Author: Michael Kelley
David Gergen Interviews with ASBA Diplomate and Study Club Member Dr. Isaac LaVant
I recently had the opportunity to sit down with Phoenix based dentist Dr. Isaac LaVant. Dr. LaVant was born and raised right here in Phoenix, AZ. He began his education at Phoenix Christian High School, then went on to North Dakota State University for his undergraduate studies. After receiving a bachelor’s degree, he went on to complete dental school at Meharry Medical College, Nashville, TN. Upon graduation, he completed an intense one-year general practice residency at Bronx-Lebanon Hospital (now the BronxCare Health System). This residency is specifically dedicated to providing advanced dental training in the areas of general dentistry, full-mouth rehabilitation, dental implants, emergency family dentistry, cosmetic dentistry, dentures, and restorative/preventive dentistry. To keep up-to-date on dental treatments, Dr. LaVant takes far above the mandatory continued education hours required by the Arizona State Board of Dental Examiners. Dr. LaVant has trained with one of the best post Graduate programs at the Spear Institute; he has also earned the recognition as Diplomate in the American Sleep and Breathing Academy which focuses on airway issues, treatment of mild to moderate sleep apnea, upper airway resistance syndrome (UARS), and snoring. In recognition of his dedication to his craft, Dr. LaVant received the distinguished the following awards: Top Dentist 2020, Phoenix Magazine Top Dentist 2021, and 2023. He was also voted one of the Top 15 Healthcare Influencers in the January 2021 issue of Phoenix Entrepreneurs magazine The Amazing Outcome of the Niece My eight-year-old niece, who experiences severe seizures up to 30 times a day, came to stay at my house. Her doctors had even suggested brain surgery to help manage her condition. That night, my sister gave me strict instructions to keep a close eye on her, as most of her seizures tend to happen while she’s sleeping. There have been studies correlating the quality of sleep and breathing at night (sleep apnea) to issues connected to over-sympathetic load during sleep and intermittent hypoxia. It’s important to understand that seizures and neuropathology do have links to untreated sleep breathing issues and fragmented sleep. Continuing with the story, that night, while my niece was sleeping, I heard her breathing. It sounded almost exactly like the voice of “Darth Vader”—heavy and labored. It startled me, so I kept going into the room to check on her. I was so concerned. I eventually woke her up to see if she was okay. Unfortunately, She was so used to this exhausting routine. She then, calmly told me, “It’s okay, I’m just having a seizure.” I asked her, “Is this how you usually breathe at night?” and she replied, “Yes.” The next morning, I told my sister, “I think you should have her airway evaluated.” Even without formal evidence and testing, it was clear to me that she had serious airway and breathing issues. She wasn’t getting enough oxygen, which could be contributing to her seizures. Coincidentally, I was attending an ASBA conference at the time, so I consulted with several colleagues about my niece’s condition. Knowing that sleep could affect her seizures, I asked around for advice. The doctors and experts I spoke to have all recommended that I suggest to my sister that she take her to see an ENT specialist. The family contacted an ENT to have her adenoids and tonsils examined. Surgery was later scheduled, but I continued searching for answers and persuaded my sister to have her airway evaluated to understand how it might be affecting everything. The ENT examined her and noticed her enlarged tonsils, observed that she breathes through her mouth, and saw that her tongue even hangs slightly outside her mouth because she can’t get enough air. Naturally, surgery was highly recommended. Surgery Surgery was scheduled, and a couple of months later, her tonsils were removed. Almost immediately, her breathing became much quieter. My sister, who was used to hearing her daughter’s breathing from across the hallway, now found herself going into her room frequently to check on her. In addition to the quieter breathing, her seizures significantly decreased. Although she was still experiencing multiple seizures, averaging 8-10 per week, my sister felt this was a positive step forward. ASBA Study Club I attended a second ASBA conference, where I had a discussion with Dr. Suzanne Mericle. She encouraged me to continue exploring treatment options for my niece. Dr. Mericle introduced me to David Gergen, and I arranged for my niece to see him for an evaluation. During the examination, it was clear that her mouth was very narrow and needed to be expanded. I explained to David that, thanks to the surgery, her seizures had significantly decreased from 30 per night to a more manageable 8-10 times per week, and her mother was relieved with this progress. However, a new issue had emerged: she had become a mouth breather, with her mouth always slightly open and her tongue pushed forward. This led to a rash on the side of her mouth, as excess saliva was frequently escaping, even to the point where a scar was beginning to form. The next step was to focus on getting her mouth to stay closed and encouraging nasal breathing to increase nitric oxide production and improve blood flow to the brain. Those principles of myofunctional therapy and doing myofunctional exercises were so important. Expansion Therapy My sister started using mouth tape and nasal strips, along with some myofunctional therapy, to help her keep her mouth closed and breathe through her nose more consistently. Working with David Gergen, we fitted her with an expansion Schwartz appliance, to further assist in widening her airway. Outcome Two months later, I saw my niece at a family birthday party, and she looked like a completely different person. Her mouth was now closing naturally, she was breathing through her nose, and her midface was beginning to develop. She had lost some weight and overall appeared much healthier. I asked about her seizures and learned that they had decreased from 8-10 events per week to about half that number. Her father came over and invited us to dinner. As a way to say thank you, during the dinner, he expressed that this was by far the best thing that had happened to her. He said, “The treatment and advice you’ve given her has changed her life.” While she still has seizures, her quality of life is so much better. Actually, she is now is a whole new world. I’m happy to report she looks like a normal little girl.” ASBA Study Club I am now a member of the ASBA study club as I continue to pursue further education and training. ASBA is an important part of the future of sleep medicine. The Academy works inter-disciplinary, bringing together physicians, dentists, myologists, chiropractors (SOT/AO) and physical therapists all together working for a common goal of improving sleep apnea awareness, treatment, and education. I highly recommend it to other doctors who are looking to specialize in sleep medicine.
My Career and Life in the Lab by Chris Morrison
I will begin my story at the time when David Gergen moved back to Arizona from Texas. He bought a house in my neighborhood. I was only 12 years old back then. David had a basketball court in his driveway, and he would be outside shooting jump shots and playing basketball by himself mostly. One day, I walked down the street to introduce myself, and he invited me to shoot baskets along with him. Little did I know, this encounter would form my life & my career and have a major influence on my life goals through adulthood. My father, Rick Morrison, was a school teacher in Arizona. He was very strict on me with my grades but also a caring and wonderful dad. He wasn’t a “traditional school teacher,” as he had long hair and looked like a hippie; it was actually appropriate for the time. Needless to say, as one can imagine, the music around the Morrison household music was a lot of the Grateful Dead ,Tom Petty, John Lennon, The Beatles and Bob Dylan. So much to my surprise, the music David was playing while we were shooting was quite similar— that of John Lennon , The Beatles ,Tom Petty and Bob Dylan. David Gergen was definitely an athlete. He had long blonde hair like my father, but nobody was going to call him a hippie. Because of his athletic frame, he looked like an athlete with long hair. For me, this was important because I’d always thought of my father as a hippie for having the long hair with the type of music he listened to, but then, there’s David Gergen, our new neighbor, who was quite the same except he’s clearly an athlete and very physically fit. So, this was a game changer for me. I realized people can look different but still be very similar in other ways. That notion really expanded my mind, and it was important for me at that young age to realize these things. David Gergen had lived in that house for 3 years, and he gave me my very first job. I was a delivery driver for Gergen’s Orthodontic Lab. David also became friends with my father, and they would talk on the phone often. They had a lot more in common than I ever knew at the time. They both expected excellence in everything they did from teaching school to making Orthodontic Appliances, and they instill that into me profoundly. That sense of excellence carried over into my life and my career. Moreover, the similarity that David and my father also built character in me; they’re two of the kindest people one can ever meet and they’re both very giving individuals. They believe in doing right by others and holding to the highest standards. After the summer was up and I had to go back to school, I worked at the lab part-time until graduation. I then took another job at a steel mill and I worked there for a little while. The pay was better, but I didn’t see a whole lot of opportunity there. I had relatives on the Police department and also at the Phoenix fire department. That whole time, the words of the man I admired most and my father also rang them into my head were, “son, stick with David Gergen and you will go places. He is a winner and he will take you with him wherever he goes. He’s a person who understands loyalty and that is the most valuable thing a person can have.” And, I learned that David truly is extremely loyal, and “will take you with him.” As father knows best, that was also the best advice my father ever gave me. At Gergen’s, we have a very strict policy about always doing the right thing. We always tell the truth, and own up to it when we make errors. But, we also learn from those errors and we dedicate ourselves to turning the appliances around in a timely manner ; that is so important to us. We have a 10-day turnaround policy, regardless of the appliance. At Gergen’s, we believe in door to door 10-day service. Over the years, even with our excellence in a 10 day turnaround timeframe, it’s very sad how many people have died while we had their sleep appliance ready to be shipped back. We will get calls with doctors saying, “sorry the patient passed away …” and that really hits home! That really affects people when you’re living it! We are thinking about their entire family, too. You feel the importance of turning the appliances around quickly and timely, as these are people’s lives we’re talking about! At Gergen’s, we’ve worked with some of the world’s finest orthodontists. Dr. Ricketts used to come in all the time and so did Steve Sabatino, Ron Roth and Paul Serrano. These are some of the finest Orthodontists who ever lived. Those guys absolutely demanded excellence and perfection. Believe me, we very much aimed to please them. David did all the TMJ and the Sleep stuff in the second half of his career, so that left me in charge of all the Ortho. Dr. Paul Serrano and Dr. Steve Sabatino, who are also both personal friends of David, demanded that level of excellence, so the pressure was on to always do an exceptional job. As I worked my tail off to impress them, I had been appointed head of the ortho department. Additionally, what I learned from working so closely with the two pioneering gentlemen is how much they cared for their patients. Both truly cared about doing the best possible job that they could do. David always pointed it out to me that in all the years he has known them, he’s never seen one of their cases relapse. Not a single case! I learned so much from working with them. For example, I learned the importance of why a lower Hawley needs a double tuck to make it fit properly and the importance of relieving the acrylic on a wraparound on the distal of the sevens to allow settling . Over the years, it became very evident to me that these guys care so much about their patients, and it’s not surprising that both of them are recognized as incredible orthodontists in our nation. In the spring of 2012, David called a very important meeting with me. His cousin Jason Wilson (the head of the sleep division), his son Johnny ( the head of the retainer division), and his son David (who was running the Illinois operation at the time) were all present at the meeting. He took us out to Ruth’s Chris steakhouse for dinner, and he said he had a big announcement: that he was going to be making some extremely significant changes inside the company. At the dinner he said, “I’m going to be leaving the lab to pursue the National Football League. I have to do this, and I can’t stay at the lab in order to pull it off. It needs to be a full-time commitment on my behalf, and over the next few months, I’m going to be choosing one of you to be the lab manager and to run this company.” I must admit I felt that I was best for the job, but at the same time, I was worried there was a lot of nepotism going on: his two sons and his cousin were members of his family , and I was the only non-family member. He said he would weigh personal relationships with girlfriends, wives, and friends who we associated with. These were all factors that must be considered, because they’re very important when making a big management decision…. family and friends can be a great asset, but they can also be a huge deterrent. I felt this was an opportunity that I had to put every ounce of my energy into, because I just knew Dave would land the NFL. He always gets what he sets his mind on. My father’s words rang through my head. “Dave will always treat you fairly. That’s just the sort of guy he is. He’ll choose talent and skill over family considerations. He wants the Company to thrive, and not go bankrupt like so many companies that have been mismanaged due to nepotism and bad personnel choices. Some have clearly chased money instead of what’s right for customers, doctors and patients. Ultimately, he chose me, he left me in charge of the entire laboratory. The entire company was a 20 million a year endeavor. It never had a sales person ever! It was only built on Dave’s reputation for punctuality and making the highest quality work in the industry (both sleep and orthodontics). So I thought to myself, everything will remain the same. I can leave everybody in the places that they’re at. We’re just not always going to have Dave in the building, but he will still be there for communication and things along those lines. See, David Gergen is by far the finest technician I’ve ever seen in my entire life. Having Dave in lab is like having four or five excellent excellent technicians! He’s that good, and he’s that fast. I had to take over the sleep division as well, and that’s when I genuinely felt the compassion and the empathy of people who suffer with sleep apnea. It’s a terrible problem, and I started working with some of the finest sleep apnea doctors in the country. The Dental icons, Dr’s Harry Sugg , Allen Bernstein and Elliot Alpher stressed the importance of turning the appliances around quickly because they told me, “these patients are experiencing a difference between life and death,“ and there has been a number of patients died while the appliances were still in the lab being fabricated. And, that only had to happen to me one time in the past before I realized the fact that “I must knock these things out faster and faster with quick turn around as this comes to a life and death matter and can very well mean that.” Unfortunately, all 3 of those gentlemen have passed, and I have been taken it all in — I tell myself, just in the past few years, their losses to this field are immense, their impact on my life will never be forgotten, and they were so powerful, genuine and great people. And just when I thought there were no more people like Dr’s Sugg , Alpher and Bernstein, then Dr. Jerry Hu walked right into my life. When Dr. Hu walked into my life, I immediately thought of those three great men. He is a man who demands excellence. He demands perfection, and he strives to be the best. He is an outstanding cosmetic dentist, and he also has an incredible understanding of pediatrics and orthodontics. Just the other day, he told me that the Herbst is the workhorse in the dental industry for mandibular advancement – oral appliance therapy. He said, “that’s hands down the best oral appliance,” and he hadn’t been a customer of ours until late, but after he used ours, he said “oh my God, your Herbst is so much better than that the other labs!” He continued, “it’s just crazy how much better it is.” And, I explained it’s because of the bites that he took and the records he took. Dr. Hu is a perfectionist and that translates to everything we do here, as we are different here at Gergen’s than other labs. You see, Dave has worked with the world’s finest doctors, and he’s an artist himself. So, everything he does has that artistic touch to it, and he taught it to all of us how to figure the path of draw in the appliances we make. Furthermore, the splints he made were the Ricketts splints, and they were started with Dave working with Dr. Ricketts. And, as well as bionators and functionals, obviously, with all of them being done with Dave’s techniques. They were all with Dave who originated them, and he taught those techniques to me. Therefore, it’s been so great working with a guy like Dr. Jerry Hu who understands the techniques and clearly appreciates it. He sends to me pictures of the VA patients, some even disabled, who he had been working on, and their successes. Showing me the results in their sleep study using my appliances, that gave me goosebumps down my spine! He told me how easy the appliances fit, and it’s because they’re not having a machine just arbitrarily pick an undercut setting, and it’s so much better at Gergen’s as the appliances are hand done and evaluated with the human touch. He also thanked me that everything at Gergen’s is handmade with that artistic talent and flair to it! He can feel and see the difference! He said, “it’s like night and day to me and my patients are very happy, especially the TMD ones because unlike other labs who don’t know what they’re doing when they use dorsal fins that lock up the joint in pain patients, Gergens Lab knows how to properly design the right type of oral appliance.” Furthermore, we at Gergen’s really like helping our veterans! We like helping people with excellent turnaround time, and we feel that it is ridiculous for timeframes longer than 10 days for such a serious medical issue of sleep apnea. It is so great to have doctors that feel the same way. Dr. Hu understands the value of commitment, excellence, and loyalty. We at Gergen’s embrace those same principles and we earn that genuine trust from talented doctors like him. Moreover, that is why we have earned the dedication, respect, and loyalty of our customers; and, that is why I love my career at Gergen’s Orthodonic Lab. Dr. Hu reminds me so much of the late great Dr. Harry L. Sugg. Dr. Sugg had at one time the biggest dental practice in the entire United States with 26 operatories under one roof and 13 associates. He was a dental icon. Recently, Dr. Hu was invited to be the keynote speaker at the Asia Pacific Dental Sleep Fellowship Meeting in Singapore. With all the accomplishments Dr. Hu had done in his life as a dentist, the entire Continent of Asia and including Australia, had their leaders show up at the fellowship meeting to work with him in collaboration and dedication in shaping the future of dental sleep medicine worldwide. I am honored to work with him because he puts in all the hard work, dedication commitment like Dr. Sugg did, and those principles also completely match what we value at Gergen’s lab. Given the important responsibilities that Dave had assigned to me, I get why it’s important to value the people who understand loyalty and truth in hard genuine work. When Dave went through COVID, I remember that David had two variances of the COVID-19 virus in his body at the same time. He had both the Delta and the Texas El Paso variants. The El Paso one attacks the heart. It sent his heart into a-fib and if that wasn’t enough, he also had the Delta variant at the same time. At a less than 1% survival rate, it seemed like he had Mt. Everest to climb. So, David had to fight for his life with the virus attacking his body from his lungs to his heart. During that time, it was very disheartening to see the lab accounts that had left. Those doctors and colleagues didn’t even bother to ask how David was doing. These were people he thought were his friends, and now, I see that he was wrong about all of them! His true friends, however, like Dr. Harry Sugg and Mr. Collins were the opposite. Dr. Sugg started prayer groups all around the country for David. Remember, he was in the hospital for about a month, being intubated and on a ventilator. Dr. Harry Sugg never gave up hope, neither did Mr. Andre Collins, the executive director of the NFLPA. Mr. Collins to this day is also one of David’s very best friends. Dr. Suggs had amassed a giant prayer group for David with over one thousand people. When Dave came back from COVID, he sure as heck did so with an awakening of who his real friends were! He literally “died a few times” along the way, but he came back each time. I am so grateful he’s here with us today. I learned something then, and that’s all about priceless relationships we develop and foster with those who hold true to the core values that our lab embraces. We all live one life, and I can see why David Gergen values Dr. Hu so much. They both strive for excellence, and they both understand the meaning of friendship and loyalty. Chris Morrison Head of Orthodontics, Gergen’s Orthodontic Lab
Personal Journey On Sleep Apnea And Obesity. By: Jerry Hu, DDS, DASBA, DABDSM, DACSDD
When I was overweight, untreated sleep apnea was the root cause. Like many with airway issues that impact growth, I was never breastfed as a baby and was a traditional mouth breather during early childhood. Additionally, I had the classic allergies and forward head posture commonly seen in children with airway problems and/or sleep breathing disorders. After my family immigrated to the US, my parents worked tirelessly to provide the “American Dream” for my brother and me. My diet often consisted of fast food, processed meals loaded with preservatives, and the unappetizing lunches served at school. This Westernized lifestyle, combined with poor nutrition, contributed to my snoring like a freight train. In fact, my whole family snored, and we used to laugh at the noise we made throughout the night. Little did I know back then, that quality sleep was crucial for my overall well-being, health, and potential to excel every day. Despite my strong work ethic and drive, which led me to earn scholarships and grants to attend the University of Michigan’s Preferred Admissions Program, my health struggles were significant. The program allowed only two students per year to be accepted and enabled me to become a full practitioner dentist at age 24 with both DDS and BS degrees. However, life was far more challenging than it needed to be due to sleep apnea. Before I became an expert in sleep medicine, I had no idea that my health issues stemmed from poor sleep. From waking up frequently at night to working twice as hard in school to achieve excellence, every activity and project was unnecessarily difficult. Even during dental school, where sleep medicine wasn’t taught, my lack of knowledge about proper sleep and nutrition worsened my health as stress increased. I became a “stress eater,” and my eating frequency and poor food choices exacerbated my health issues in a vicious cycle. Daytime sleepiness forced me to push myself harder, knowing I aimed to be the best in my field. Throughout my life, I tried almost every diet plan and exercise program available. Without understanding the importance of proper sleep and the impact of leptin and ghrelin, my weight fluctuated despite various programs. From Atkins and Paleo diets to exercise routines like “P90X” and Shaun T, I would lose weight only to gain it back. Stress levels and abandonment of these regimes made it even harder. Even as a nationally award-winning cosmetic dentist, I often needed naps during the day. I now wonder how much more I could have achieved if I had started my career with knowledge of sleep medicine. After gaining credentials in various cosmetic and implant dentistry academies, I opened a second clinic in Anchorage, Alaska. As the business grew, so did my stress and health issues. I had uncontrolled hypertension, which required multiple medications, and intense GERD, for which I relied on Nexium. My sleep was fragmented, and I was well over 350 pounds, with blood panels showing alarming cholesterol and triglyceride levels. The cycle seemed to be spiraling toward early death, and I knew something was missing. My employees, friends, and family were concerned about the risk of a sudden cardiovascular event. It was then that dental sleep medicine saved my life. Reflecting on it, I also believe I extended my parents’ lives by addressing their sleep apnea issues. None of our primary care physicians or healthcare providers discussed sleep with us, and their answers never involved questions about our sleep quality. I learned early on that “what we don’t know, we don’t know.” I don’t blame the primary care physicians, as their medical and dental education in sleep medicine was minimal. Evidence-based literature now shows a myriad of serious systemic problems stemming from poor sleep quality, but it is encouraging that awareness is growing. New medications like Ozempic are also helping people with weight loss and other issues. When I first learned about sleep medicine, I began with my own sleep study. The results revealed an RDI of 38 and frequent oxygen desaturation into the low 80s. I was in sympathetic overload every night, and I was unaware of how detrimental this was to my overall health and recovery. Additionally, acid burns and erosion of my teeth, along with terrifying sleep bruxism, contributed to my misery and stress. As I am CPAP intolerant, I delved into treatment options in dental sleep medicine. I urgently needed a customized oral appliance, and as I pursued triple board certification in DSM, I also incorporated myofunctional therapy and expansion appliances. All these appliances demonstrated benefits, such as increasing mitochondria in cells, which led to more rapid cell turnover, improved metabolism, and more profound weight loss. Achieving quality N3 slow-wave sleep and 25% REM sleep allowed me to conquer my weight issues in addition to my sleep problems. I challenged myself further by enrolling in a three-year Jinen Ryu Okinawan Karate program to attain a black belt. Overcoming childhood struggles and self-esteem issues, I told myself, “I can do this.” The journey was incredibly challenging, but as I lost weight and gained energy, I found the progress in weight loss and strength astonishing. Achieving my black belt involved enduring grueling tests, including an eight-hour endurance test. Afterward, I felt immense pride in my achievement. With my new physique and muscular build, I gained confidence and was even approached by the Hell’s Angels. It has been amazing working with Angels’ President, Brian Cey. I conquered the uphill struggle and demonstrated that perseverance can lead to transformative results. The black belt gave me not only confidence but also clarity about my calling: to make a difference in sleep apnea education, awareness, and treatment. After losing over 135 pounds, my RDI dropped to 4.8, and my oxygen levels remained above 90. My health improved dramatically, with all my panels returning to normal ranges. I hired a personal trainer, a retired army ranger, and achieved impressive physical feats, including 20 pull-ups in a single gym session. I wish I had the health and body I have now during grade school, as I could have excelled in sports. Reflecting on my journey, from learning about sleep medicine to enduring intense physical challenges, I recognize how it all connects to my calling. I am committed to educating others and spreading awareness about sleep medicine and treatment. Before After
Dear members and colleagues of the American Sleep and Breathing Academy (ASBA),
As the President of the Academy, it is important to inform our members about significant issues as they emerge in the field of dental sleep medicine.Part of the mission of the ASBA is to empower our members to reach their fullest potential by providing unbiased education, research, and training. This commitment translates into the high level of service and excellence that our members bring to their patients.As many of you know, with the proposed changes to oral appliance therapy (OAT) reimbursement and the reduced availability of CPAP machines, OAT companies in the field wish to position themselves as leaders in an effort to either capture market share or simply stay afloat, as these are difficult times.Therefore, we encourage dental sleep specialists to moderate from any excessive promotion of any one company as “the best in the industry” or making claims that “no other has done more for this industry” as these statements are difficult to substantiate and could be misleading or misunderstood; especially when discussing a company that has unfortunately filed for Chapter 11 bankruptcy. You can read about it here.NorthStar Orthodontics and Smile Direct have not been able to stay in the field after similar steps, leaving cases in mid-process to be locked up and thrown away; Hurting both providers and patients.Other companies, such as Vivos, have received approval for using OAT to treat patients with severe sleep apnea. Additionally, individuals like Dr. Robert Ricketts, Dr. Thomas Meade, David Gergen, Dr. Wayne Halstrom, Dr. Timothy Adams, and Dr. Dave Singh can all claim some level of recognition for their contributions to advancing our field.We encourage responsible community members to actively use social media to promote their practices, but always in a way that respects others.As always, we want each doctor to do their due diligence and look at the history, the experience and evidence of any laboratory they select. There are many options to choose from.As a physician in this field, I notice my colleagues evaluating whether to strengthen their collaboration with dental sleep specialists to advance OAT, or wait to intervene if those efforts begin to falter.Rodolfo Ferrate, MDPresident, American Sleep and Breathing Academy
Call to Action! Read about Possible Changes to Medicare Reimbursement
Call to Action! Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments Read about proposed changes by Centers for Medicare & Medicaid Services to Medicare Reimbursement for Custom Oral Appliances issued on July 31 2024. ASBA and our medical partners believe that Medicare should continue to cover OAT under the DME category. Reclassifying oral appliances from DME to Physician Services could potentially lead to reduced reimbursements.” The Academy’s philosophy has always centered on the principle of “what is best for the patient!” This focus also extends to supporting our doctors, ensuring they can uphold the core of our mission: prioritizing the patient through clinical excellent. David Gergen ASBA CEO and original PDAC contributor in 2012 has contacted his namesake David Gergen Political commentator and former Presidential advisor, a friend of the Academy to engage with our Political Action Committee. Former Attorney General for the Sate of Arizona Mark Brnvoich is spearheading the outreach to CMS to arrange for an in-person meeting to present the case. ASBA members, you need to be heard! Although studies examining the impact of public comments on decisions made by the Centers for Medicare & Medicaid Services (CMS) are very limited. We believe it’s crucial for dentists to submit their comments, as the Government Accountability Office mandates that all public comments be reviewed. Comment from organizations, academies, and societies are taken more seriously, which is why it’s crucial for the AADSM, ACSDD, and ASBA to take a strong stance in supporting dentists. Additionally, on a serious note, this is a great opportunity to weigh in and share your expertise with influential policy makers. Please consider submitting a comment using this link: https://www.regulations.gov/document/CMS-2024-0256-0045/comment Important Date Deadline for comments is 5:00 p.m EST September 9, 2024. CMS-1807-P is the designation for the proposed rule released by the Centers for Medicare & Medicaid Services (CMS) regarding the Calendar Year (CY) 2025 Payment Policies under the Physician Fee Schedule (PFS) and other related changes. Proposed Rule Changes for Medicare Reimbursement for Custom Oral Appliances: As part of the proposed rule CMS-1807-P, specific changes are outlined for Medicare reimbursement concerning custom oral appliances, particularly those used to treat obstructive sleep apnea (OSA). HCPCS Code E0486: Current Use: This code is used for custom-fabricated mandibular advancement devices designed to reduce upper airway collapsibility. The device must meet specific criteria, such as having a fixed mechanical hinge and the ability to adjust the mandibular position incrementally Your comments can make a difference by giving the government the facts about dental sleep!
Evaluating Facial Asymmetry and the Relationship of the Maxilla to Cranial Bone Restrictions: A Case Report Utilizing a Homeoblock Dental Appliance
Timothy C Adams DDS Looking at Facial Asymmetry from a Dentists’ perspective is often overlooked due to the way we are trained to view and treat our patients. The importance of understating this facial asymmetry has a profound effect on the patient’s entire health. It is important to recognize these patients and treat them where possible since it has dire consequences on their whole-body health. Realizing that many of our patients are suffering from TMD, Airway and Neurological symptoms is the beginning of recognizing how powerful and impactful treating these patients can be with a dental appliance. It is a well-known fact that posture does dictate airway and neurology. To better understand this relationship of Posture, Airway and the Autonomic Nervous System requires a reacquaintance of basic anatomy and in particular cranial bones. The human skull consists of twenty-nine bones. Eight bones are in the cranial system, fourteen bones in the facial group and seven more bones consisting of the inner ear and the hyoid bone. The cranial bones have movement dictated by their sutural anatomy and pressure from the cerebral spinal fluid (CSF) which is pumped throughout the spinal cord and brain within the confines of the dura. This CSF is critical for oxygenation and nourishment of the brain and spinal cord, eliminating toxins and cooling the pituitary and hypothalamus which is critical for hormone regulation. The cranial bones are grouped into whether they are paired or midline bones depending on whether they cross the midline or not. When we look at the face, the skin is supported by fat pads and bone. When we remove the skin, fat pads and look at the position of the cranial bones we start to notice a pattern of asymmetry. Due to many factors such as sitting in the pelvic girdle for 9 months before birth, the journey through the birth canal, C-sections, diet, and the lack of breast feeding can all influence cranial bone positioning and cranial facial asymmetry. Since dentists deal with the oral cavity and are trained to compartmentalize the parts of the body, we fail to realize the connection of the maxilla to the rest of the body. The maxilla is a paired set of bones that is connected to the paired palatine bones which subsequently interlocks into the sphenoid bone. The sphenoid bone is the central cog of all the cranial bones, just like a central cog to a watch. It is shaped like a swallowtail butterfly with a greater and lesser wing. The greater wing of the sphenoid is the back of the orbit of the eye (ocular asymmetry). The significance of this relationship of the maxilla to the sphenoid bone is critical to understand. If the sphenoid bone is the central cog of all the cranial bones and the maxilla can impact the sphenoid bone indirectly via the palatine bones, then leveling out the maxilla can have an impact on the whole cranial system. Figures 1,2 Of the ways to accomplish this leveling of the maxilla, I have used in this case report an appliance called the Homeoblock appliance. The premise of utilizing this appliance is that its’ design allows for changes to occur in the cranial bone positioning. Our body is designed to be a closed loop kinematic skeletal chain. Within this closed loop system there are two openings, The arch of the feet and bite. At the end of each swallow cycle the teeth come together which can be more than 2000 to 3000 times a day. When the teeth come together the loop is closed or locked in. This locks the whole system into this closed loop kinematic skeletal chain. So, any adjustments that are attempted to be made with the cranial bones are locked back in the skeletal system at the end of each swallow cycle as the teeth come together. This demonstrates the power that dentists have to help the health care TEAM unlock and free up the restricted cranial bones, thus affecting facial asymmetry and the rest of the posture, airway and neurology. The Homeoblock appliance has numerous features that are unique to its’ design. The main feature that I will focus on is that the appliance only allows the patient to bite on one side. This block on just one side is critical to how it affects the closed loop system by creating a gap or space to allow for the restricted cranial bones to be freed up. This can have a major impact on these patients being treated for TMD, airway and Autonomic Nervous System challenges. Since posture dictates airway and neurology, many symptoms of TMD and airway restrictions can be helped by improving the facial asymmetry of these patients. CASE REPORT A 37 year old female patient came into the office as a new patient. After a new patient exam and further questioning the patient alluded to the fact that she has many symptoms of TMD and has been treated with 7 different TMJ appliances over a 10-year period of time. Her symptoms included: headaches, sinus issues, cervical issues, ringing of the ears, dizziness, jaw clicking and popping, forward head posture and tight facial muscles. She was seeing a Chiropractor on a weekly basis. The patient was treated with a Homeblock appliance for 20 months. We utilized Analyze 14 software designed at the Mayo Clinic to evaluate and measure the changes noted below. Figures 3 and 4: There are 7 cranial strain patterns recognized in the chiropractic world. 4 are physiologic and 3 are pathologic. In my observation this patient fits the left side bending pattern which is designated as a physiologic cranial strain pattern. NOTE: A special thanks for the work of Dr. Jonathan Howat and Dr. Bob Walker. The lines used to demonstrate facial asymmetry features were originally designed by Dr Bob Walker to be for boney reference points (Triplanar Analysis). The supraorbital notched representing the orbital plane, the external auditory canal representing the otic plane and the maxilla / occlusal plane relating the teeth to the cervical plane. I have modified this by estimating where the boney reference points are on the soft tissue and have added a vertical line that runs down the center of the forehead through the philtrum of the lips. Improved symptoms after 20 months of wearing the Homeoblock appliance at night only. Sinus issues are no longer a symptom. Headaches are totally gone. Had originally tried 7 different appliances over a 10-year period. Cervical issues are now nonexistent. Clicking and popping nonexistent. Jaw does not shift like it use to. She saw a Chiropractor every week. At about the 3 month mark her Chiropractor noticed a big improvement and recommended seeing her every month. She now goes about every 3 months. The muscles of the face are much more relaxed. Feels like her bite has a place(home) to go to. No longer struggles to bite her teeth together. Snoring drastically reduced as noted by her husband. Thrilled with her new face rejuvenation. Symmetrical and more natural looking. “Never dreamed an appliance could give these results”. CONCLUSION The Homeoblock appliance is a unique and valuable tool for dentists to have in their armamentarium. It is simple and comfortable for the patient to wear and very easy for the dentist to use as there are minimal adjustments needed. I recognize in dentistry that there are many ways to get from point A to point B in the clinical arena. This is one of my appliances of choice because it addresses the root cause of the symptoms by affecting posture, airway and neurology. So, the band aid approach of many appliances (treating the symptoms) on the market can be addressed and allow for the root cause of the symptoms to be addressed and treated more ideally.
Voting to begin for 2025 Lifetime Achievement Awards and Induction into ASBA Hall of Fame
American Sleep and Breathing Academy “ASBA” Lifetime Achievement and the ASBA Hall Of Fame Awards Hall Of Fame The ASBA Hall of Fame, established in 2008, honors members who have made significant, substantial, and long-standing contributions to the field of Dental Sleep Medicine and to the Academy. Inductees are recognized for their career achievements, sustained commitment to advancing the profession, and significant contributions to the field, all while maintaining a high level of professionalism among their dental and medical peers. Awards The ASBA Awards are inclusive and open to clinicians who have made significant contributions to the field of dental sleep medicine. The 2025 Lifetime Achievement Awards will be presented at the Sleep & Wellness Conference on April 4-5, 2025, in Houston, TX, with honorees being inducted into the Hall of Fame. Nominees Click here to view list of nominees Nomination Process Each year, the Executive Board and active Academy members who are also prior Hall of Fame inductees participate in the voting process with the following breakdown of votes: An Executive Director and two Executive Board members, comprising a group of three individuals, have the authority to nominate a minimum of three candidates, with the option to nominate additional candidates. The current ASBA President is allowed 3 nomination votes Active prior Hall of Famers get 2 nomination votes; however the immediate past Hall of Fame winner(s) from the prior year will get an additional 2 nomination votes (totaling 4 nomination votes). Once the candidates have been confirmed by the Executive Board, all ballots will be emailed exclusively to current and active members. Voting 1. Existing Members: Every ASBA member in good standing receives three votes for the election: one vote for their first choice, a second vote, and an additional third vote as a benefit for being a member for multiple years with the Academy. 2. New Members: Newly active members not in the “existing members “ category will get 2 votes, and one vote per individual candidate (not 2 for same candidate). The Ballot must have 2 votes on it or it will be nullified. 3. Election voting ends January 31 2025. (Any Candidate receiving more than 250 votes will be inducted into the Hall of Fame of ASBA) Top 2 Candidates with the highest tally of votes will be inducted in to the American Sleep and Breathing Academy “ASBA” Hall Of Fame Nominees Click here to view list of nominees
Will Inspire remain an Innovative Alternative to CPAP?
As many are aware, Inspire medical’s sleep apnea never stimulator was issued with a recall earlier this year. FDA Definition: A situation in which there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death. The FDA has elevated a recall of Inspire Medical’s nerve-stimulating implant for the treatment of obstructive sleep apnea to Class I. https://www.fda.gov/safety/industry-guidance-recalls/recalls-background-and-definitions Here is an extract from a recent report in fiercepharma: The FDA issued a Class I recall for Inspire IV implantable pulse generators due to a manufacturing defect that could cause “electrical leakage,” leading to fast battery drains, weakened therapy, or potential shocks. No injuries or deaths have been reported. The recall began on June 17, with healthcare providers and patients advised to schedule checkups. A noninvasive diagnostic process can identify the defect, but some devices may require revision surgery. The device, implanted near the collarbone, helps keep airways open during sleep by stimulating hypoglossal nerves. In June 2023, the FDA expanded the device’s use to more patients, and by May, 1,250 U.S. medical centers were offering the therapy. Then again the healthcare technology report informs that Inspire Medical Systems has secured FDA Approval for Next-Gen Neurostimulator as of early August. Inspire Medical Systems Secures FDA Approval for Next-Gen Neurostimulator. What are the negatives of Inspire sleep? Besides surgical risks, some people may experience discomfort or unpleasant side effects from the Inspire sleep apnea device. These may be sensations like dry mouth, tongue discomfort, or feeling aware of the device. Can Inspire sleep be removed? It is possible to remove Inspire through a special surgical procedure. Can you feel the Inspire device? A patient can expect to feel a tingling sensation, or mild contraction in their tongue muscles. What are the negatives with Inspire? The most common side effects associated with Inspire treatment are tongue abrasion, mouth dryness, and discomfort stemming from the nerve stimulator. Some people experience muscle atrophy and partial tongue paralysis. What will be the impact? A recall can sometimes undermine providers’ confidence in the safety and efficacy of the device. As a result, patients might explore other alternatives, such as oral appliance therapy (OAT) and positive airway pressure (PAP) therapies. In response to the original question, “Will Inspire remain an innovative alternative to CPAP?” the outlook appears highly favorable for Inspire Medical Systems. The growing demand from patients who discontinue using CPAP and actively seek referrals for hypoglossal nerve stimulation surgery indicates strong, patient-driven interest in this alternative therapy. Sources: FierceBiotech Image copyright Inspire Medical Systems