Dental Sleep Medicine Best Practices

This course has been specifically designed to introduce dental sleep medicine concepts in an entertaining, honest, and straightforward fashion using evidenced based concepts and emphasizing the model change required to successfully implement these concepts into a general dental practice.

Many commercial organizations are bombarding dentists with information about the potential role of dentistry is sleep medicine; unfortunately, only a fraction of those who take the courses that are consequently to learn sleep medicine have ever successfully added these concepts to their general practice.  This course will teach not only the concepts of sleep medicine but emphasize the challenges for the general dentist that need to be addressed successfully to benefit help your patients with sleep disturbed breathing conditions.

This evidenced based course will review the current lit from physiology of oral appliances to the role of oral appliance therapy and CPAP in sleep medicine.  All literature references will be made available to all attendees!  While the emphasis of the course is a deep dive into the science of sleep medicine, Dr. Glassman will weave the traditional methods of the business of dental sleep medicine with the Dedicated Sleep approach. 

Subjects covered in depth include:

— The Model Change Required to move from dentistry to dental sleep medicine

— The Challenges of Dental Sleep Medicine – Dental Myth Busting

— History and Epidemiology of sleep medicine and dental sleep medicine

— Consequences of Sleep Disturbed Breathing

— Sleep Medicine principles including normal sleep staging 

— The continuum of Sleep Disturbed Breathing

— Non-obstructive sleep disorders 

— Pathophysiology of obstructive sleep apnea 

— Screening Tools/ Diagnostic Testing for OSA – Review of Pediatric OS

— The use of Home Sleep Testing and polysomnograms 

— The changing role of AHI in diagnosis

— History Taking, the clinical exam, and patient consultation

— Oral appliance Therapy including physiology and appliance choices, Documentation/Patient Flow/Physician contact with each visit

— Supportive therapy options:  The role of nasal breathing, positional therapy, treatment of restless leg syndrome, myofunctional therapy, etc.

— Non-OAT treatment options (Positive pressure, surgery,)

— Prevention, Diagnosis, and Treatment of Appliance Complications

— Defining, preventing, and treating Occlusal Dysesthesia

— Parasomnias and Movement Disorders with special emphasis on bruxism

— TMD for the general dentist including parafunctional control 

— Patient Communication Skills as well as Keys to communicating with physicians. Practice management: The Four Agreements.

Basic Sleep principles, including both the physiology of sleep and the pathophysiology of obstructive sleep apnea, will be taught in detail.  A short history of the disorder and a section on epidemiology is included.  Treatment alternatives will be reviewed, and of course oral appliance therapy will be taught in detail.  A critically important section on bruxism, a movement disorder of sleep, as well as a section on dealing with the temporomandibular joint issues and other comorbidities of oral appliance therapy including the “dreaded” occlusal changes, will emphasize the difference between fact and fiction.

The “soft skills” taught at this course are, frankly, as valuable as the evidenced based education into the science of sleep.  An honest look at appliance therapy results allows the practitioner to appropriately set patient and physician expectations, a key to the success of any DSM practice.

Upon completion of the course, attendees will be able to: 

— Comprehend the basic science of sleep medicine

— Understand the role of oral appliance therapy in sleep medicine and be prepared to initiate oral appliance therapy in your treatment regimen

— Effectively screen patients for sleep disturbed breathing

— Understand the importance of diagnosis and why snoring only appliances without diagnosis are contraindicated.

— Appreciate the importance of coordinated care with our medical colleagues and gain the skills needed to coordinate care for your mutual patients

— Gain a new appreciation for when and why occlusion matters and how that determines the design of bruxism appliances

— Master appropriate screening and diagnostic procedures and alternatives for increased access to care

— Document diagnosis and treatment appropriately for “Track 1 and Track 2 patients.”

— Increase your referral pattern beyond your own patients

— Gain sufficient knowledge of the types of appliances that are available as well as being prepared to choose an appliance and effectively prescribe and manage the chosen appliance

— Gain the skills required to diagnose the potential untoward effects of oral appliance therapy and treat them accordingly

— Gain an appreciation for evidenced based therapy and have that evidence at your fingertips for your reference as needed

— Appropriately apply the risk/benefit quotient when treating patients in relationship to any occlusal changes or the other untoward effects that may occur

— Appreciate the epidemiology of sleep medicine and use that evidence in treatment decision making

— Return to the office with confidence in one’s knowledge not only in sleep disturbed breathing, but in issues that involve occlusion and joint dysfunction. 

Day 1

7 – 8 Full Breakfast and Registration

8 – 9 Introduction: Goals of the Course, Dental Model vs. Medical model Outlining and defeating myths The Challenges of Dental Sleep Medicine

9 – 10 Epidemiology and Co-Morbidities: Current Lit Review of Epidemiology. Cardiovascular disorder physiology/Stroke/Diabetes/Hypersomnolence. Etc.

10:15 – 10:30 Break

10:30 – 12: Basic Sleep Medicine. Sleep Staging: PSG’s for diagnosis. Introduction to OSA Definitions and Pathophysiology. AHI Discussion - Pediatric OSA

12 – 12:45: LUNCH

12:45 – 1:30 Screening Tools in the Dental Office: Screening Tool Options Consultations (Hygiene and Dr.). The History and Clinical Exam

1:30 – 2: Oral Appliance Therapy including Physiology of OAT

2:00 - 3:00 Oral Appliances: Indication for Oral Appliance Contraindications for Oral Appliance Review of Alternative Appliances Available Insertion and Follow up Visits

3:00 - 4:00 The Dedicated Advantage

4 – 4:30 - The Four Agreements

4:30 – 5:45. Alternative Treatments: CPAP, BiPAP, Auto-PAP, Inspire,  Surgery, laser therapy, ExCite,  Supportive Therapies:  Position, Nasal, etc. Video of patients with OAT therapy.

6:30 Social Event — Wine/Cheese and more at Dr. Barry Glassman’s Home

Day 2

6:45 – 7:30. Full Breakfast and Registration

7:30 – 9:00. Complications of OAT - Occlusal Dysesthesia

9:00 – 9:30 HST’s for Diagnosis and Titration.

9:30 – 10:30. Documentation/Patient Flow. 

10:30 – 10:45: Break

10:45 – 12 Bruxism and Sleep 

12:00 - 12:45. Lunch

1:00 – 5:30 We move to a local Dental Office for Hands on Portion: The entire patient flow process is demonstrated followed by Hands On Session:

Exams - Bite Registrations - Appliance Insertions