Trends in Dentistry: Snooze Alarm
Dentists and laboratories need to wake up to sleep dentistry’s market potential
By Pam Johnson
Each December, IDT identifies major trends in dentistry poised to impact your clients and your businesses. For the coming year, there are three business environment changes on the horizon: digital dentures, sleep dentistry, and dental insurance.
Payam Ataii, DMD, is an award-winning graduate of Tufts Dental School who has treated more than 1,000 patients with clear aligners and sleep oral appliances as mono- and combo-therapies at his private practice in Laguna Hills, California. Below, IDT asks him about the emerging market of sleep dentistry.
IDT: Undiagnosed and untreated sleep disorders in the US have been characterized as a rising albeit hidden epidemic. What are the statistics that support that characterization and what economic impact does this have on the American economy?
Payam Ataii, DMD: Approximately 70 million Americans suffer from some form of sleep disorder problem with an estimated 60% of these 70 million having a chronic disorder, according to published studies by the National Center on Sleep Disorders Research (NCSDR), an organization within the National Institute of Health (NIH). The American Sleep Apnea Association estimates that nearly 80% of patients who have moderate to severe sleep apnea are undiagnosed. Left untreated, sleep disorders can lead to serious health risks such as hypertension, risk of stroke, asthma, and heart disease, as well as mental health issues such as depression, anxiety, and insomnia. These associated health problems are a major driver of healthcare costs in the US. “Sleep disorders, sleep deprivation, and sleepiness add an estimated $15.9 billion to the national healthcare bill,” says the NCSDR. The CDC adds that “up to 6,000 fatal crashes each year may be caused by drowsy drivers.3”
IDT: What role has dentistry traditionally served in identifying, diagnosing, and treating patients with sleep disorders? Has that role been changing in the past few years and if so how and why?
Ataii: Dentists have traditionally been on the fringe of sleep disorders by screening and referring patients to sleep physicians or, occasionally, receiving a referral from a sleep physician of a failed CPAP patient. However, dentistry's role has been changing as the medical profession now recognizes the unique position that dentists play in healthcare. Most patients see their dentist more often than they see their physician, and at the same time more dentists are realizing that they have a responsibility for the airway since it is within their scope of practice. This was supported recently by the ADA's position statement that urges every dentist to screen patients for sleep disorders, increase their education on this topic, and treat patients with oral appliance therapy as appropriate.
IDT: What is the revenue stream potential that could be realized by incorporating sleep disorder therapy in the dental practice?
Ataii: Treating sleep patients can be a good source of new revenue for a dental practice if done correctly. Even if we, as an industry, treated just a fraction of the 70 million Americans who have chronic sleep disorders with oral appliances, this could result in a multi-billion dollar industry. Doing the math: 1% of 70 million is 700,000 patients multiplied by $5,000 to $10,000 per treatment. That's a $3.5 billion to $7 billion market!
IDT: There has been an explosion of sleep appliances launched onto the market as well as personal health tracking devices that offer consumers a method to track sleep habits. Are these indicators of a potential upward trend toward public awareness and dentistry adapting to a growing demand?
Ataii: Although the dental sleep industry is still very nascent, more and more programs and lectures are now being offered at dental conferences. In addition, public awareness of the dangers of sleep disorders has been increasing with news stories about train and bus accidents where the engineer's or driver's sleep apnea was the major contributing factor to the accident.
As a result, manufacturers have now responded with personal devices such as Fitbits that measure not just steps but also sleep activity. These type of devices have helped raise the awareness of the general public about the importance of sleep and its impact on overall health.
IDT: As manufacturers of Class-II sleep disorder appliances, what do laboratories need to know to effectively service this market segment?
Ataii: Most laboratories only offer one or two of the many appliances currently on the market. Offering a limited number of appliances is an issue because dentists are quickly realizing that they need many different appliance choices since patients are all different and no one appliance fits all patients. As a general practitioner who treats sleep patients, and given the high profile nature of sleep medicine these days, I only want to work with laboratories that are FDA-approved and that offer a wide selection of FDA-cleared sleep appliances. FDA compliance is important for dental insurance reimbursement for these appliances and also because of increased FDA compliance enforcement due to this industry's increased visibility.
IDT: Are there controversies among sleep dentistry experts on the best appliances, techniques, and protocols to use for patients suffering from sleep disorders?
Ataii: Since the dental sleep industry is still in its infancy, our protocols remain very rudimentary. For example, often the “standard of care” to set the bite registration on sleep patients is recommended at 70% of maximum protrusion. That percentage is arbitrary and can lead to possible complications, such as temporomandibular disorder (TMD), malocclusion, and other problems if these dental appliances are positioned without careful consideration. The reality is that to avoid these issues, multiple disciplines should be involved in the development of an appropriate treatment plan that aims to properly fit a patient with an oral appliance. Beyond sleep dentistry—which is what is mainly being taught today—you will need to incorporate orthodontics, TMD, myofunctional, and airway management expertise. That is why companies that have brought all of these disciplines together under one roof such as SleepArchiTx are gaining traction.