Good morning. This is More Than Teeth. The newsletter that helps dental sleep professionals get 1% better every week.

More Than Teeth was founded on the belief that high-quality, actionable information should be freely accessible to all, not just those willing to spend tens of thousands. We wanted to change this narrative and committed ourselves to delivering free, fresh, and no-nonsense content for dental sleep professionals.❤️

Today’s edition covers a lot:

• Clinically Proven Ways to Increase Compliance

• The Vagel Nerve: The Unknown Super Highway

• OSA can cause eye problems?!

• Increasing Case Conversion

• What Dentists Regret About Becoming Dentists

It’s a 7-minute read today👇

Clinical Corner

🥼Use the clinical corner as your secret weapon to impress your colleagues and patients!

1/ Winning the Sleep Apnea Battle: The Latest on Oral Appliance Compliance

An extensive study has been making waves in the sleep world, focusing on strategies to bolster the use of OSA therapies among patients - we're talking about everything from education to support to behavioral interventions. The study was enormous, covering 30 individual studies and roping in 2047 participants.

And while the focus was on CPAP, we've got some exciting takeaways for us in the oral appliance corner.

Your ringside updates

1. Supportive Interventions: Don't underestimate the power of a comforting presence. Providing ongoing support led to an increase in treatment adherence, which in our case means more regular use of oral appliances. (Quality of evidence: Low to moderate)

2. Educational Interventions: Make sure your patients know the score. The more they understand about OSA and their treatment, the more likely they are to stick with it. Cue more consistent use of their oral appliances. (Quality of evidence: Moderate)

3. Behavioral Therapy: Encouraging patients to make lifestyle changes had the most significant impact. A big win for overall health, with an impressive knock-on effect for oral appliance use. (Quality of evidence: Low)

So, what do the stats say?

Now, let's chat numbers:

• Supportive interventions bumped up the number of patients using their treatment consistently from 59 to 75 per 100 and added an extra 50 minutes per night.

• Educational interventions saw a similar metric rise from 57 to 70 per 100 and added an extra 35 minutes per night.

• Behavioral therapy made a significant leap from 28 to 47 per 100 and added “just under an hour” per night.

Here's the authors' take

While all three interventions showed encouraging results, behavioral therapy led the way in encouraging adherence. However, this intervention had lower evidence quality.

In essence, it's clear that supportive, educational, and behavioral interventions can significantly help patients adhere to their OSA treatment better. The study did note that the long-term effects on factors like daytime sleepiness, quality of life, and cardiovascular risks are still under the microscope.

Your key takeaways

Try incorporating these interventions to better patient compliance with oral appliances. Remember, every patient is different, so personalize your approach accordingly.

2/ The Vagus Nerve: Key to Managing Sleep Apnea and Enhancing Health

Let's discuss a small but significant nerve - the vagus nerve.

Boosting the Beneficial Effects

The vagus nerve is essentially a brain-body superhighway, controlling essential functions like heart rate, digestion, and respiration. It's also a central player in our body's "rest and digest" response. Did you know you can enhance its performance?

Let's dive in: Studies show that the vagus nerve's function can be boosted by electrical stimulation (VNS). VNS comes in two forms - invasive and non-invasive.

Invasive VNS: A device is surgically placed under the skin to stimulate the vagus nerve. Mostly utilized for epilepsy and resistant depression, it has the potential for treating other conditions. For example, invasive VNS was found to reduce inflammation and IBD symptoms in Crohn’s patients over 4-6 months. However, there are minor risks, such as infection or breathing difficulty.

Non-invasive VNS: This carries the same benefits but without the risks. Techniques include transcutaneous auricular vagus nerve stimulation (taVNS) and cervical transcutaneous vagus nerve stimulation (ctVNS), where an electrode is placed on the ear and neck respectively.

Non-invasive VNS Benefits

What does non-invasive VNS offer your patients? Here's what the research indicates:

• 20-40% decrease in seizure frequency for epilepsy patients

• Reduced inflammatory markers in the body

• Notable relief in gastrointestinal pain, pelvic pain, and migraines

• Decreased depression and anxiety scores

• Alleviation of indigestion symptoms, IBD, and decreased inflammation in patients with gastrointestinal disease (Sounds like an airway improvement..😉)

Sounds great, doesn't it?

Enhancing the Vagus - No Surgery Needed

You don't need surgery to improve vagal tone. Certain non-invasive, lifestyle-based approaches are also beneficial. While more research is needed to validate their effectiveness, many patients have already reported advantages.

Exercise: Good for muscles and the vagus nerve. High-intensity exercise, in particular, improves vagal tone, especially in individuals with chronic heart failure. Even light exercises like walking can enhance HRV.

Breathing and Meditation: The vagus nerve controls breathing, and certain breathing practices can enhance its function. Simply making your exhalation longer than your inhalation can reduce stress, alleviate anxiety, and improve chronic pain and gastrointestinal symptoms.

Diet and Probiotics: Anti-inflammatory, nutrient-rich diets are beneficial. Fish oil supplements increase vagal tone and HRV. Probiotics can improve gut health and strengthen the gut-brain axis.

Cold Water Baths: Brief two-minute cold baths can lower heart rate, boost HRV, and enhance parasympathetic nervous system activity post-exercise. It's cool, but worth it!

Tapping, Gargling, and Laughing: Although evidence is limited, these activities are believed to stimulate the vagus nerve and improve its function.

Appreciating the Wandering Wonder

Why is the vagus nerve vital? It's the longest cranial nerve, starting from the brain stem and extending down to the neck, chest, and abdomen. It impacts the gastrointestinal system, heart, lungs, tongue, and throat and is critical to our autonomic nervous system (ANS). Its role in our well-being is substantial, and its dysfunction can contribute to health issues.

Three Easy Steps to Support the Vagus Nerve

Enhancing vagal tone can improve health, especially for those struggling with GI problems, heart disease, or anxiety. Here's how you can assist your patients:

1. Encourage exercise: From leisurely walks to high-intensity workouts, any physical activity helps.

2. Suggest deep, slow breathing: Longer exhalations than inhalations can make a difference.

3. Advocate a healthy diet: Nutrient-dense, anti-inflammatory meals and probiotics can boost vagal tone.

The vagus nerve may be a lesser-known part of our anatomy, but it has immense potential in managing sleep apnea. By utilizing interventions to boost vagal tone, we can broaden our dentistry toolkit and assist our patients in achieving better health.

Let's make the vagus nerve a win for our practice!

3/ 👁️ The Eye-Opening Link: Sleep Apnea & Eye Health

Let’s unmask the mysterious connection between obstructive sleep apnea (OSA) and eye diseases.

🎯 The Target

A recent systematic review and meta-analysis is shining light on the murky waters of OSA's association with eye disorders. The aim? To help dental sleep professionals like you not only understand but take proactive steps to prevent these related issues in patients.

🔬 The Science

Casting their net wide, the researchers trawled through databases like PubMed, EMBASE, Google Scholar, Web Of Science, and Scopus, combing studies from 1901 to July 2022.

The big questions they sought to answer:

1. Is there a significant association between OSA and the odds of developing eye conditions?

2. Can an understanding of these connections help us provide better patient care?

🎲 The Odds

The results are in, folks, and the dice don't lie. They examined eight eye conditions in relation to OSA and found varying levels of association. Here's the breakdown:

• Non-arteritic anterior ischemic optic neuropathy (NAION): The odds were highest with an odds ratio (OR) of 3.98 [95% CI 2.38, 6.66].

• Floppy eyelid syndrome (FES): Close second with an OR of 3.68 [95% CI 2.18, 6.20].

• Retinal vein occlusion (RVO): OR of 2.71[95% CI 1.83, 4.00].

• Central serous chorioretinopathy (CSR): OR of 2.28 [95% CI 0.65, 7.97].

• Keratoconus (KC): OR of 1.87 [95% CI 1.16, 2.99].

• Glaucoma: OR of 1.49 [95% CI 1.16, 1.91].

• Idiopathic intracranial hypertension (IIH): OR of 1.29 [95% CI 0.33, 5.01].

• Age-related macular degeneration (AMD): OR of 0.92 [95% CI 0.24, 3.58].

Note: All associations were significant (p < 0.001) except for IIH and AMD.

🚀 The Takeaway

Sleep apnea isn't just about catching Z's – it's associated with NAION, FES, RVO, CSR, KC, and glaucoma. 🧐 So what does this mean for youl?

1. Awareness: Recognize the signs of these eye disorders in your OSA patients.

2. Referral: Collaborate with ophthalmologists to screen and assess patients for potential OSA.

With this powerful knowledge in your toolkit, you're primed to help your patients not just sleep better, but see better too. Let's keep those peepers healthy!

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Business of Sleep

📈Better businesses = more lives saved!

Brewed Fresh for Success: Amp Up Your Sleep Practice Conversion Rates 🚀

Hope you're ready to stir up your Monday with some inspiring insights and tactical takeaways. Today, we're diving into the world of treatment plan conversion rates – the lifeblood of your practice. 🩺

📉 The Falling Numbers Game

Picture this: A friend, let's call him "Mike", runs a successful general dentistry practice in the West Coast, treating sleep apnea with gusto. But suddenly, his treatment plan conversion rates plunge from a healthy 70% to a concerning 16%. His explanation? That five-letter word we're all tired of hearing: COVID.

💪 Embrace the Hustle

But here's the deal. Despite the setbacks and the storm, we're channeling the spirit of Abraham Lincoln: "Things may come to those who wait, but only the things left by those who hustle." So, it's time to tighten your belt, set your eyes on the prize, and ready yourself to navigate the headwinds of adversity.

🗺️ Unpacking the Treatment Plan

Let's get to the nitty-gritty. Mike's practice is fee-for-service (FFS) based, catering to most dental insurances and overseen by a sleep physician. Every patient's sleep study indicates OSA and recommends oral appliance therapy. So far, so good.

⚖️ Balancing the Clinical and Financial

Think of your treatment plan in two halves: the Clinical Treatment Plan (your jam), including sleep test review, treatment options discussion, and the patient's decision to proceed; and the Financial Treatment Plan (the domain of your "Closer"), detailing the value included, payment options, and securing payment from the patient. Both are crucial, and if either fails, it's game over. No better sleep, no improved health, no increased production.

👑 Crafting the Comprehensive Treatment Plan

The aim of the Comprehensive Treatment Plan is simple: creating a value path to which the patient can easily say "yes". This includes everything from case initiation and oral appliance (with a 2-year warranty) to adjustments, titrations, and efficacy home sleep studies.

💳 The Power of Third-Party Financing

In a world that operates on credit, offering third-party financing options is a game-changer. And yes, you can afford to offer 24-month financing, especially when you control the global fee for services rendered. Here's the truth:

• 24-month financing is cheaper than a "no"

• It matches your warranty and adjustment period for therapy

🗣️ Communication for the Win

Finally, let's talk about how to seal the deal with some communication best practices:

• Who says what: Divide the treatment plan into the clinical and financial components, and handle the conversation that aligns with your strength.

• Value Building: Let your Closer clearly explain what's included in the treatment plan. No jargon. No complexity.

• Payments: List out all payment options before presenting to the patient. The closing question? "Which payment option fits best in your budget?"

• K.I.S.S. (Keep It Super Simple): The quickest way to lose a case is to complicate it. Keep it simple, score the "yes."

Ride the waves, keep tweaking, keep giving. The more you hustle, the more you'll thrive. Trust us on this one. 🌟

Something Sweet

🍭Stuff so sweet you might get a cavity..

What would you add to this list? Comment below!

Miscellaneous

😅P.S. … I forgot something

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