Author: Michael Kelley

Rani Ben-David, president and founder of Sleep Group Solutions (SGS), Hollywood, Fla, wants SGS seminar attendees to learn from the best, particularly from those who actually practice dental sleep medicine. “Most of the SGS speakers/teachers are diplomates of the American Sleep and Breathing Academy [ASBA],” says Ben-David. “They are not merely dentists who read studies then come and teach. They practice what they teach.” Offering about 90 dental seminars per year in the United States and Canada, the 13-year-old SGS recently decided to use mostly ASBA diplomates to teach its courses in 2018. The decision comes from a need to tap into the diplomates’ expertise, as well as an appreciation for the overall tone set by the ASBA. “The ASBA is a down to earth academy,” says Ben-David. “The board members and everyone involved are so connected. The diplomates are genuinely helpful. Last year when I went to the ASBA conference, the lectures were top of the line and the subjects were great. All the diplomates, board members, and executives were welcoming to the new doctors and new people. It feels like they want to help the other members succeed, and that’s how an association/academy should conduct its business. There is no feeling of being an ‘outsider’ with the ASBA.” Ben-David hopes more members will ultimately join the ASBA as a natural byproduct of the seminars based largely on that welcoming atmosphere. “When someone comes to a new association, they can feel like outsiders,” explains Ben-David. “However, at the ASBA, new doctors are welcomed by board members, welcomed by the CEO [David Gergen], the president [Kent Smith, DDS], and Alan Hickey, the executive director who helps run the association.” ASBA diplomates are as experienced on the business side as they are on the clinical side, an aspect of the educational process that should never be neglected. Ben-David puts it this way: “These docs are highly successful, and they are there to save patients’ lives. It’s important that new docs who come to SGS seminars see that lecturers are diplomates in a reputable academy like ASBA. Fortunately, the future is bright. I have sleep docs and ENTs asking me, ‘Where can we find dentists who treats sleep apnea?’ It’s not going to stop. Dental sleep medicine is only going to grow.” SOURCE/RELATED LINKS About Sleep Group Solutions For more information about the Dental Sleep Medicine CE seminars hosted by Sleep Group Solutions, visit sleepgroupsolutions.com   Learn More about becoming a Diplomate Click Here  

ORLANDO, FL – The American Sleep and Breathing Academy’s work with the National Football League Players Association (NFLPA) continued last month prior to the NFL’s Pro Bowl game in Orlando, Florida. The relationship has led to real benefits for NFL players while continuing to raise awareness among the general public, many of whom pay attention to the actions of their grid-iron heroes. Ronald Rosenbaum, DMD, PA, helped foster that ASBA/NFLPA relationship at last month’s Pro Bowl game. As a veteran private practice dentist, Rosenbaum discovered dental sleep medicine a few years ago, and it quickly became his passion. With ASBA Diplomate status secured, Rosenbaum got the invite to the 2018 Pro Bowl and eventually took impressions for 25 NFL players at the nearby University of Central Florida’s medical facility during the same day health screening event. “David Gergen [CEO of the ASBA] is trying to help these ex-NFL players to breathe better, live better, and improve their quality of life,” says Rosenbaum, owner of Cosmetic, Restorative & Preventive Dentistry, Pembroke Pines, Fla. “About 70 players rotated through, and only one said, ‘I don’t want this. I don’t think I have sleep apnea.’ The rest were open, honest, and receptive. In their screening questionnaires, we could see their numbers. We did not expect to take 25 impressions, but they know that oral appliances work.” Rosenbaum called the overall experience “wonderful” and described the players as “big teddy bears who wanted to feel better and have more energy, because a lot of them were lethargic.” Rosenbaum acknowledges that “CPAP works” but says, “most will not wear it, and even when they do wear it, it can get leaks, and patients can develop issues. It can be good at first and then turn bad. The oral appliance is the best thing for these guys, especially the football players.” Recently, Rosenbaum has been working with Sleep Group Solutions (SGS) and Rani Ben-David, SGS’ president and founder, using the pharyngometer to measure the airway. “We also test the nasal cavity,” says Rosenbaum, who intends to continue lecturing on behalf of SGS in 2018 and beyond. “In just a matter of 5 hours I added 25 retired NFL players as patients to my sleep practice. The screening was organized, professional and beyond what I expected. Having the screening inside the Health Center at University of Central Florida was the cherry on top. Taking my staff to the Sleep Group Solutions/ASBA Boot Camp was the best decision I could have made; I heard awesome feedback from other doctors about my staff. This is one of the most exciting things I’ve done in years and I highly recommend all of my colleagues to join the ASBA, attend the annual meeting and bring your staff for the boot camp.  It’s fun, exciting and financially rewarding. These NFL players are amazing to work with,” said Dr. Rosenbaum. “Next is Project Rose. I’ve talked with a couple of the guys within Project Rose and the numbers are astounding. Project Rose is going to change dental sleep medicine not only am I excited to help more people with oral appliances, I’m definitely ready for the payout as well.” To register for the ASBA Annual Meeting and add your staff to the Boot Camp, visit sleep-conference.com. To find out more about Project Rose, email David Gergen at gxployer@aol.com or call 602-478-9713.        

WASHINGTON, D.C. – The long push to get federal certainty in the diagnosis and treatment of obstructive sleep apnea in transportation workers came a step closer last week. In a meeting with the staff of Rep. Anna Eshoo, Dr. Elliott J. Alpher asked for support in the efforts to get a dental sleep medicine expert appointed to the Federal Motor Carriers Safety Administration’s Medical Review Board.     FMCSA-Medical Review Board This five-member panel of physicians sets the health and safety guidelines for truckers. The MRC also sets training standards for more than 5,000 certified medical examiners who perform physicals on truckers. Yet no member of the MRC has been trained in the diagnosis and treatment of sleep apnea. Rep. Eshoo has long been a supporter of federal regulatory authority over the diagnosis and treatment of obstructive sleep apnea among transportation workers. In 2016, she hosted an educational session for members of Congress on the devastating effects of obstructive sleep apnea. According to statistics from the ASBA, obstructive sleep disorders affect over 25 million Americans, and that number is on the rise. Current FMSCA Medical Review Board guidelines base a diagnosis on three criteria, while the American Sleep and Breathing Academy standard includes 14 scientific and medical points, including intraoral exams and measurements and allows for a home sleep study. Become part of the Academy committed to advocating for the Sleep Dentist and Dental Sleep Medicine Join the ASBA

LAS VEGAS – Can a chronic condition such as sleep disordered breathing be eliminated? It’s ultimately a scientific question, but Dave Singh, DMD, PhD, DDSc, is also quick to point out that the answer is not a threat to anyone’s livelihood. “No one is going out of business,” says Singh, owner, Vivos BioTechnologies Inc, Cedar Crest, New Mexico. “You have mild, moderate, and severe cases. A possible cure is about collaboration and cooperation. No one is excluded from this party. If you’re happy with your CPAP, that’s great. If you’re happy with your oral appliance, that’s fine. There are people who don’t like the mask, and with the oral appliances there can be side effects.” During his keynote address at the Annual Sleep & Wellness Conference hosted by the American Sleep & Breathing Academy (ASBA) April 13-14, 2018, Las Vegas, Singh will describe sleep apnea procedures that are approved by the FDA and covered by medical insurance. “I’ll talk about the different options,” he says. “There are alternatives in addition to CPAP, surgeries, and mandibular advancement devices.” Visit Conference Website http://sleep-conference.com Viewed as a whole, Singh sees vast opportunity, and his optimism is infectious. “The future of dental sleep medicine is off the charts,” he says. “It’s the right thing at the right time for the right reasons. I’ve been in the field for a long time, and now we’re seeing public awareness of the issue, and a realization of how sleep apnea affects overall health. “If we as dentists can help to identify these patients by screening people, getting a diagnosis by working in collaboration with medical colleagues, and determining alternatives, it’s all a win-win,” continues Singh. “This is the golden age of dental sleep medicine.” In an effort to cement dental sleep medicine within the larger medical world, Singh is working with two university hospitals in the United States to eventually formulate a new specialty, curriculum, and residency training. “The idea is that dentists will come into the sleep medicine program as a one-year, full-time fellowship in sleep medicine for dentists,” explains Singh. “They would go through that full-time training, and when they come out the other side, we expect a new specialty to emerge called dental sleep medicine, just like you have oral surgeons and orthodontists. This is where ASBA is at the forefront. It’s all about laying this exciting foundation for the future of the profession.” REGISTER FOR THE SLEEP & WELLNESS CONFERENCE http://sleep-conference.com Dr Dave Singh DMD PhD DDSc Dr. Singh is a Diplomate of the American Sleep and Breathing Academy. He is the founder of the field of pneumopedics and cranofacial epigenetics, including epigenetic orthodontics, having realized a few years ago that there is a natural way for the body to remodel the upper airway, reshape bone and move teeth into their correct positions painlessly without the use of surgery or drugs.

RECOMMENDATIONS FOR THE NTSB FOR IMPROVED SAFETY IN TRANSPORTATION INDUSTRIES RELATED TO FATIGUE, DAYTIME SLEEPINESS, POOR SLEEP HYGIENE, UNDIAGNOSED & UNTREATED OSA, AS WELL AS IMPROVEMENT IN TECHNOLOGICAL UTILIZATION Neal Seltzer, DMD, FAGD, D. ABDSM, D. ACSDD, D. ASBA History: 1.   There is overwhelming historical evidence, both medically and anecdotal, of an increase in sleep disorder related illness affecting individuals health, morbidity and mortality as well as the effect these conditions have on learning, job performance and personal and public safety in all fields. Nowhere more is this evident than in the transportation industry. The Federal Aviation Administration, The Federal Motor Carrier Safety Administration, The US Coast Guard, the Federal Railroad Administration, and National Highway Safety Administration, to name a few, have over a decade of recorded accidents and disasters shown to be related to human error caused by fatigue resulting from poor sleep, overwhelming caused by undiagnosed and untreated Obstructive Sleep Apnea. (OSA) 2.   There are many sleep related illnesses that lead to the above-mentioned issues, however the most prevalent disease due to an increase in sedentary life styles and poor diet, as well as underlying genetic factors, is Obstructive Sleep Apnea.  It is estimated that 30 million Americans suffer from some level of this condition.  This is a condition in which an individual’s airway collapses during sleep, preventing airflow and decreased oxygenation.  The results of this stress on the body lead to, or contribute to, many medical conditions such as cardiovascular disease, increased risk of stroke, increased risk of diabetes, erectile dysfunction in men, weight gain, and poor sleep quality from repeated awakenings secondary to gasping, choking and drops in blood level oxygen.  In addition, OSA is highly associated with load snoring that impacts the sleep quality and lives of others sleeping in the vicinity of the person in question and subsequently these other individuals suffer secondary consequences of their interrupted sleep leading to their own personal issues and public effects. 3.   As serious as the medical conditions related to OSA are, and as widespread as their impact is, the remarkable truth is that this disease is easily diagnosed and in most cases completely treatable. 4.   The medical advancement in this field over the last 30 years has been incredibly successful in developing sophisticated sleep studies capable of diagnosing a myriad of sleep related illnesses including OSA.  Just as impressive are the advancement in treating these problems.  In the case of OSA just about anyone suffering from this condition can be helped if they are treated by a knowledgeable medical /dental team who are well versed in the etiology and treatment options available today. Education & Awareness: 1.  First and foremost, there is a lack of education in both the medical world and the public at large in identifying and recognizing signs and symptoms that would suggest a sleep related illness. Sadly, very little time is spent training physicians about sleep related illnesses, their effects on the body, tests available, and even more so, up to date cutting edge treatment options.  Individuals who suffer from many sleep related conditions are either not aware they have these issues or deny the severity of the effects they have on the body.  Also, most people are uninformed as to how easily most of these conditions can be cured or treated. 2.  Lack of awareness has lead to a public safety issue of undiagnosed OSA on an epidemic scale. This same lack of awareness and understanding of the ease of diagnosis & treatment has created a fear amongst many industries that identifying these problems will lead to people losing their jobs. On the contrary, identifying sleep related issues such as OSA and treating them properly is actually a win for all involved. –  Individuals will be healthier, feel better, and perform tasks more effectively and more safely. –  Industries will find improved work performance, decrease in safety related accidents, cost Savings in production and insurance. – The Public will reap the benefit of safer conditions in all industries, cost reduction secondary to savings from effective production and decreased financial  losses and insurance costs. Diagnosis: 1.  The number of patients who suffer from OSA and remain undiagnosed is staggering. 2.  This is due to lack of education on the part of the medical community and the realization that the public at large does not recognize the signs and symptoms related to OSA. 3.  There is need for better screening and understanding of the impacts of OSA 4.  Sleep testing via sleep studies called polysomnography (PSG) are reliable in diagnosing most sleep disorders and must be mandated in all industries that effect public safety. There is no room for error in this situation or excuse for bypassing it. The missed diagnosis and hence lack of treatment could be the next industrial or transportation accident waiting to happen.  It is imperative that a mindset of prevention should be the mantra of every industry.  If we recognize that most fatigue related accidents can be avoided with proper testing,  diagnosis, and treatment, there is no excuse for not having them done. Treatment Options: 1. For many sleep related issues, a treatment as simple as more hours of sleep may be the solution. In other cases it could be as simple as positional therapy ( changing and maintaining a new sleep position; side vs back), or medication may be the answer.  A simple sleep study could show the results of this. 2. For OSA , there are now more treatment options than ever.  Depending on the severity of an individual’s obstructive sleep apnea ( based on diagnosis from a sleep study called a  polysomnography or PSG) treatment may be: A. CPAP – continuous positive air pressure- provided by wearing a mask that is connected to a small air pump that delivers air under pressure to assure that one’s airway does not collapse during sleep. B. Surgical intervention – There are various surgical procedures depending on severity that can help to open an airway and prevent collapse C. Oral Appliance Therapy -These are essentially custom fit devices that a person wears in their mouth , that positions the jaw and prevents collapse of the airway when muscles relax in sleep. NOTE- these devices must be FDA cleared and should be fabricated by a knowledgeable & credentialed dentist D. Other-There are a few additional treatment modalities that have evolved including : positional therapy to help pts sleep in optimal positions to reduce OSA,  weight loss, EPAP ( nasal expiratory air pressure)  , glossal nerve stimulation ( to keep the tongue from relaxing  too much at night). These  are devices that are similar to pacemakers and are considered surgical. E. Combination Therapy – combinations of any of the above. For years the treatment options were limited and unfortunately both the medical profession and the public are not aware that many simple, easy, and  reliable solutions that  are now available. The greatest hindrance  perhaps,  was that with few choices, patients were unable to be compliant with treatment.  One example was the fact that , although capable of treating OSA, CPAP machines were and still are difficult for people to adapt to and long term use was rare as people could not tolerate them. With the advent of Oral Appliance Therapy ( OAT) , these extremely successful and well tolerated devices have proven to be far more compliant.  As a matter of fact, this is the most prevalent treatment of OSA in Europe used far more successfully than CPAP.   Even some of the inventors and original researchers  of CPAP have acknowledged and welcomed OAT as a better , more compliant, and successful treatment. These factors are not well known.  Plus , oral appliances are optimal for conditions prevalent  in most transportation industry environments. They do not require electricity, they are small and easy to transport, they take up little room in tight quarters, they require very little maintenance. Monitoring Compliance: 1.  Even more important than diagnosing a sleep disorder such as OSA, is the ability to ensure that the proper treatment solution is effective and well tolerated. Compliance is the key to delivering a healthy result and ultimately a result that provides increased public safety for industries. 2.  For years only CPAP use could be monitored utilizing recording devices that communicated with physicians as to the amount of hours the device was worn. However, due to the difficulty of using CPAP due to discomfort , many patients would tamper with the device to  “fool” it or “trick” it to show compliance when in actuality there was none. 3.  Oral Appliances have proven to be extremely successful, well tolerated, and the most compliant treatment option, yet they are still not utilized to their potential due to lack of education amongst physicians and insurance companies. There are miniature compliance recorders that can be embedded within an oral appliance to now prove compliance. Studies are showing oral appliances to be better tolerated and hence more compliant than CPAP,  yielding equal results in mild and moderate OSA. Guidelines and Recommendations; 1.  Evidence suggests that sleep related illnesses and conditions must be diagnosed and treated to insure improved health of individuals and public safety, especially in the transportation industry. 2. This should not be left to discretionary judgment.   Similar to other types of mandated testing , it should be a requirement for people who have occupations potentially effecting the safety and well being of the public at large to be mandated  that they be tested for sleep related illnesses.  (every state department of motor vehicles requires a vision test,  there is mandatory drug testing in many industries) . The tests are simple, reliable, and cost effective when compared to the industrial accidents caused by fatigue.  More over industries should be rewarded and given insurance premium reductions 3.  These tests should be conducted by qualified individuals. Preferably, physicians well trained and credentialed in sleep medicine. 4.  Treatment must be offered and delivered by trained and credentialed physicians & dentists. 5.  Individuals must prove that their treatment is effective with follow up testing and must show compliance in treatment.  There are reliable methods that will show that treatment options are working and that individuals are following treatment recommendations properly. 6.  Follow up testing must be consistent and frequent. Unfortunately, unlike vision that changes slowly over time in most cases, sleep disorders can change for better or worse in short periods of time. Simple weight gain of as little as 10 pounds can negatively affect obstructive sleep apnea. So guidelines must be in place to account for these possible changes. Other  Areas of Discussion , Concern,  and   Technological Advancement: In addition to advancements in diagnosis and treatment of sleep related illnesses leading to fatigue, it is suggested that the NTSB also look into other  technologies to prevent  “falling asleep at the wheel” such as devices that alert drivers, pilots, engineers etc that they are off course or drifting out of a normal pathway.  There should be investigation into fail-safe systems and computer assisted systems that react when , despite our best efforts as human beings to avoid fatigue related or health related disasters , the unavoidable occurs. Despite all efforts and best intentions,  there are intangible concerns that can contribute to fatigue related accidents  that will require human beings to use honesty and use good judgment .  These can include such simple issues as just not getting enough sleep and/or  having an poor night’s sleep due to illness or stress. in these cases we still need  more education and conversation to make people aware of the potential issues that can arise from their fatigue.   Conclusion: An overwhelming amount of transportation & industrial accidents are documented to be related to fatigue caused by undiagnosed and untreated Obstructive Sleep Apnea. The science of detecting and treating this disease has advanced to the point where very few people should still be suffering from its effects.  In turn, our understanding of how, when left untreated, it can cause personal life threatening health issues and public safety issues of massive proportions, it should be required that insurance companies pay for testing and there should be industry wide mandates for treatment when the public safety is at risk.

Treatment is not always over after diagnosis and fabrication. Instead, patients frequently find their way back to the office complaining about jaw pain. Fortunately, there are relatively simple solutions. Dan Tache, DMD, has pondered these solutions for the better part of a decade after leaving a traditional practice in 2008 to pursue orofacial/TMD pain treatment full time. As a diplomate of the American Sleep and Breathing Academy “ASBA” and an educational presenter for Sleep Group Solutions, Tache´ plans to share his expertise during 2018 the Sleep & Wellness Conference April 13-14 in Las Vegas. “On occasion, custom oral appliances create discomfort due to cramping muscles that cause patients to feel like their bite is off,” says Tache´. “Patients can’t chew, their ears hurt, sinuses hurt, and often patients must abandon treatment, or use it less, because of the discomfort and the fear of irreversible problems.” In many instances, dentists are ill prepared to deal with what are often simple problems. Those who attend Tache’s seminar will hear remedies, specifically ones focused primarily on the pterygoid muscles. “There are a set of stretching exercises that can reverse the pain rather quickly if the doctor can properly inform his/her patients,” says Tache´. “I will also explain the etiology and causes of the common side effects brought on by mandibular advancement devices.” After describing specific stretches, Tache will illustrate how to modify custom appliances to minimize the amount of advancement—mostly by increasing the vertical height of the appliances. “There are ways to modify the splint that uses less advancement and more modification of the vertical height of the appliance, as well as contributing to airway stability,” says Tache. “Nasal valve collapse may compel us to over-advance the mandible when we could use nasal valve stabilizing devices to augment splint therapy.” It may sound circuitous, but Tache is convinced that the logic can be effectively demonstrated, primarily because, “some airways will respond to y axis titration, or making the appliance higher, and you must know how to do that.” Tache’s presentation will be one of 16 taking place at this year’s annual conference hosted the the ASBA. To Learn More Click Here

Invitation from Dr. Kent Smith, DDS The annual “Sleep and Wellness” conference organized by the American Sleep and Breathing Academy (ASBA) is being held April 13-14 in Las Vegas, NV. Expected attendance will be approximately 600. Conference Website http://sleep-conference.com The ASBA’s annual meeting focuses heavily on practice management for the dentist, which includes building the right team, obtaining proper medical insurance, scheduling, marketing, building relationships and finding ways to grow a dental sleep practice. We have also added some incredible speakers from outside the field, such as Dr. David Berg, CEO of Redirect Health and foremost expert on healthcare coverage in the U.S., that we believe doctors will find interesting and helpful. Those of us who have practiced for a while understand the benefit of an organization that lobbies for improved reimbursements for oral appliances, while seeking to lower ever-escalating health care costs. This is one of the main reasons I became involved with the ASBA’s Political Action Committee. Of course, we’re not the only group with a PAC, but I suspect we played a small part in galvanizing other groups in the space to become more active. Whatever the case, added involvement from other groups is a positive for our industry and their members. At ASBA, our goal is to be more like a concierge Academy. We want to be directly accessible and responsive to our members’ needs. Above all, our relentless focus is to help dentists in sleep medicine become more successful. Attend Conferences, Get Out of the Office, Attend Sleep and Wellness I started to collect conference badges years ago, and now have many hung on a wall in my office. Why do conferences matter? You must never stop learning. Networking is key. Make sure you know who will be there, research them and meet them. The ASBA has an excellent clinical education program. No matter how experienced you are, everyone can learn. The educational aspect of the conference will expose you to new ways of running your practice, conducting your business better and being more productive. Networking with peers is important. The conference provides a great opportunity to network. Your fellow colleagues, like yourself are there to help. There are always new vendors and suppliers. Don’t shy away from the exhibit hall. Invest a little time and turn them into your friends and allies. Industry vendors know a lot about the current business climate. Don’t forget about entertainment and fun.  Add a layer of enjoyment to the meeting. We have a number of cocktail and evening speaker events scheduled during the conference Conference Website http://sleep-conference.com Dr. Kent Smith DDS Dr. 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. He is current President of the ASBA.

Most experts agree on an average of twenty minutes for the perfect nap. But Dr. Kent Smith, D-ABDSM, ASBA, president of the American Sleep and Breathing Academy and the founder of Sleep Dallas, says that it “depends on the reason for the nap, but fifteen to forty-five minutes is considered an optimal duration, as longer than that can put you into a REM cycle, making you feel groggy.” The trick is to avoid entering deep sleep, which takes time. This is why shorter naps are optimal. Smith says, “If you have only five minutes to nap? Go for it. Even that short period has been shown to improve alertness and certain memory processes.” Read the full article here.