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Heat-Cured Hard Acrylic VS Dual Laminate Appliances

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Weekend courses teaching oral appliance therapy are conducted all over the country and with over 100 commercially available oral appliances it can be really difficult to navigate the appliance selection process. Considering the mechanical functioning of the appliance is essential when determining which one to choose for treatment, but often times the material used to construct the appliance is equally as important and overlooked. Two of the most generally known materials are heat-cured hard acrylic and dual laminates. Studies have shown that while there are advantages and disadvantages to each material, most doctors favor heat-cured hard acrylic appliances because they have a compelling superiority over the latter when it comes to fitting, repairs, longevity and patient comfort.

Some of the most pressing issues in doctors’ offices are fitting the appliance correctly in the patient’s mouth. Obstructive sleep apnea is a serious medical condition that can sometimes be so severe that doctors don’t have time to send back an appliance to be remade if it doesn’t fit. National statistics show a lower percentage of remakes in hard acrylic formed appliances. The reason for this can partly be credited to ease of modification chairside due to minor cosmetic dental changes. If anything changes in the patient’s mouth for example, the addition of a crown, a completely new appliance must be created as realignment can’t be done in laminate appliances. On a hard acrylic appliance, the appliance can sometimes be ground to re-fit. Furthermore, the addition of clasps in hard acrylic appliances provide further retention whereas a laminate appliance does not allow for it to contain clasps.

Repairs are inevitable when it comes to oral appliances. Fortunately when repairs are necessary, the ramifications can be minimized simply by the choice of appliance design. Doctors can take a more basic approach to repairing hard acrylic appliances including, but not limited to, effortlessly bonding new acrylic to cracks or chips in their own. Mending a laminate appliance can become more complicated when considering the soft liner located on the inside. Many times that same soft layer has been shown to absorb moisture and start to yellow with bacteria. Unfortunately this is not a matter of repair, rather a matter of replacement.

Gergen’s Orthodontic Lab, which is the largest manufacturer of the Sleep Herbst in the country, has seen hard acrylic appliances last over to 20 years. Regrettably, the soft layer in laminate appliances always eventually loses the bond to the hard layer- meaning it will always peel apart over time, leading to the doctor sending it back to the manufacturing lab to be rebuilt.

Typically patient comfort is one of the cornerstones of the decision making process in choosing treatments. While each of the designs have equal amounts of pros and cons to patient satisfaction, time and time again there have been proven patterns and methods that demonstrate it is easier to overcome the cons associated with treatment via hard acrylic appliances. This is contrary to general belief being that dual laminates are more comfortable. Moreover, tongue space is greatly reduced in dual laminate appliances due to the extra layer being present.

All things considered, both hard acrylic and dual laminate appliances grant favorable benefits in many cases. Clearly though when taking into account the comparison of both designs regarding fitting, repairs, longevity and patient comfort the preferred choice when selecting one of the two is the hard acrylic design more often than not.

Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

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Special Committee In Washington To Look At Oral Appliance Therapy As Benchmark Therapy For OSA, Thanks To The ASBA And Our Team

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More great news coming from The American Sleep and Breathing Academy! It is no secret that the ASBA has been working tirelessly for the advancement of dental sleep medicine and, in September, the culmination of all of that hard work will come to fruition. Key members of the American Sleep and Breathing Academy, along with NFL icons such as Roy Green, and Congressman Marty Russo will be in front of a special congressional committee speaking about treatment of Obstructive Sleep Apnea (OSA) with oral appliance therapy.

Spearheaded by Congresswoman Anna G. Eshoo, this special committee was assigned a health and science aid to gather information on the effectiveness of oral appliance therapy in treating OSA. Congresswoman Eshoo’s main goals with forming this committee is to make oral appliances a benchmark therapy. The hope is that the information gathered within this committee, along with insight from these key ASBA members, will help to educate patients on all treatment options; an education that is not typically presented at the time of treatment. “In a world where CPAP is over prescribed and patient outcomes are less than ideal, this meeting of ASBA elites and political powerhouses will change the landscape of dental sleep medicine”, says David Gergen, Executive Director of the American Sleep and Breathing Academy.

The ASBA is the only Academy that is fighting for dentists in the space that we call sleep. There is strength in numbers and the ASBA currently has 770 members. It is the fastest growing academy in the World. Now is your opportunity to be a part of an organization that is paving the road for oral appliance therapy to be the benchmark in OSA treatment. Visit americansleepandbreathingacademy.com to join the movement.

Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

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Future Reimbursement In Dental Sleep Medicine To Be Based On Diplomacy And Patient Outcomes

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The American Sleep and Breathing Academy (ASBA) is an organization dedicated to enriching our members’ knowledge and skill in the treatment of sleep disordered breathing. Our goal is to provide current evidence based information to our members and enable them to provide optimal treatment for their patients. The ASBA offers Certification to its members as a confirmation of their knowledge, skill and experience. While there are multiple levels of Certification within our organization, the primary goal is to show the industry that our diplomates are able to achieve better patient outcomes and a more successful business overall.

It is very important that a dentist needs certification from an accredited academy because dental sleep medicine must be consistent based on outcomes and the literature. If we look into the future of healthcare in the not so distant future, reimbursement will be factored on credentialing and patient outcomes. The ASBA is a unique organization that emphasizes research and outcome monitoring in combination will contribute to the success of our diplomate members.

The ASBA diplomate will show the medical world that they are a master of dental sleep medicine. Insurance carriers require quantifiable information to show patients and referring physicians that their doctors have higher treatment outcomes; in addition if you are already a diplomate in another academy and become a diplomate of the ASBA you are more likely to receive referrals from local physicians as a double diplomate. This includes but is not limited to compliance monitoring and objective outcomes monitoring which will confirm that an ASBA diplomate provides a certified higher standard of care.

As an ASBA member, you have an opportunity to attend the ASBA review course for diplomacy September 23rd and sit for the exam September 24th in Phoenix, AZ. Register here or call 602-478-9713 for more information.

Certification guidelines include:

  • 40 hours of continuing education in Dental Sleep Medicine, in the last 2 years. This year’s Board Review and Annual Meeting can count towards the 40 hours. Proof must be emailed to psv101@icloud.com before sitting for the certification exam.
  • Submit 10 cases that you personally treated successfully with Oral Appliance Therapy.
  • (Each case submission must be submitted and numbered as cases 1-10, with no names. Names must be whited out!)
  • Three must be severe, that were reduced by at least 50%. Three must be moderate that were reduced by at least 50% and have a treated AHI of less than 10. Four can be mild to moderate with a treated AHI of less than 5.
  • The diagnostic and follow up studies must be administered by a 3rd party diagnostic facility using either HST or PSG., and must be emailed to psv101@icloud.com, by January 15, 2017.
  • Pass the 100 question, certification exam, given on September 24, 2016. Categories for the exam:
  • Basic Sleep Medicine, Oral Appliance Therapy, Polysomnography, Portable Monitors, Surgery, Pediatrics, Complications, CPAP, Imaging
Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

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Final Public Listening Session Today! Let Our Voices Be Heard!

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truckaccident-300x240                                                                                                                                                    Today at 1:30PM- 3:30PM PST the third and final public listening session will be held at the Westin Bonaventure Hotel and Suites, 404 S. Figueroa St. in Los Angeles. On March 10, 2016 The Federal Motor Carrier Safety Administration and Federal Railroad Administration announced a notice of proposed rule making to receive feedback about any potential sleep apnea regulations. Information on the prevalence of moderate-to-severe obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway and rail transportation, and of its potential consequences for the safety of rail and highway transportation can be solicited at this hearing as well as be submitted online in the form of comments. The 90-day comment period will be ending June 8, 2016.

Through the listening session, interested parties will have one last opportunity to share their views and any data or analysis regarding sleep apnea with representatives of the FMCSA and FRA. As a contributor, you are asked to identify whether you are in the transportation industry or medical profession, but you can choose to remain anonymous. The Agencies will transcribe all comments and place the transcripts in the dockets FMCSA-2015-0419 and FRA-2015-0111.

Previous listening sessions took place May 12 in Washington, D.C., and May 17 in Chicago. Highly prioritized concerns during the sessions have included the cost of sleep studies for drivers and locomotive engineers, the failure of most safety-sensitive transportation employees with apnea to use their CPAP machines and ensuring that any apnea mandates consider safety benefits over costs and driver health.

As ASBA members, we need to provide input on how it is important to driver and public safety to be treated for OSA. For those who are unable to attend in person, the entire proceedings of today’s listening session will be available on the through a live webcast, which can be found here.

Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

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Medicare and Private Insurers Raise Rates for Sleep Apnea Dentistry

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trend
Sleep therapy continues to receive scrutiny by regulators and payors. Centers for Medicare and Medicaid have been monitoring patient outcomes and clinical yield for patients. There has been no formal announcement as to their findings however CPAP reimbursement continues to be cut while Oral Appliance Therapy reimbursement has officially been increased by Medicare. Revenue from code E0486 has doubled in recent months according to reports by ASBA members, Industry leaders predict that private insurance will follow Medicare reimbursement guidelines.
 Supporting this trend is the recent announcement by Cigna the first private insurer to develop a national policy for Oral Appliance Therapy, settling on $2500 as a bundled fee. In other regions fees have increased by 25 to 100%. Jurisdiction “D” reimbursement rates has remained unchanged.
 Insurers are expected to work with industry to monitor outcomes data to balance revenue and patient care expectations. It is also very significant and important to note that evidence of post graduate training and Diplomacy has become a method that some insurers use to deny insurance claims (this is new and bears watching).
 The American Sleep And Breathing Academy continues to monitor insurance reimbursement, and policies through its relationships with Washington DC insiders like Congressman Marty Russo and others.
 “In June of 2015 the ASBA was the first organization to warn Dentists of the risk to using the “S” code for billing TMJ Splints. Advance notice of this change saved ASBA members thousands of dollars in hard costs associated with billing errors and uncollected revenue.” – David Gergen CDT
 The latest opportunity identified by the American Sleep And Breathing Academy team of lobbyists is a new government protocol for chronic care management. CCM has the potential to contribute a strong revenue stream for sleep apnea dentists in 2016. The physician who developed the Chronic Care Program spoke at the Sleep and Wellness conference in Scottsdale AZ April 15 and 16. 
 
CMS Bets on Oral Appliance Therapy a blog post Gergensortho.com
A running discussion for the last 6 years here at Gergens Orthodontic Lab has been the CPAP as Gold standard of sleep therapy vs Oral Appliance therapy debate. These discussions usually go for hours and have gone on for years. The strongest debate has been between David Gergen President of Gergens Orthodontic Lab and Executive Director of American Sleep and Breathing Academy (ASBA) and Randy Clare who supports CPAP. Gergen knows CPAP has its place and time in the sleep world, but strongly feels that the oral appliance will surpass CPAP as the go-to treatment within 10 years. Clare would debate if that’s the case, respiratory techs will be managing the oral appliance patients not the dentists. Back and forth compliance vs treatment efficacy. David Gergen has been back and forth to Washington working with congressman Marty Russo trying to get some traction within the federal government on this issue.
The key point of distinction of course is what drives medical care in the United States is reimbursement. The story for CPAP in the reimbursment arena since competitive bidding became an issue has slowly restricted access to care and fed a consolidation of providers. Fewer providers to provide care and the care they can afford to provide is less personal which results in lower compliance rates which results in lower reimbursement. January 1 2016 CMS cut CPAP reimbursement by 25%. Will this affect a diagnosed OSA patients ability to get great care of course it will.
On the other side of the ledger Oral Appliance therapy has not been a focus for CMS. The OAT program has been way underfunded. This has made access to oral devices for sleep apnea difficult for medicare patients. Dentists were not finding it easy to provide care for these patients because reimbursement was so low. January 1 2016 CMS raised reimbursement for OAT to $3700 in jurisdiction B (see attached EOB) If you don’t know your jurisdiction for medicare I have also added a map for your use.
I expect that this will increase access to care significantly. I feel it indicates a trend and perhaps insurers are ready to consider higher compliance rates and better return on sleep therapy dollars. After all the dental team sees the patient at minimum every six months which is a much better way to manage a lifelong condition with severe health implications.
Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

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Oral Appliance Therapy, Public Awareness, Sleep Medicine, Sleep Organizations

Arizona Cardinals Join ASBA, Phoenix Police, and Pro Player Health Alliance For The Worlds Largest Sleep Apnea Awareness Event

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20160126_chadiwck_19.33.50                                                                                                                                                                                                                                                                                                                    Pro Player Health Alliance is an organization dedicated to helping treat former NFL players who suffer from obstructive sleep apnea (OSA). As a result these superstar athletes then become more than just patients, but every day people who publicly support and spread the awareness of OSA at events across the nation. With a combined effort of former NFL greats, local establishments and public figures, the community as a whole can unite to direct potential patients toward dental/medical professionals who can help.

 

The next Pro Player Health Alliance event, aimed at improving awareness and undersDavid Gergen Larry Fitzgerald Roy Green Alan Hickey Randy Claretanding of sleep related disorders in the general public, is also a fundraiser to benefit the Phoenix Police Foundation. In addition, it will be the first official celebration to kick off the new season for the Arizona Cardinals. Shining a light on life threatening health complications that can be caused by allowing OSA to go untreated has become a primary objective for the Arizona Cardinals since partnering with Pro Player Health Alliance. Location and time of the public awareness event and fundraiser will be Tuesday September 6, 2016 at 6:30 p.m. to close at Padre Murphy’s 4338 West Bell Road, Phoenix AZ 85308. It is expected that this event will draw over 5,000 thousand attendees.

Roy Green, NFL legend and former Cardinals WR/DB has said, “If I had met David Gergen years ago, I may not have had to experience having a heart attack, let alone three heart attacks and two strokes. I am extremely grateful for what he’s done for me and my former teammates and I’m glad to be a part of spreading awareness on sleep apnea so others don’t have to go through what I did.”

Pro Player Health Alliance President David Gergen, owner of Gergen’s Sleep Appliance Lab and Executive Director of the American Sleep and Breathing Academy is an icon throughout the dental sleep community and will be the MC for the event. David will be on hand to help the public meet their favorite player and to share his extensive knowledge of sleep disorders including the dental treatment of sleep apnea.

David Gergen on stage

 

 

 

 

 

 

 

“Over the years more and more retired NFL greats have contacted me regarding their sleep apnea. I am happy to refer them to a dentist or medical doctor who can help them. It became very obvious that the general population was having the same issue. Roy Green and I decided to help the retired players and improve awareness of sleep disorders by promoting large public events.” – David Gergen

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Is The Professional Sleep Community Represented Fairly?

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In the last several weeks there seems to be a lot of buzz surrounding the AASM/ABSM’s announcement that they will be developing and administering a new credentialing exam for professional sleep techs sometime later this year.

As we are all trying to understand the reasoning behind this “surprising” pathway, we are being told by the AASM/ABSM that their reasons for adding a fourth sleep credential include low pass rates with the existing RPSGT exam and complaints from sleep center/lab physicians that the new crop of RPSGT’s do not have the skills needed to meet the labs needs regarding patient care and professional processes.

Now I know that I am just a mere educator and simply hold multiple credentials in a variety of related professions, which includes being a proud registered sleep tech for about 15 years, so maybe I am not smart enough to understand this reasoning by the AASM/ABSM. But what stands out in my mind is where is the representation I have always paid for, and expected, from the AAST?

After finding out about this new credential pathway I did some of my own investigation to try and find the answers to some questions that my elected AAST leadership has yet to answer. I called numerous sleep centers accross the country and spoke with many center/lab physicians and techs and without failure each and every one of them had “no such complaints” as explained to us by the AASM/ABSM. Maybe I just did not ask the right people, after all I am “only” a sleep tech and educator.

Now I admit that I have limited resources and time and could not possibly contact everyone to ask their opinion. So I asked myself who could do this for me, for us. Who has the resources to contact some 17,000 RPSGT’s and thousands of accredited sleep facilities and physicans to ask the same questions that I asked when I contacted just a few dozen. 

From what I am reading in the blogs, and Facebook, and other cyber space sites is that many of you are asking the same question and most of you are coming to the same conclusion: the AAST, the AASM, and the ABSM. After all, isnt this why we have paid year after year of membership fees, supported annual meetings, and donated our time to further the cause of sleep professionalism. My expectation, maybe your expectation as well, was that my membership dollars and my donated time was not only to futher the cause of sleep professionalism but was to also protect my credential. Doing both would protect my livelihood as well.

As I said in the beginning of this rant, maybe I am just not smart enough to understand where my representatives have been on this matter, much less where they stand today. I also dont understand why nobody asked me my opinion about any of this over the last several years. And the same concern was expressed to me when I called upon the physicans and techs that I have spoken with over the last week or so.

The actions taken by the AASM/ABSM/AAST may be based on valid reasoning and concerns. I have no way of knowing one way or the other. So far they have only told us what they want us to know and have not released any valid data to support their decision. However what I do know is that the actions, or lack of action, by all three entities have thrown this profession into chaos. And the statement by the AASM/ABSM that I will be able to “grandfather my RPSGT” to their new credential means that at some near point in time my RPSGT credential will be worthless.

Its important to also remember that many of our representatives in these organizations are volunteers. They too have donated massive amount of their personal time and energies to support our profession. But it is also important to understand that their are also many “paid” representatives and staff that depend on the survival, and expansion, of these organizations for their income and in some cases, their positions of power and authority.

How each of you react to this chaos that was thrown upon us is a personal decision. I have read and heard that many or you are cancelling memberships and others are cancelling plans to attend the national meeting and opting instead to pay their dollars to state and regional meetings. Still others are taking the “wait and see” approach to see where the AAST  “publically” stands when they eventually do take a stand either way for the development and testing of the new credential.

Whatever action you take or dont take I suggest that you stay informed and do your homework. Talk to each other, send emails to your elected industry and organization representatives. Make an informed decision on what action you take as an individual. For me, its pretty simple personal decision; since I am not smart enough to be asked my opinion I will be attending the Southern Sleep Meeting in New Orleans where I can be with other RPSGT’s who may actually think that I have something of value to say.

Joseph Anderson, RPSGT, RPFT, CRT-NPS, RCP

Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

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