Why You Should Add Sleep to Your Practice This Year

Episode #375 with Dr. Mark Murphy

Dental sleep medicine has gotten easier, safer, and more effective. And on top of that, up to 25% of the U.S. population have obstructive sleep apnea. If you haven't already, why not add sleep to your practice today? To further explain why you need to add airway, Kirk Behrendt brings back Dr. Mark Murphy from ProSomnus, along with advice on how to start implementing it into your practice. If you want to help people have better lives with airway, listen to Episode 375 of The Best Practices Show!

Main Takeaways:

Up to 25% of the U.S. population have obstructive sleep apnea.

Today, dental sleep medicine is easier, safer, and more effective.

Now, 20% of physicians are favorable towards oral appliance therapy.

There's never been a better time to add sleep to your practice.

Not adding sleep could mean liability for malpractice claims.

Quotes:

“20% to 25% of the U.S. population — 40 to 50 million Americans — have obstructive sleep apnea. What's counter to that thought is, 40 to 50 million have obstructive sleep apnea, but only 10%, maybe 15%, have ever been diagnosed. So, 85% of that population that I just talked about have never been told they have obstructive sleep apnea. They think it’s snoring. Snoring does not mean sleep apnea, but they go together very much, very frequently, most of the time.” (4:33—5:00)

“You think back to your training, you learned the six essential elements. And one of them was oxygen. You can't live three minutes without it. And so, it’s a very essential element. And we didn't know and understand much about sleep. When the older generation like me were learning about physiology, we didn't learn much about sleep. We still don't know a lot, but we know a lot more than we did. And sleep is critical to our overall health.” (5:16—5:40)

“They're tying poor sleep to things like dementia, cardiovascular disease, stroke, arrhythmia, diabetes, depression, we could go on. It doesn't start or cause all those diseases. Maybe the only disease it’s actually tied to from a causal standpoint might be arrhythmia. But it makes every one of those things on that list worse, so that you're 23 times more likely to have a heart attack, four times more likely to have a stroke, five times more likely to die of COVID-19 if you've got obstructive sleep apnea.” (5:40—6:04)

“Picture that you've got two pathways when you look at one of your own patients and you say, ‘This patient looks like they have sleep apnea, and they should get tested.’ I can either, in all but about four or five states, I can order the sleep test. I cannot read it and interpret it — I can read it, but I can't interpret it. I can't issue a diagnosis. I can't order up an oral appliance. That always has to be done by a physician. But I can order the starting of the ball to roll down the hill. Or I can send them to my local sleep physician. Those are my choices.” (12:50—13:17)

“I can order the sleep test and then a doc-in-the-box who’s sitting in an office somewhere, god knows where in the country, but they're licensed in your state, reads and interprets the sleep test, writes a diagnosis, and writes you a prescription. That's fine. It doesn't endear you to your local physicians at all, but it’s a way to get the ball rolling in your own practice. And I do that about half the time. The other half of the time, I send them to my local physicians, who are sleep physicians, and they do the testing. And if they're mild or moderate, they send them back to me. And if they're severe, they send them for a CPAP. And we’ve all agreed to those kinds of protocols and standard operating procedures.” (13:17—13:49)

“If you went back just five years ago, if you found one out of 100 physicians who was favorable towards oral appliance therapy, grab on and go find another one. Today, if you went looking at that same 100 physicians, you'd find 15 or 20. That's a big deal. Now, it’s still a one out of five proposition. I'm not going to lie to you, it’s not like 50% of the time physicians are favorable. But now, one out of four, one out of five physicians are favorable towards oral appliances when the patient can't or won't wear a CPAP or is mild or moderate.” (13:50—14:22)

“The four pillars are pretty straightforward. In your practice, you've got to screen, you've got to test, you've got to treat, and then you've got bill and documentations. So, you've got four different things that you've got to become adept at, or you've got to outsource.” (16:19—16:33)

“Today, we've got easier-to-work-with devices that you don't have to advance the mandible as far, so you get less of the difficulty of getting the bite back. The side effects have all been controlled. And so, it’s much safer, easier, much more effective to be able to treat those patients today than it has ever been. We’re getting higher efficacy than we did with the old handmade devices, all the old-style devices. The newer advancement devices, the new artificial intelligence design, robotic manufacturing devices, are giving us tremendous advantages.” (17:29—17:57)

“When you look at those four pillars [of screening, testing, billing, documentation], I think we've got it simplified enough that it’s easier. It’s less complex. Now, the complexity is in choosing which partner I want for a billing partner, or choosing which software I want to use, or choosing which device I want to use. But that's a lot easier than saying, ‘I'm going to struggle to figure this out and not get paid.’” (18:19—18:38)

“The amount of patient interaction time is totally dependent on how much you want to do in this process. You can delegate almost all of the time, effort, and energy to your auxiliary staff and team just by properly training them.” (21:40—21:53)

“When you think about somebody who said, ‘I want to get into implants,’ or, ‘I want to get into ortho,’ and this is going back 20 years ago, they realized 20 and 25 years ago, ‘Wow, that takes a lot of training,’ because there are a lot of parts, there are a lot of pieces, there's a lot of protocol. Each system is going to be a little bit different — wires, loops, brackets, all that, or each kind of implant system and screw, and what kind of driver you need, and how many centimeters you're going to take out. There was a tremendous amount of parts and pieces you had to inventory, track, and be knowledgeable about. Today, if you're a restorative dentist and implants come along, you point to the edentulous space, your surgeon sticks an implant in, and then they put a scan body on with a number on it that tells me exactly how to make the crown you're going to put. It’s gotten so ridiculously simple that we should be charging less for those crowns, shouldn’t we, rather than the normal fee. But we don't. That's okay.” (23:20—24:12)

“[Dentistry is] still not easy, but it’s a lot easier. And I think that's where I see dental sleep medicine.” (24:29—24:34)

“We’re seeing the nuts-and-bolts part kind of go the way implants and orthodontics have gone, that technology caught up with what we were trying to do by hand. And so, that's been remarkable. So, there's never been a better time to do this in your practice, because you've got so many billing choices, you've got so many software choices, reimbursements are great from the payers, physicians are starting to trust us.” (25:58—26:24)

“If I were saying easy on a scale of zero to ten and I thought about implants or ortho, I would say that when I first got out of dental school, and that was a long time ago, or when somebody got out of dental school 15, 20 years ago, implants and orthodontics were hard, like eight, nine, or ten hard. They were hard. Today, you'd say it’s two or three, four at the most. It’s not even a five or a six.” (27:30—27:52)

“Technology has gotten better. The materials have gotten better. The devices have gotten smaller. You would expect the results to get better — and they have. So, easy? Yeah. Safe? Yeah. So, way easier, way safer, and now even more effective — so effective now that we’re going to really win the hearts of physicians, like they have in several foreign countries. We’re going to have the hearts and the minds of physicians in the United States.” (30:21—30:47)

“You should at least be screening your patients and referring them to someone else. Because if you're not doing anything at all with airway today, you're going to hold yourself and your team liable, potentially, for malpractice claims. Because the ADA resolved — not yesterday, not last October, not a year ago — in 2017, four-and-a-half years ago, that we should be screening for airway and sleep-related breathing disorders. That's not new stuff. So, someday, all the attorneys are saying, we’re going to see a claim against the dentist who missed an opportunity to pick up on somebody having, just like we could've missed a periodontal diagnosis, we could've missed an endodontic treatment diagnosis, we could've missed impacted wisdom teeth diagnosis. So, we’re going to have a culpability for undiagnosed fill-in-the-blank disease. And in this case, it would be airway.” (33:33—34:23)

“The second reason that a young dentist would want to [add sleep] is, I cannot imagine for a young dentist — any dentist — to not find incredible fulfillment for themselves and their team in helping people have better quality of life. Better quality of a smile, high five. That feels great. Getting somebody out of pain, back into function, high five. Feels great. But, man, when you get two people back together in the bedroom — so, I wouldn't want a dentist to miss the opportunity to get the fulfillment in their heart for what they're doing.” (34:23—35:00)

“Now, more than ever, it’s easier to do and safer. It’s more effective. Now, more than ever, where we’re facing the staffing challenges we have, what a wonderful way to expand your capabilities and your production in your practice doing meaningful things that also pay well without needing a larger staff. Now, more than ever in our lives as dentists, do we have a more serious part of healthcare that we could be associated with. And it is delightful to be able to do that, to help people have better lives. It is so fulfilling, so rewarding in so many ways, both spiritually as well as financially. There's just never been a better time to branch out into this kind of thing.” (42:50—43:35)

Snippets:

0:00 Introduction.

1:46 Dr. Murphy’s background.

4:01 Why dental sleep medicine is an important topic.

6:21 There's never been a better time to be a dentist.

8:41 How to make the business part of this work.

12:28 More physicians are now favorable toward oral appliances.

15:55 The four pillars of dental sleep medicine.

18:40 Billing software is user-friendly.

21:03 Patient interaction time is dependent on you.

22:54 Dental sleep medicine has gotten easier.

27:18 Dentistry, in general, has gotten much easier.

31:44 The medical world’s opinions on dental sleep medicine.

33:07 Why you would want to do airway.

37:56 Where to start to implement airway.

40:11 Think medical, not dental.

42:34 Last thoughts.

Reach Out to Dr. Murphy:

Dr. Murphy’s email: mmurphy@prosomnus.com 

Funktional Sleep website: www.funktionalsleep.com

Dr. Murphy’s social media: @mtmurphydds

Dr. Mark Murphy Bio:

Dr. Mark Murphy is an American Board of Dental Sleep Medicine Diplomate and has practiced in the Rochester area for over 35 years. He is the Lead Faculty for Clinical Education at ProSomnus Sleep Technologies, Principal of Funktional Sleep, serves on the Guest Faculty at the University of Detroit Mercy School of Dentistry, and is a Regular Presenter at The Pankey Institute. He has served on the Boards of Directors of The Pankey Institute, National Association of Dental Laboratories, the IdentAlloy Council, The Foundation for Dental Laboratory Technology, St. Vincent DePaul’s Dental Center, and The Dental Advisor. He lectures internationally on Leadership, Dental Sleep Medicine, TMD, Treatment Planning, and Occlusion.