By: Michael O. McMunn, DDS, MAGD, ACD
One of my favorite aspects about the practice of dentistry is the abundance of continuing education courses one can take. I have been to Pankey, LVI, Misch Institute Pikos, local, state and university sponsored courses too numerous to name them all. But, in my 32 years of practice I had never taken a course in dental sleep medicine. In fact, when I saw that a sponsor known as Sleep Group Solutions was offering such a course in Miami, I made the decision to travel from the great state of Virginia to sunny Miami to check it all out.
It was at the SGS seminar in Miami, that I first learned of the important, if not critical, role we dentists play in the screening of our patients for sleep related breathing disorders (SRBD). Dr. Dan Taché, a practicing dentist who hails from Green Bay, Wisconsin lectured for two days on the responsibility that dentists have in identifying patients with the probability of a disease called sleep apnea. He spoke of the oral signs which indicate the likelihood of an obstructive tongue and airway. These are signs I have observed for all my years in practice but never, not once, related them to a breathing disorder. Scalloped tongue, linea alba, high palatal vaults, Class II occlusion, coated tongue, Friedman Tongue Position index, tooth erosion from GERD, and bruxing are all visual signs of a person with a SRBD and until the SGS courses by Dr. Taché, I had not a clue. I was shocked at how I never put one plus one together to equal two when it came to looking down the oral cavity into the upper airway and hypopharynx and summlzing that the patient may have a serious snoring problem or life threatening condition called sleep apnea.
I recall a quote I once heard, “What the brain does not know, the eye cannot see.” That was me! My brain did not know a thing about sleep apnea and therefore, over three decades my eyes did not see the relationship aforementioned oral and facial signs and their relationship to a disease that is responsible for the poor health and early death of millions of people. Dr. Taché spoke of the statistics that there are an estimated 20 million adults with sleep apnea, but only 8% are ever diagnosed and only 3% are under treatment!
I thought, there is no other health professional that looks at more upper airways than the dentist and the dental hygienist. Why are we not doing more to identity the 92% the of population that stop breathing for 10 seconds or longer, 10, 20,30, even 50 times an hour or more? Why are we not helping to reduce the number of strokes, heart attacks, highway deaths due to sleepy drivers and divorcees due to bed partners sleeping in separate rooms and the resulting loss of intimacy? I again was reminded of a quote that is so appropriate for this situation. “If not us (dentist) then who? If not now, when?”
For me, the answer was, it must be the dentist and the time was now. As I mentioned earlier, we dentists and hygienists observe 10 to 30 oral cavities a day as we screen for oral cancer and diagnose periodontal and dental disease. What other health professionals even come close to screening that many potentially undiagnosed obstructive upper airways? I must admit that Dr. Dan Taché changed the way I now look at my patients forever. Since it is my responsibility to be the best and most complete dentist for my patients, I have changed the way I do my initial extraoral and intraoral exam for TMJ, MPD, dental disease and periodontal disease, I am now looking for upper airway obstruction signs on every new patient as well as all of my recare patients.
When I came back to Virginia, I had a passion to alert my 6,000 plus Virginia dental colleagues regarding our duty to screen and refer possible sleep apnea patients to the appropriate medical specialist to make a definitive diagnosis. If we do no more than screen and refer, we will collectively save tens of thousands of lives. If we elect to get involved in working with our medical colleagues in the treatment and monitoring of patients with snoring and/or sleep apnea, then we will open up an eternally new opportunity for treatment and profit in our dental practices.
This passion enabled me to bring together a core of interested dentists who believed that we needed to educate our dental colleagues about the serious problem that snoring and sleep apnea pose for our dental patients. We have formed a new organization and it is called, The Virginia Academy of Dental Sleep Medicine (VADSM). We held our first statewide meeting in conjunction with the physician sleep specialists and their group, The Virginia Academy of Sleep Medicine. Dr. Dan Taché was our guest speaker. He spoke to the dentists and physicians in the morning on the topic of sleep apnea and bruxing. He did a remarkable job and the physicians’ response was exceptional. In the afternoon Dr. Taché spoke to a full house of dentists on an overview of the field of dental sleep medicine. After the meeting the president of the physicians’ group approached me and asked if our Virginia Academy of Dental Sleep Medicine would like to meet again in 2011 by once again holding our annual meeting together. This symbolic relationship is crucial to the proper working relationship between the medical and dental profession.
The VADSM now has a website and I encourage the reader to visit the website, www.VADSM.org , and be sure to read our mission statement. It is our hope that each state will start an academy of dental sleep medicine with the expressed intention of educating the dentists, dental students, hygienists, assistants and dental technicians as to the dental professional’s responsibility to be leaders in the field of sleep medicine. We have an opportunity as the experts in upper airway knowledge and experience to save lives and improve the sleep habits of millions upon millions of patients across this great nation.
I would like to acknowledge the dentists who helped put together The Virginia Academy of Dental Sleep Medicine: Dr. Scott Gore, Dr. Barry Kurzer, Dr. Erika Mason, Dr. James Schroeder, and my son, Mike McMunn, Jr. ,owner of Mike’s Mouthpieces dental lab which makes oral appliances for the treatment of snoring and sleep apnea. If any dentist would like to discuss how to start your state’s Academy of Dental Sleep Medicine please contact Dr. Michael McMunn at mmdrmike@aol.com.
