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Good morning. We’re grateful that you’ve joined us for your weekly dose of what matters in the wild world of dentistry. Let’s get into it.
 

Gimme a break: British dentists have declared war on…. Kit Kats? And they aren’t alone. Food giant Nestlé recently introduced a line of ‘nutritious’ cereals targeted at kids, including a new Kit Kat variety. While presumably tasty, the British Dental Association and 10 other health bodies were shocked to find out a single bowl was 25% pure sugar - an entire’s day’s worth in just one serving. No wonder they taste so good.

In today’s edition:

• Prevalence of OSA in down syndrome

• Why? Answer, craniofacial characteristics.

• Treatment options for those with down syndrome

• 7 pitfalls for dentists treating OSA

• Vivos Therapeutics makes history

6 minute, 25 second read time today👇

Clinical Corner

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

Key Takeaway🔑

1/ OSA Rate and Severity is Higher in Individuals With Down Syndrome

What Happened: A study at Cincinnati Children’s Hospital Medical Center on children with Down Syndrome (DS) aged 0-7 years found that 94% of those who underwent polysomnography (PSG) had obstructive sleep apnea (OSA), with 60% showing moderate to severe OSA.

Why It Matters: This study highlights the high prevalence of OSA in young children with DS, emphasizing the need for early screening and intervention, especially in those with additional risk factors. Dentists who look at more than teeth are particularly suited to help screen these wonderful individuals!

Practical Takeaways:

1. Early Screening: It's important to conduct early HST screening in children with DS. Set up hassle free HST’s for your high-risk patients.

2. Monitor High-risk Children: Special attention is needed for children with DS who have additional health issues like feeding difficulties or airway abnormalities.

3. Follow-up Interventions: There are many options that can significantly improve OSA in children with DS. Patient compliance is a big factor when choosing which therapy but options such as expansive orthodontic appliances and tooth positioning appliances have been shown to be clinically significant!

2/ Why? Answer, Craniofacial Characteristics

What Happened: The study compared craniofacial and oral characteristics of children with and without Down syndrome (DS). It found that children with DS often have reduced jaw dimensions and skull base, leading to class III malocclusion, periodontal diseases, and other dental anomalies.

Why It Matters: These unique craniofacial features in children with DS contribute to the higher incidence and severity of obstructive sleep apnea (OSA). Understanding these traits is crucial for early diagnosis and treatment, which can significantly improve their quality of life.

Practical Takeaways:

1. Early Dental Assessment: Regular dental check-ups are important for children with DS due to their unique oral health challenges.

2. Multidisciplinary Care: A team approach, involving various specialists, is essential for managing the health of children with DS.

3. Customized Treatment Plans: Treatment should be tailored to the specific needs of each child with DS, considering their unique craniofacial characteristics.

3/ Treatment Options for OSA in Children with Down Syndrome (DS)

Overview

Nine treatment options for managing OSA in children with DS were reviewed in this study. The treatments range from surgical procedures like adenotonsillectomy to non-surgical options such as CPAP therapy and weight loss strategies. While an airway dentist may not perform many of these options it is important to educate patients and their parents of their options.

Why It Matters

Addressing OSA in children with DS is crucial due to its negative impact on health, behavior, and cognitive development. Effective management is challenging due to DS-specific characteristics, making this study pivotal in guiding clinical decisions.

Key Practical Takeaways

1. Adenotonsillectomy (AT): Common first-line treatment but shows limited effectiveness in DS, with many patients requiring additional interventions.

2. Lingual Tonsillectomy (LT): Effective in reducing OSA severity in patients with residual issues post-AT.

3. Continuous Positive Airway Pressure (CPAP) Therapy: Efficacious in reducing OSA severity, but adherence to treatment is a challenge.

4. High-Flow Nasal Cannula (HFNC): Useful in patients struggling with CPAP, but more research needed.

5. Hypoglossal Nerve Stimulation: Shows significant promise in reducing AHI, with good tolerance and adherence.

6. Tongue-Based Procedures (Genioglossus Advancement and Radiofrequency Ablation): Effective in reducing OSA severity in DS.

7. Myofunctional Therapy: No significant improvement in OSA severity with short-term therapy; longer duration studies needed.

8. Pharmacologic Interventions (Intranasal Corticosteroids and Leukotriene Inhibitors): Limited data on efficacy; no significant improvements noted in mild OSA cases.

9. Weight Loss: Important for managing OSA in obese children with DS, but specific data for DS is lacking.

Effectiveness Ranking (Most to Least Effective)

*according to the study.

1. Hypoglossal Nerve Stimulation

2. Lingual Tonsillectomy

3. Tongue-Based Procedures

4. CPAP Therapy

5. Adenotonsillectomy

6. High-Flow Nasal Cannula

7. Myofunctional Therapy

8. Pharmacologic Interventions

9. Weight Loss

Additional Note

Orthodontic treatments like rapid maxillary expansion, although not included in the study, are noteworthy for their potential benefits. It's emphasized that a multitude of options exists for helping DS patients with OSA, underscoring the need for individualized treatment plans.

Business of Sleep

📈Better businesses = more lives saved!

7 Pitfalls Dentists Encounter in Sleep Apnea Management

Integrating the treatment of obstructive sleep apnea (OSA) into dental practices is not just an expansion of services; it's a pivotal step towards holistic patient care. However, this integration comes with its set of challenges, ranging from team training to patient management and collaboration with medical professionals.

Integrating a Sleep Coordinator

A common pitfall in dental practices tackling sleep apnea is the absence of a dedicated Sleep Coordinator. This role is integral to the smooth functioning of sleep apnea services. The Sleep Coordinator becomes the central figure in managing patient progress, overseeing Home Sleep Tests (HSTs), handling medical billing and insurance, and ensuring all relevant paperwork and records are meticulously managed. Their responsibilities extend to coordinating patient consultations and facilitating peer-to-peer reviews with insurance companies. For a general dentist branching into sleep medicine, this role is indispensable for maintaining the quality and consistency of care.

Comprehensive Team Training

Another critical area is team training. Often, the dental team might feel out of depth with sleep apnea screening and treatment due to a lack of proper training. This gap can lead to errors in patient records, insurance claims, and HST management. The entire team, including hygienists and office staff, must be well-versed in their roles related to sleep medicine. This involves understanding the nuances of screening processes, recognizing the importance of accurate record-keeping, and being adept at managing billing requirements. Regular, in-depth training sessions can empower the team, instilling confidence in their new roles and responsibilities.

Fostering Team Buy-In

The success of integrating sleep apnea treatment also hinges on team buy-in. Without the team's full commitment and understanding of the importance of OSA treatment, inconsistency in patient care is inevitable. It's crucial to educate the team on the seriousness of OSA and the life-changing impact of its treatment. Personal stories, especially involving team members or their families, can be powerful in creating a deeper, personal connection with the cause. This approach fosters a sense of purpose that goes beyond financial incentives.

Streamlining Patient Screening

Inconsistent patient screening is another hurdle. A structured and uniform screening protocol needs to be in place. Every patient should be evaluated for OSA symptoms as part of their routine dental check-up. This requires the team to be trained in not just identifying physical signs like neck size or obesity but also in effectively communicating with patients about their symptoms. Regular practice and a clear understanding of the screening's importance are key to making this a seamless part of the patient's visit.

Enhancing Case Presentation

Effective case presentation is crucial in convincing patients to undergo treatment. Dentists must be adept at communicating the risks associated with untreated OSA and the benefits of treatment clearly and empathetically. Addressing financial concerns is also vital. Patients often hesitate due to cost implications. Transparent discussions about insurance coverage, out-of-pocket expenses, and available payment options can help alleviate these concerns.

Navigating Medical Billing

Medical billing complexities can be overwhelming and often lead to delays in treatment and reduced profitability. Adequate training for the business team in medical billing or opting for third-party billing services can streamline this process. It's also beneficial to have the practice credentialed with insurance providers to facilitate smoother billing and reimbursements.

Building Physician Relationships

Lastly, developing a solid network with physicians is crucial for a successful dental sleep practice. This relationship-building takes time and effort but is vital for extending care beyond the existing patient base. Establishing trust with general practitioners and sleep physicians, documenting treatment successes, and educating them about Oral Appliance Therapy's benefits compared to CPAP can lead to mutual referrals and a broader patient base.

Conclusion

Incorporating sleep apnea treatment into a dental practice is a multidimensional endeavor that goes beyond clinical skills. It encompasses team training, effective communication, administrative efficiency, and forging partnerships with medical professionals. By addressing these aspects comprehensively, dentists can not only expand their practice but also play a crucial role in enhancing their patients' overall health and well-being.

Something Sweet

🍭Stuff so sweet you might get a cavity..

Exclusives for More Than Teeth Readers

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Miscellaneous

😅P.S. … I forgot something

Vivos Therapeutics makes history with first ever oral device that is cleared to treat severe OSA.