a Dorsal Fin appliance for more than 40 years because I was simply not in love with the design, and I’ve been well are aware of cases where the appliance has broken and the fin has been asipirated into the lungs. There have been, to my knowledge, 16 lawsuits settled beacause of this occurance. Dr. Wayne Holstrom has the most amazing slide. It shows the fin in the lung, and I just would not put my name on an inferior appliance. Even though Respire Medical asked me to take the Respire Appliance to Market and I worked very hard with Wally Raad CDT to improve the design and fuctionality of the Respire Appliance. There was no room for slop, and every appliance needs slop. Without the slop, there will be no lateral movement, and without lateral movement,  no sinodial fluid will flow. After a great deal of effort,  I had to disassociate myself from the Respire Appliance. Friends, I am now pleased to inform the industry of Gergen’s Orthodontic Lab’s first Dorsal Fin Appliance. Just like the Gergen Herbst Appliance that has only a 1% breakage rate (The Industry’s highest rated appliance) I have, with the help of Cory Carmen of Leone, designed a Dorsal Fin that will have the same success as the Herbst Appliance. A nearly indestructable Dorsal. I’m calling it Dave’s Dorsal, or Double D. In January 2012 there were over 80 labs making sleep apnea appliances with PDAC. After a six year study, they threw out all of the other labs except for Gergen’s Orthodontic Lab, the highest rated lab, and the runner-up lab. They also threw out all of the other appliances except for the Herbst appliance because of the high success rate and extremely low breakage. The industry sorely needed this appliance because of patients who could not tolerate the hinges of the herbst. This is, hands down, the best dorsal appliance to ever hit the market.

We would like to wish our esteemed colleague and founding member of the American Sleep and Breathing Academy Dr. Harry Sugg a wonderful 80th birthday. We hope you are blessed with health and happiness for many more years to come. Dr. Sugg still runs his Wheatland Dental Care Practice in Dallas, TX. His list of accolades are too long to mention, so we though it would be a good idea to republish one of his articles so you can the understand the man… the icon!.   National Football League (NFL) players get used to excellent medical care during their playing days as high profile athletes, and that yearning for the best continues into retirement. Plenty of cowboys from the ranch, and even a few from the gridiron, find their way through the doors of Dallas-based Wheatland Dental because they want the best treatment. Dallas Cowboy legend Tony Dorsett (running back), Michael Irvin (wide receiver), Preston Pearson (running back) and Derek Kennard (center who blocked for QB Troy Aikman) are just a few of the many football legends who rely on the dental team at Wheatland headed by Harry L. Sugg, DDS. According to Kerry Sugg, Dr. Sugg’s wife, Derek Kennard has said that Dr. Sugg’s intervention, in the form of oral appliances to treat obstructive sleep apnea, saved his life. “Derek’s brother died of sleep apnea at the age of 39, and his brother was younger and thinner,” says Mrs. Sugg. “Derek told us about his own depression, headaches, and he had severe sleep apnea. Derek could not wear a continuous positive air pressure [CPAP] machine because he was claustrophobic and just CPAP intolerant. The oral appliance worked really well for him. Derek believes he could have played at least five more years if the oral appliance had been available.” Eric Dickerson, current holder of the record for most rushing yards gained during an NFL season, makes the long trip from Los Angeles specifically to visit Sugg’s practice. “We made him an oral appliance,” Sugg says. “It got rid of his massive headaches. He sleeps great, and we rebuilt his entire mouth. I said, ‘Eric, I’m almost 2,000 miles away. Are you sure you want to make this trip?’ He said, ‘Absolutely’ and he had a lot of appointments.” Experience and Education Longevity is impressive on its own, but the 40-year legacy of Harry Sugg, DDS, transcends the mere passage of time. As the owner of Dallas-based Wheatland Dental, Sugg has distinguished his dental career through an enduring dedication to his patients and the profession. Much of that dedication demands an unrelenting willingness to accept change, as well as a desire to participate in continuing education courses. “These days, we literally don’t do anything like we did when I got out of dental school,” says Sugg. “The closest thing would be extractions.” Pretty much everything else—fillings, crowns, root canals, partials, dentures, orthodontics—are all different today. As for treating sleep disorders; “We had no earthly idea about sleep,” Sugg muses. “We had no idea about disorders of the jaw joint and all the pain and headaches associated with it, or whatever ideas we had were totally wrong.” To deal with the daunting explosion of new technology, Sugg has never fought progress, but instead has chosen to embrace new ideas. “They talk about being on the leading edge of technology,” he says. “I was on the bleeding edge.” A lifelong obsession with motors and all things mechanical has served Sugg well, but may not have always led to harmonious relationships with roommates. Kerry Sugg explains: “At one time, Harry’s roommate had moved out and he could not figure out why. Well, Harry had his motorcycle in his dorm room along with part of a Corvette that he was working on.” Early on, Sugg briefly dropped out of dental school to take a job as a pilot with United Airlines in Washington, DC. The career change ultimately proved short-lived, and he eventually came back to dental school. The Bleeding Edge As a working dentist in the real world, Sugg’s early-adopter ethos and mechanical mindset usually served patients and the practice well, but not always. “I would be number one way too many times,” Sugg says with a chuckle. “Sometimes I should have waited and at least have been number two. I got into things before other people worked the kinks out.” A prime example was dental implants. Sugg installed a full mouth of implants on the owner of Curtis Mathis Televisions using the old Blade implants. Sugg admittedly “sunk a bunch of time and money” into the implants which were eventually made obsolete by new developments. On the other end of the spectrum, Sugg worked closely with Dr. John Schoeffel for two and a half years to develop the Endo-Vac, which eventually became the standard of care in root canals. “That was a big winner for the improvement of patient care,” Sugg reveals. So much willingness to try new things has led to a “closet full of stuff that I bought, tried out, and then decided not to use.” A typical ratio might be two or three enduring “winners” out of every 10 developments. “Are the other seven a waste?” asks Sugg. “No, they really were not, because you never would have found the two or three that worked if you had not tried all ten.” As a pioneer in the field of electronic dental anesthesia, Sugg received an invitation years ago from 3M to be a guest lecturer. Sugg and his wife spent four days at 3M’s massive headquarters in St. Paul, Minnesota, meeting with execs, sales people, and technical staff. 3M executives were amazed at the testimonials that praised the electronic unit’s ability to reduce pain. In the current era of widespread opioid addiction, Sugg muses that the innovation was probably ahead of its time. “I still use it to this day,” he says. “We’ve been able to reduce the use of opioids among patients by 70%.” That spirit of innovation, community, and family is a familiar thread through Sugg’s past, present, and future. When Kerry and Harry’s daughters were young, they frequently helped out with the practice. They grew up, but that family atmosphere is still a vital part of the practice. “We live three miles from the office,” says Mrs. Sugg. “This is our community.” Part of Sugg’s legacy amounts to a lead-by-example willingness to attend educational courses—a lot of educational courses. The proper mindset, Sugg contends, is to view continuing education essentially as a part-time job. “Alan Hickey [executive director of the American Sleep and Breathing Academy] just signed me up for a two-day course this October 2018 in Phoenix,” Sugg says. “Professionals should be nothing less than continual students. It’s a choice.” In his younger days, Sugg used to take courses “almost constantly.” These days, he laments that a relatively small percentage (about 20%) of the profession now regularly pursues continuing education. “When you would go to these courses, so many times a third or a fourth of the dentists were the same ones you saw a month ago at a different course,” he reveals. “The course-takers and the non-course-takers.” Sugg’s deep educational dive took fruitful detours, particularly in the exploration of temporomanidular joint (TMJ) pain, eventually leading him to an association with Dr. Harold Gelb. Gelb’s world famous practice in the heart of New York City was considered the epicenter of TMJ expertise, and Sugg’s work with Gelb eventually landed him a place on the original Gelb Academy Board of Directors. “I was really privileged to work with him,” remembers Sugg. “Years ago, his rent alone in New York was a million dollars per year on the top floor. He is retired now, but it was impressive indeed.” The commitment to education spread across the United States, and even internationally, with an invitation to Sugg to be the dean of a dental school in Dubai. Prior to that, representatives from the then Soviet Union asked if Sugg would host dentists from overseas. “They had grown up under communism, and now they were trying to operate under capitalism,” says Kerry Sugg. “The request grew to 13 dentists, and Sugg and one other dentist in the region hosted them. The visiting dentists said they would never believe another negative thing about Americans because we were so generous with them. It was incredible.” The Road to Sleep About a decade ago, yet another course would lead to a deep involvement with oral appliances to treat sleep apnea. The class in Boston, taught by Ed Spiegel, led to additional courses in Phoenix—and eventually to a meeting with David Gergen, founder of the American Sleep & Breathing Academy. “Dave Gergen changed my life, and I mean that from the bottom of my heart,” Sugg says. “He is passionate about anything he does. Numerous people had tried to get in with the National Football League [NFL], with absolutely no success. Dave went after it, and a year and a half later he was in.” With help from the ASBA and Gergen’s leadership, oral appliances have gained respect within the medical community. Even though M.D.s occasionally hesitate to acknowledge the clinical importance of oral appliances, Sugg offers words of hope: “Some M.D.s still do not have a high opinion of oral appliances. The American Medical Association recommends oral appliances for mild to moderate sleep apnea, and yet too many M.D.s will recommend a CPAP across the board. We work hand in hand with M.D.s, and fortunately the medical profession is gaining a greater appreciation for the effectiveness of oral appliances.” Sugg has been keen to address the problem of sleep disorders in children, an area he believes M.D.s and dentists alike have neglected. His most successful case involved a 6-year-old girl who was the shortest child in her class. “She had daily nose bleeds, head aches, and would refuse to sleep in her bed, instead opting for a recliner where she could lie more upright,” Sugg explains. “She had bad snoring. In three days with a fixed oral appliance, she was sleeping in her bed with no nosebleeds, no headaches, and no snoring. In 17 months, she grew 12 inches.” Oral appliances resonated with Sugg as soon as he discovered a simple fact; they work. The “does it work or not” philosophy has served him well and attracted a massive base of patients, including a few famous ones such as Charlton Heston (star of the legendary 1959 film Ben Hurr and the Planet of the Apes movies from the 1960s), and the actual coaches (Herman Boone and Bill Yoast) from the 2000 Remember the Titans film starring Denzel Washington as coach Herman Boone. “I’m grateful for the knowledge my educational background has afforded me, and I always look forward to new and better ways to treat my patients,” Sugg says. “There is still an excitement about patient care. I am at the office all week. I have absolutely no plans to retire.” “If you’re not getting enough oxygen, in the case of sleep apnea, it’s a big problem,” adds Kerry Sugg. “In the case of Derek Kennard, he was depressed with bad headaches. Typically a doctor would give him something for depression and/or something for pain control, when what he really needed was his airway open to get better oxygen. If your body is not getting enough oxygen, you are not going to be in peak performance.” Harry L. Sugg, DDS – At a Glance founder of Wheatland Dental, Dallas, Texas; dentist for the United States All America Bowl in San Antonio, held at the Alamo Dome; founding board member of the American Sleep & Breathing Academy (ASBA); helped develop the Endo-Vac root canal system; undergraduate degree, Memphis State University; • dental degree, University of Tennessee; first recipient of Boston lifetime achievement award for contributions to dentistry; • residency at V.A. Hospital, Memphis Tennessee; and • first inductee to the ASBA Hall of Fame.  

In the radically changed work rhythms of the global pandemic, workers are discovering a new life no longer dictated by the strict schedules of the office. BBC.com took note of the relatively new phenomenon in a June 23 Rethink article that pondered: Will companies help us improve our sleep habits?   “Our sleep does seem to have changed during the pandemic,” writes Matthew Walker, sleep scientist, on behalf of the BBC. “There is some emerging data from some sleep-tracking companies that suggests people are going to bed at different times from before, but also, typically, on average, waking up a little bit later.”  For Walker, it comes down to additional harmony with what he calls the “chronotype.” Evening or morning person? Working from home gives more latitude, and that can lead to better sleep. As for “forcing it,” Walker contends that these biorhythms are largely genetic. “Companies can then start to try to accommodate – as much as they can – people’s individual work schedules,” Walker predicts. “And in that way they allow the employee to start sleeping in a much more compatible way with their biology, rather than in conflict, which is what many of us seem to do in this modern world.” Ultimately, better sleep can lead to better health, whether in a pandemic or not. “What we know is that there is a very intimate relationship between your sleep health and your immune health,” adds Walker, “and one example I think has implications for the coronavirus. Researchers found that if you’re not getting sufficient sleep in the week before you get your standard flu shot, you produce less than 50% of the normal antibody response, rendering that vaccination far less effective.” Source: BBC

In March 2020, the RECOVERY (Randomized Evaluation of COVid-19 thERapY) trial was established as a randomized clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment).  According to a press release issued by the University of Oxford, more than 11,500 patients were enrolled from over 175 NHS hospitals in the UK. More than 2,100 patients were randomized to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4,321 patients randomized to usual care alone.  Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%). Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14).  Based on these results, one death would be prevented by treatment of around eight ventilated patients, or around 25 patients requiring oxygen alone. Peter Horby, professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and one of the chief investigators for the trial, said: “Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”  An article in STAT News cautions that “full data from the study have not been published or subjected to scientific scrutiny” but conceded that outside experts had “embraced the top-line results.”  Source: BBC