How to Be Confident in Your Dental Sleep Medicine Practice

Newly installed AADSM president David Schwartz, DDS, has worked in a collaborative sleep medicine setting for more than a decade. And he wants other dentists to enjoy the benefits of multidisciplinary colleagues too.

By Sree Roy

David Schwartz, DDS, was aware enough of the therapy options for primary snoring that when an ear-nose-throat specialist recommended he have a uvulopalatopharyngoplasty, Schwartz declined the surgery and instead made himself an oral appliance. “It worked really well to control the snoring. I used that at the time as kind of a launching pad for me to become more involved in sleep medicine,” says Schwartz. That formative experience occurred about a quarter of a century ago.

Now the 58-year-old married father of three has been installed as the president of the American Academy of Dental Sleep Medicine (AADSM) and has embarked on a two-year term. He previously served on myriad AADSM committees and “the last thing that I remember is I was on a committee for the board review course, which was being run by two doctors who were on the board of directors. They had asked me if I would consider serving on the board of directors. I was honored and scared all at the same time, but I’m happy that I did that,” Schwartz says.

Residing in a Chicago suburb, Schwartz works as dental sleep director at The Center for Sleep Medicine, which has several locations in and around The Windy City. This means that for the past 12 years, Schwartz has been working on a team with neurology, pulmonology, psychiatry, ear-nose-throat, pediatrics, and more. “I’ve worked for many years in a collaborative setting, and I would like to have the other 3,000 members that are part of this academy have the luxury of working in a relationship like I’ve had,” Schwartz says.

Schwartz is in a position to move the needle on collaborative care, as well as other issues that are important to dental sleep medicine practitioners. One that he has been vocal about is a desire to “greatly increase the awareness of oral appliance therapy and the role that the qualified dentist can have in screening and managing sleep apnea and snoring,” he says. “I think the most frustrating part of a patient who’s seeking help for their sleep-related breathing disorder is the reason they’re so reluctant to get tested to begin with is they feel they’re going to have ‘one of those CPAPs.’ We have to bring them back around. Let those patients know and educate them: Just because you’re diagnosed doesn’t mean you’re going to have to have a CPAP machine; there are alternatives.”

Dentists are experienced with offering options to patients, Schwartz says, citing tooth fillings as one example (where choices include silver, porcelain, and gold, among other materials). “It has to be that the patient is making the decision with the dentist,” he says. In the case of obstructive sleep apnea, it means “educating the patients enough so they can have that conversation with their sleep physician to come to a proper choice that they’re going to be compliant with,” Schwartz says, versus the patient being told what to do.

Another area in which Schwartz wants progress is in using new technology to identify and treat patients. “We have so many of the wearable devices that will diagnose patients now with an EKG—when patients have [atrial fibrillation], they can look on their Apple Watch and it’ll alert them to that.” He sees an opportunity for dental sleep medicine practitioners to work with their medical counterparts to tap into consumer tech.

The AADSM has made progress on several fronts in recent years, one being that its Mastery Program—a clinically-focused educational curriculum about oral appliance therapy for obstructive sleep apnea and snoring—has grown exponentially, creating a useful standard by which physicians and patients can find dentists with evidence-based knowledge.

“We took that bull by the horns, and we’re the ones who established the curriculum in an unbiased way by making sure…[the] program is not-for-profit, unbiased, and evidence-based,” Schwartz says. “If you take a course given by one of the vendors, they’re going to talk about their device and methods—not that they’re bad methods, but they’re not unbiased.”

Schwartz credits the Mastery Program with creating a scenario in which “we’re approaching a critical mass of dentists who are trained and identifiable to help treat the burden of sleep apnea”—that is, a database of more than 1,300 dental sleep medicine practitioners to whom other providers can refer. Contrast that to the year 2006, when Schwartz became board certified and was one of just a few hundred dentists who had undergone evidence-based sleep medicine training. “We couldn’t go to providers and say, ‘refer to us,’” at that time, as there weren’t enough qualified dentists to refer to, he says.

The AADSM opted to create the Mastery Program in lieu of pursuing a Commission on Dental Accreditation (CODA) specialty designation because such recognition requires a 2-year postgraduate training program. While there is plenty of content to create such a program, dental sleep is still mostly overlooked by dental schools in their 4-year standard curricula—so no school is creating a postgraduate continuing education program in dental sleep medicine at this point. “They’re starting to incorporate some [dental sleep] lectures now—maybe two hours of lecture in dental sleep medicine throughout their 4-year dental school curriculum—but they’re not really going into it,” Schwartz says. The Mastery Program is a way to get needed training to dentists without the hurdles of becoming a specialty.

Another area where the AADSM reconsidered an approach was it recently discontinued its facility accreditation program. “That was a tough one for us,” Schwartz says of the decision to end the program, which had endured for nine years. Ultimately, the number of facilities earning and renewing accreditation was not enough for the academy to effectively advocate for them, he says. But, “we’re making all of those resources available into tools for the members—best practices—without the administrative burden on our end. They can still download and follow the accreditation standards on their own,” he says.

The AADSM can also help dentists who are struggling with how to compete with nearby practitioners who are trained in only one or a few specific appliances. As a solution, Schwartz also points to unbiased evidence-based knowledge as a competitive advantage. “Building a successful dental sleep medicine practice is contingent upon providing high-quality care to patients,” he says. “If the doctors are in it because they think they’re going to make a lot of money doing it, they’re doing it for the wrong reasons.” Referring physicians can see through a dentist who is making oral appliances for the revenue, he adds.

“The important thing is the patients are seen by dentists who are well-trained and use more than one particular device. Those patients are then going to refer other patients and are going to refer back to the [referring] sleep physician…and it will cement that relationship,” he says. “The appliances will continue to change and to evolve. The Mastery Program provides a general overview of all the appliances and a great foundation for the participants.”

When asked to recommend one thing that dentists can do today to improve their referral relationships with physicians, Schwartz says that increasing familiarity with nomenclature and best practices is key. “The most important thing is to educate themselves,” he says. “That way they can communicate at a level that imparts a confidence to the sleep physicians who are trying to send patients to them.”

And one thing that physicians can do to improve their referral relationships with dentists? “Seek out dentists that are Qualified [have taken the Mastery 1 course and passed the exam] or Diplomates by the [American Board of Dental Sleep Medicine]. That’s going to allow them to work with people who have really committed to improving the lives not only of their patients but that already understand dental sleep medicine and sleep medicine as a whole.

“They have to start trusting. If they don’t find somebody who they feel is competent, they need to look to others….[Physicians] have to trust that they’re going to find somebody who knows what they are doing.”

Sree Roy is editor of Sleep Review.

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