WHAT IS MISSING IN YOUR COMPREHENSIVE DENTAL EXAM?

A truly professional comprehensive dental exam examination (D0150 or D0180) should include much more than what the CDT codes delineate.
What is essential?
Beyond the obvious FMX, the charting of existing and needed dental and periodontal conditions, and an oral cancer screening, there are many other useful evaluations which are directly related to our services and are within our range of authority and responsibility. 
The Comprehensive Exam should also include measurement of vitals such as blood pressure, a sleep dysfunction (Obstructive Sleep Apnea) screening such as the Epworth Sleepiness Scale, a nutritional analysis and a careful discussion of any notable items (alerts) in the patient’s med history. These things don’t need to be spelled out in the CDT code. They come with our desire to do what we know is right. .
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  TMJ exam, facial muscle palpation, Mallampati classification (of the airway entrance) and 
an oxygen saturation test will provide critical information.  Any dentist/hygienist will chose how extensive they wish their dental exams to be and what should be included.
Would we be “spending too much time” in a dental exam visit?

Not if we care about our patient’s total well being, about our conscience, and about our dental license.

And is this nearly always accepted by patients as hugely valuable and with appreciation?     YES, it is, where the dental team shows their patients how much passion, care and skill they have. I see it in many dental offices.    The really successful ones.

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A Hygienist is in a uniquely key position.
Here’s your opportunity to increase your service to your community, to create your “niche”, and  to stand out in your community as a complete care-giver.
It is reported that 34% of the population has Sleep Apnea symptoms. 
One of the next three patients that walk thru your doors is a Sleep Apnea victim. Are you able to help them?
Does your New Patient Exam include a screening for Sleep Apnea?
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Interested? Then check this out:   www.sleepgs.com

SLEEP APNEA- 22 MILLION AMERICANS SUFFERING.

 It is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. 
FAT GUY SLEEPING
If we accept the reports that a minimum of 80% of Sleep Apnea is undiagnosed, then only 20% is actually addressed in any fashion.

The undiagnosed may fit into these categories:

1. Patients have no idea that such a thing as Sleep Apnea exists.

       Hard to believe it but there are such people.
2. They know about, but have no idea that they suffer from, Sleep Apnea .
        “Isn’t snoring normal?”  “Doesn’t everyone wake up 4-6 times a night?”
3. They know they have the symptoms of Sleep Apnea but are in denial.
        I know a smart lawyer who insists sleep apnea does not exist. He tells me that I am “just as bad as [his] wife” who listens to him snore and gasp for breath every night.
4. They know they have problems but refuse to do anything about it.
       Some have heard horror stories about CPAP machines and simply do not want to take action. They need to learn about the oral appliance therapy (OAT).
5. Misdiagnosed Sleep Apnea.
        There is a lack of knowledge of sleep apnea among many health professionals.

It is very difficult to get these people to want to be screened and diagnosed by just telling them that something is wrong. It is necessary for them to “see” it for themselves and for them to adopt a top down approach – of their own volition.
The best way to do this is to educate them in the most simple, effective, non intimidating and cost effective way – we can show them films of OSA victims having sleep events.  We must find a way to get them diagnosed and filmed and then show them their results. This is an massive education deficit issue.
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LEARNING DSM TO BUILD A REWARDING PRACTICE

Dr. Barry Freydberg, a nationally recognized authority on the treatment of sleep disorders shared his unique perspective on his very successful Dental Sleep Medicine practice at a training course in Florida on Feb. 12,13.  This was an awesome learning experience.
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Next up in the DSM training seminars is Charlotte with Dr. George Jones and Las Vegas with Dr. Marty Lipsey.   Both seminars are held on Friday and Saturday, Feb. 19-20.
Included in these A to Z presentations is Medical Insurance billing, Codes, Fees and Procedures.  And you will receive 16 CE credits to jump start your new year.
GENIUS
You will be prepared to do far more as a comprehensive care-giver for your patients and the new ones who seek your services.
Review the course outlines and register here:

02/19/2016 – 02/20/2016
CHARLOTTE, NC CHARLOTTE, NC 

DoubleTree by Hilton Hotel Charlotte Airport

02/19/2016 – 02/20/2016 LAS VEGAS, NV LAS VEGAS, NV 

The Westin Las Vegas Hotel – Casino & Spa

ARE YOU LOOKING FOR A WAY TO STAND OUT IN YOUR COMMUNITY?

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Here is how you can gain respect as a thought leader, generate New Patients, and provide a great public service.

Select a topic that will draw an audience. The “hottest” topic today is Sleep Apnea. Just google into the internet and you will see the widespread interest in Obstructive Sleep Apnea. People are becoming very aware of the dangers caused by the stoppage of breathing while they are asleep. They are looking for answers and very few Dentists are prepared to help them. Take a training course or a seminar, become knowledgeable in the signs and symptoms, the risk factors, and in the various treatment options. Sharpen your expertise.
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Here’s how you do it:
Present a free seminar in your Reception Room. Select a date at least one month out so you and your invitees will be able to get it into your schedules.
How to Announce and Promote it:
  • Have a “sign-up sheet in your office
  • Send out email announcements to patients of record; ask them to assure their place by return email.
  • Let each invitee know they may invite two friends or relatives.
  • Place a large colorful poster in your Reception Room.
  • Distribute flyers to local businesses and professional offices.
  • Place a small display ad in your local newspaper.

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Some Tips for your Seminar
  • Present it in the largest room in your office- usually the Reception Room
  • Prevent any interruptions – turn off phone ringers, etc.
  • Have a “Welcome Table” with some juices and other beverages (sugarless, of course).
  • Have your flyers, brochures, and business cards on the “Welcome Table”.
  • Prepare a power point presentation with video.
  • Subjects like Sleep Apnea are serious, but to keep the audience entertained, infuse some humor.
  • Encourage interactive participation. Invite questions from the audience.
  • Prepare some hand-outs for the participants to take home.
  • These are just a few ideas. I am sure you will think of a lot more.

Objectives and Outcomes

You will be respected as a Leader and Educator.

You will generate New Patient leads.

You will provide a needed and valuable public service.

If you want some help with any of this you may email me: cskdoc@ aol.com

HERE’S HOW IT SHOULD BE DONE!

A California dentist teaches us all how to do it.
He offers free Sleep and Welfare screenings in Health Fairs and in his office.
He scores these benefits:
  • Helps these people discover their underlying causes of sleep dysfunction.
  • Spreads a huge awareness of the dangers of Obstructive Sleep Apnea 
  • Creates recognition that he is a generous, caring healthcare professional
  • Builds a Dental Sleep Medicine practice
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We applaud you, Dr.Thuy Nga Le Vu
Now you ask, “Why didn’t I think of that?”  If you think it’s a good idea, DO IT NOW! Contact your mall administrator and local Chamber of Commerce and discuss the nearest opportunity.

Roseville, CA   California Dentist, Dr. Thuy Nga Le Vu and staff were recently trained in identifying, diagnosing (with physicians) and offering treatment for patients with the deadly disorder, Obstructive Sleep Apnea.  Trained by Sleep Group Solutions, Galleria Smile Designs, and all three of their locations, will bring their turnkey protocol to three different health fairs to spread the awareness of sleep apnea and ways to treat it. Galleria Smile Design will also provide Sleep Apnea screening and treatment in-office, by appointment.

Upcoming health fairs are open to employees and some public members, at the California Correctional Health Care Service on August 26, The Department of State Hospitals Health and Wellness on September 8th, and the UPS Health and Safety BBQ on September 11th.  Dr. Vu and staff are looking forward to raising awareness, as well as offering a solution.  “We are honored to help spread awareness that this treatment can save lives, not only for themselves but others around them that may be affected.”  says Dr. Vu.  “It affects everyone around us, even when sharing the same road with someone falling asleep at the wheel due to OSA, they may not even be aware of it.”  Dr. Vu’s staff will do an initial patient screener with the Epworth Sleepiness Scale, and schedule appointments for any sleep apnea red flags.

“We find an enormous amount of patients and employees who suffer with high blood pressure,  obesity, gerd, and scalloped tongue.  These are all implications that OSA may be present.”  says Dr. Vu.  Snoring, along with many of the symptoms Dr. Vu’s practice is suffering with are commonly connected with OSA.  “Many of my patients are currently on CPAP, but are non compliant, so we are happy to offer a solution.”  Oral Appliance Therapy is an effective way to treat mild to moderate OSA, and are saving lives with non compliant CPAP users.

For patients who suffer with snoring, high blood pressure, daytime fatigue, morning headaches, and even Type 2 Diabetes, relief may come from Oral Appliance Therapy.  Sacramento area patients can reach Dr. Vu’s friendly and knowledgeable staff at 916-787-1232 or online at  Galleria Smile Designs.

Abfractions are difficult to explain to patients. Here is a simplified explanation

“Doctor, I always thought these notches are from brushing too hard. They are painful and I have them on my teeth on both sides. What causes them?”  

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Here is a simplified explanation:

An abfraction occurs on the lower part of the crown of a tooth, near the gum line.

            The enamel covering the crown tapers down to its thinnest there. When the occlusion (bite) is not balanced, there will be uneven pressures on the biting surfaces of teeth. Those pressures cause a torque on the tooth which produces a slight bend at the center where the crown meets the root. As the tooth keeps bending, the thin enamel at the bottom of the crown, near the gum line, chips away. The sensitive “dentin” surface inside the enamel is now exposed. Vigorous, improper teeth brushing will then wear away the unprotected dentin and the notches will grow deeper and larger.

The dentin also becomes vulnerable to acid erosion from foods such as citrus.

             The uneven bite pressures also cause a loss of gum and bone attachment around the roots so the roots become progressively exposed adding to the acute sensitivity to touch and cold. Advanced effects can be fracture of the tooth at the crown-root junction, tooth mobility and serious gum disease. 

            Abfractions can resemble other conditions like decay or toothbrush abrasion, but the treatment is more specific. The treatment, after diagnosing the cause as a bite dysfunction, consists of balancing the bite to equally and properly distribute the pressures and then to restore the lost tooth structure. An occlusal guard may be required. About 25% of the population clench or grind their teeth at night (and are completely unaware of it!). Obviously, the earlier this condition is discovered, the less damage to the teeth and bone will have occurred. In advanced cases crowns may need to be placed to protect the weakened teeth. There are some cases where orthodontic treatment may be necessary. 

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Abfractions are non-carious cervical lesions (NCCL) caused by flexural forces, usually from cyclic loading; the enamel, especially at the cementoenamel junction (CEJ), undergoes this pattern of destruction by separating the enamel  rods.  Studies show that within the same patient, teeth with abfractions presented more gingival attachment loss than those without abfractions. However, associations were not demonstrated between premature contacts in centric relation (PCCR) and the presence of abfractions or increased attachment loss.

Abfractions are common in patients with Obstructive Sleep Apnea. Nocturnal bruxism plays a major role.

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 QUIZ

True/False

  1. Abfractions are usually caused by improper teeth brushing.                   (F)
  2. Abfractions are a specific type of dental decay.                                       (F)
  3. Correction of an abfraction requires more than just a cervical filling.       (T)
  4. Nutrition plays a role in worsening abfractions.                                         (T)

Multiple Choice

Which are correct?

  1. .Abfractions occur primarily on the facial surfaces of teeth.
  2. A porcelain veneer can have an abfraction.
  3. Abfractions occur only on maxillary teeth.
  4. An abfraction may be able to cause a separation fracture of a tooth crown.
  5. All the above.

The treatment options include all except one of the following:

  1. Orthodontics
  2. Nutritional adjustments
  3. Occlusal adjustment
  4. Periodontal Therapy
  5. Cervical restorations

OBSTRUCTIVE SLEEP APNEA- JUST A MAN’S DISEASE??

 

Scary that most Sleep Apnea victims have Acid Reflux…. and other comorbidities.

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The Causes:
During the cessations of breathing the body will increase its efforts to take in air.
Abdominal contractions are exaggerated and increase until breathing resumes.
The contractions squeeze the stomach and force acid up the esophagus.
The efforts to breathe also increase a negative pressure in the esophagus which also pull up acid.

Become a Sleep Medicine Dentist and help your patients that have these Sleep Apnea connected comorbidities and symptoms-
Diabetes, High Blood Pressure GERD, headaches, nocturnal bruxism.

Explanations like this are presented in the upcoming Sleep Apnea seminars:
Oklahoma City    Dr.Damian Blum
Atlanta                 Dr. Marty Lipsey
Hollywood, FL     Dr. Dan Tache’
Boston                
Dr Barry Freydberg
Indianapolis        Dr. George Jones
Orlando               Dr Anjoo Ely
Miami                 
Dr Barry Freydberg
Houston              
Dr.Damian Blum
Scottsdale           Dr. Marty Lipsey

You can view the dates and course outlines and register here:
http://sleepgroupsolutions.com/2.0/modules/piCal/index.php?smode=&op=&cid=2

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Autumn Starts September 21st- Sleep Well!

Sleep soundly this fall- don’t sleep with sound.

8-3-14 SAW WOODIn denial, many people still ask, “What’s the big deal about snoring?” “Don’t most people snore?”

Snoring is disturbing and is a major cause of spousal alienation. Who can sleep with the sounds of a freight train two feet away from their ear? Spouses of snorers often have to move into separate bed rooms and sales are up of homes with two Master bed rooms.Snoring is, however, the most attention demanding WARNING SIGN of serious sleep dysfunction. 

It is the common denominator in the Sleep Apnea equation. Snoring, like pain, should sound an alert to us that there is something more serious to look for under the surface.

We continue to learn about more illnesses connected to Sleep Apnea

Cancer

Researchers suggested a correlation between sleep apnea and increased cancer risk of any kind. A Cancer study of 1,240 participants who underwent colonoscopies found that those who slept fewer than six hours a night had a 50 percent spike in risk of colorectal adenomas, which can turn malignant over time. Another 2012 study identified a possible link between sleep and aggressive breast cancers. Ref: 2010 American Cancer Society Other serious ailments known to be tied to Sleep Apnea are:

Obesity, Dementia, Depression, Diabetes Mellitus, High Blood Pressure, Chronic Daytime Fatigue, Motor Vehicle Accidents

With an assortment of health threats like these, all Sleep Apnea related, we need to show more respect to snoring.

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What would make YOU stand out and be sought out as a Dentist?

I’m sure you understand that now, more than ever, you need to stand out and be able to offer not only EXCELLENCE, but also DIFFERENCE. In this sluggish economy, where there is a perception of “financial doom”, (I personally don’t believe in that.), dental consumers have a tight hold on their wallets and reports of dental service acceptance show a concerning drop.
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What would make YOU stand out and be sought out?
WHAT ‘UNIQUENESS” ARE PATIENTS LOOKING FOR TODAY?
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What are YOU doing now to offer a unique service? Your First Class Service and Patient Engagement are expected as basic “givens”. But what is your clinical niche?
Are YOU the dental practice they must go to? Are you the only practice around that offers “invisible” braces, or mini-implant dentures or Nutritional Analysis ?  Are you the “Holistic Dentist”, the “Soft Tissue Management Dentist”, the “Snooze Dentist”,  the “Snore Dentist”? Are you the “Sleep Dysfunction Dentist”?
EVOLUTION OF DENTAL DEMAND
Remember how it was about 20 years ago when teeth whitening (aka “bleaching”) was the “new kid on the block”- THE “HOT BUTTON”? If you had an “in-office” Bright Smile or Zoom machine, you could schedule an operatory all day long with patients from near and far. After that we had the “porcelain age of dentistry”, when the media made patients very image-conscious for “smile enhancements” at any cost while the public was more confident in the future of the economy . Teeth whitening is now offered in nearly every practice, and in most as a discounted loss leader. Cosmetic crowns and veneers are now a lower patient priority.
Implants were the next rage in dental attractions. Today most dental practices are offering implants.
SO, WHERE ARE WE NOW?
What would make YOU stand out and be sought out?
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Dental Sleep Medicine is where Teeth Whitening was 20 years ago.
It is the “hot button” where Implant Dentistry was 10 years ago.
Strike while the iron is hot.
DSM can be your uniqueness to serve the needs of 34% of your existing patients and attract many new patients.    Take the training and stand out as the “go-to” dentist in your area.
9-11-14 UNIQUE ON PEDESTAL
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