Dentists Play Important Role in Sleep Medicine

Branching into sleep medicine doesn’t require a major financial investment, though it does take an investment of training time.

When the field of sleep medicine began, pulmonologists were at the forefront, studying how some people’s breathing changed at night and coming up with a pressure mask — the continuous positive airway pressure (CPAP) device — to help patients with sleep apnea.

Thus, almost from the start, the people diagnosing the condition also had a tool available to fix it. Back then, dentists weren’t part of the equation.

“Early sleep medicine professionals weren’t aware of how dentists can help,” said Steve Carstensen (pictured), DDS, co-founder of Premier Sleep Associates, Seattle.

What many people don’t know is that soon after the CPAP was developed, another approach came on the market.

“Oral appliances came about within 5 years of CPAPs being available in the marketplace,” Carstensen said. “Oral appliances were developed by physicians and dentists working together.”

Though it’s taken time, more and more physicians, and patients, dentists have begun using oral appliances to treat sleep apnea, and the result has been a new business opportunity for many dentists, including Carstensen. He’s been in practice for 32 years, and has incorporated sleep medicine into his practice for the past 2 decades.

Carstensen said branching into sleep medicine doesn’t require a major financial investment, though it does take an investment of training time, since most dental schools don’t cover sleep medicine in depth. He said there are a number of sleep medicine training programs, including some at dental schools, and the American Academy of Dental Sleep Medicine that offers a “Qualified Dentist” designation, which dentists can obtain to demonstrate their expertise.

Other than that, there’s no expensive equipment that needs to be purchased, though there is 1 piece of equipment dentists don’t usually need.

“To do this is we have to have a scale in our office,” he said. That’s because weight can have an impact on sleep apnea.

Carstensen, who is also editor in chief of Dental Sleep Practice magazine, said dentists who add sleep medicine to their services will need some understanding of the available oral appliances. Around 100 are on the market, but he said dentists need only become familiar with a handful in order to serve a broad range of clients.

Once a dentist is trained and has the minimal equipment needed, 1 of the first steps is to add questions to patient intake procedures to screen for sleep problems. Doing so will help identify patients who may benefit from an oral appliance or other device.

One question that often comes up when Carstensen speaks, is insurance. Sleep therapy is a medical procedure, so it must be billed to a patient’s health insurance, rather than dental insurance. Carstensen said that can cause headaches for a billing department, though he said there are plenty of vendors available that can help a dentist adapt to the billing requirements for the devices.

The good news, Carstensen said, is that insurers generally cover oral appliances, with occasional restrictions. What they don’t cover is all of the administrative time it takes to bill, get medical records, and outfit patients with the device. That’s why Carstensen said it’s critically important that for a dentist to accurately understand the administrative demands of sleep medicine, and then factor that time into the fee for the service. Dentists who fail to account for the extra time in their fee, “will be on the wrong side of the money equation.”

For dentists who calculate their time correctly, the money equation can be quite good, though Carstensen said dental sleep medicine isn’t a “magic fountain of cash.” Rather, it’s a solid income stream, a chance to branch out, and an opportunity to identify and help out patients who could benefit from sleep therapy or who don’t do well with a CPAP mask.

Still, Carstensen doesn’t think every dentist needs to become a sleep medicine specialist. Ideally, he said each area would have some dentists who practice sleep medicine, to whom other dentists could make referrals. Some dentists could specialize exclusively in sleep medicine, though he said a given area doesn’t need more than a few people with that exclusive niche.

Even if a dentist decides not to go into sleep medicine, that doesn’t mean it should be ignored.

“I think that every dentist should be looking for patients in their practice at risk for airway problems,” he said. “And it’s very easy to implement screening questionnaires in their practice.”