Playing Russian Roulette with the Lives of Your Patients

Think of your patients, especially the ones who've been coming to see you at least twice a year for many years.

Which of them will you miss most if they die?

That is a bitter prospect even to imagine.

As dentists, we rarely if ever have to deal with the subject of patient deaths.

Most dentistry poses minimal, if any, serious health risk. Even so, we train, retrain, and train some more, to do everything within our power to promote the well-being and safety of our patients.

So the odds of you causing a patient to die in your chair are really, really minute.

But what if one or more of your twice-yearly patients were to die of oral cancer, and you failed to catch it?

That, undoubtedly, would be devastating, even though you did nothing proactively to cause the deaths.

What about when one or more of your patients die from a stroke, heart disease, or diabetes?

"Those deaths," you might console yourself, "were beyond my purview."

Perhaps. And perhaps, not.

As it turns out, far more Americans die each year from complications related to Obstructive Sleep Apnea (OSA) - such as heart attack and stroke - than from oral cancer. While most dentists routinely screen our patients for cancer, comparatively few of us help screen our patients for OSA, much less treat them for it.

OSA is a dangerous medical illness with a safe and effective dental solution. In fact, treating a patient for sleep apnea is one of the safest, if not the safest dental procedures available, period.

Your Patients at Risk

The distressing fact is that probably 10% or more of your current patients are at serious health risk from sleep apnea and don't even know it. What if it turns out that you - a dentist - could save their lives by providing them an effective dental sleep appliance, but don't?

That is the true-life Russian roulette that we play with the lives of our patients when we close our eyes to the prevalence of OSA, and to our ability to intercede.

There are umpteen reasons why a general dentist should offer those diagnosed with OSA a dental v. medical solution. These include allowing patients who already know and trust you to remain in your practice, rather than have to obtain a sleep appliance from another dentist; and attracting first-time patients who come for OSA treatment, and stay for general dental care.

But no reason is as compelling as safeguarding the health and improving the lifestyle of your patients - both existing and new.

Protecting the quality of life of our patients is already a high priority for most of us. People who live with dental pain, or who are ashamed of their teeth and smile, need our help - even if they are not at high risk for serious illness.

The same is abundantly true for our patients who suffer from sleep apnea, which often causes day-time fatigue, mental fog, sexual dysfunction, and moodiness, among other lifestyle hardships.

What modern medicine has ascertained is that every organ in the human body and every disease we contract is impacted by the quality and quantity of sleep we get.

After a good night's sleep, we're more likely to look, feel, and function at optimal levels. After a poor night's sleep, our mood, energy, concentration, and appearance all suffer.

String together enough bad, sleep-disrupted nights - such as those associated with obstructive sleep apnea - and we become vulnerable to a chain reaction of health problems, as well as a two-to-seven-fold increased risk for motor vehicle accidents.

A Soft Tissue Issue

OSA is recognized as a chronic medical disease and thus must always be diagnosed and managed by a licensed sleep physician. Its relationship to dentistry stems from the fact that sleep apnea is associated with the soft tissue of the mouth and throat.

OSA occurs when the upper airway muscles relax during sleep, obstructing the airway, and causing the sufferer to stop breathing momentarily. These interruptions, which can occur hundreds of times nightly, reduce oxygen levels in the blood and are typically followed by brief awakenings that disturb sleep.

Obstructive sleep apnea is more likely to occur in men, especially those who are overweight and have thick necks, although it impacts men and women of all sizes and ages, as well as children. Smoking, excessive drinking, and the use of sedatives have also been associated with an increased risk of sleep apnea.

The standard of care for patients with sleep apnea is to use a CPAP (continuous positive airway pressure) machine nightly. But many patients won't tolerate wearing a tethered mask the entire night - using CPAP only part of the time or not at all.

A safe, widely accepted alternative, is to fit the patient with a so-called sleep appliance, which is worn like an orthodontic retainer or sports mouth guard, and is generally better tolerated than a CPAP face mask. It is dentists who pioneered the use of oral appliance therapy and more than 150 oral appliances have been cleared by the Food and Drug Administration for the treatment of OSA.

To properly fit a sleep appliance requires a skilled, specially trained dentist, who takes appropriate impressions and ensures that the patient has hard and soft tissues that will support an appliance. Sometimes a patient seeking a dental sleep appliance will need restorative dental work prior to being fitted.

A Master Series Course

Beginning in November 2017, DOCS Education, widely respected for the quality of its curricula and faculty, will begin offering a two-day Master Series: Dental Sleep Medicine course providing exclusive training and treatment protocols available nowhere else. The course will be led by John H. Tucker, DMD, himself a sleep apnea sufferer, who has been educating dentists on the proper and safest dental sleep medicine protocols and how to incorporate them into a general practice for more than a decade.

DOCS Education members increasingly report that their patients are asking them - their trusted dentist - also to provide dental sleep appliances, rather than requiring their patients to visit an unfamiliar dentist to benefit from the treatment.

"Meeting the needs of patients, safely and effectively, has always been our central focus," explains Dr. Michael D. Silverman, president and co-founder of DOCS Education. "In offering our new Master Series: Dental Sleep Medicine course, we are furthering our mission to educate and train dentists so that they can make quality care available to as many people as possible."

No dentist, ever, should have to face the prospect of losing a patient to stroke, heart disease, or diabetes, only to wonder if obstructive sleep apnea played a role in that death, and if a dental sleep appliance might have saved their patient.

As dentists, we would never neglect the necessity to screen our patients for oral cancer, nor would we forgo the regular training and preparation necessary to resuscitate a patient should the need ever arise.

Taking two days to acquire the skills to treat patients at risk for OSA is no different.

Whether or not you, the dentist, suffers personally from OSA, completing this important new course will undoubtedly allow you to sleep easier, just knowing that you are ready to meet the threat that OSA poses to the health and lifestyles of your patients.

Editor's Note: To register for Master Series: Dental Sleep Medicine, or to learn more about the course, visit: bit.ly/DOCS_DSM

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The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.