Tag Archives: David Gergen

Heat-Cured Hard Acrylic VS Dual Laminate Appliances

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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ASBA Is The Only Academy Fighting For Dental Rights In The Sleep Apnea Arena-ASBA Receives Support From Congresswoman Anna G. Eshoo Written By David Gergen

Congresswoman Anna G. Eshoo and Dr. Alpher
Congresswoman Anna G. Eshoo and Dr. Alpher

The Georgia’s new legislation now says, “Depending on the diagnosis of the type and severity, one possible treatment option for obstructive apnea is the use of oral appliances.  The design, fitting, and use of oral appliances and the maintenance of oral health related to the appliances falls within the scope of the practice of dentistry.  The continuing evaluation of a person’s sleep apnea, the effect of the oral appliance on the apnea , and the need for, and type of, alternative treatment do not fall within the scope of dentistry.  Therefore, the prescribing of sleep apnea appliances does not fall within the scope of the practice of dentistry.  It is the position of the Board that a dentist may not order a sleep study. Home sleep studies should only be ordered and interpreted by a licensed physician.  Therefore, only under the orders of a physician should a dentist fabricate a sleep apnea appliance for the designated patient and conduct only those tasks permitted under OCGA title 43, chapter 11. (Adopted 4/1/2016)”

This is very disappointing for dentists in Georgia. Let’s look at the interpretation of this new law. Does it mean a dentist will no longer be able to titrate their appliance by using a home sleep test? It surely means a dentist cannot refer out to a sleep testing company such as Complete Sleep, Snap or Easy Sleep or hand out an HST to one of their patients and have a Board Certified physician do the read and diagnosis. To the ASBA this is horrible news and we will be fighting it with all of our resources. You will be pleased to know that just yesterday, ASBA Board Member and Diplomate Dr. Elliott Alpher was in Washington D.C. alongside Congresswoman Anna G. Eshoo discussing this very topic and transportation.

David Gergen, Dr. Alpher, Marty Russo, Roy Green, Lieutenant Holmes, Mark Walczak, asba
David Gergen, Dr. Alpher, Marty Russo, Roy Green, Lieutenant Holmes, Mark Walczak

Dr. Elliott J. Alpher, Diplomate to and representing the American Sleep and Breathing Academy and Congresswoman Anna G. Eshoo (DCalif.), Ranking Member of the Energy and Commerce Committee’s Subcommittee on Communications and Technology for the 114th Congress met today to ask her support on proposed rulemaking for screening, diagnosing, treating and tracking compliance of Obstructive Sleep Apnea (OSA) in individuals occupying sensitive positions in highway and rail transportation.

The Federal Motor Carrier Safety Administration (FMCSA) and Federal Railroad Administration (FRA) have requested data and information concerning the prevalence of moderate-to-severe obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway and rail transportation, and on its potential consequences for the safety of rail and highway transportation.

Many mental functions are reduced when an individual experiences fatigue and sleepiness. It is estimated that 20% of accidents are caused by drivers’ inattention and sleepiness, and the occurrence of drowsiness when driving is a major risk factor for dangerous accidents. Chronic excessive sleepiness and sleep-disordered breathing are common in commercial vehicles drivers.

Dr. Alpher Washington D.C.
Dr. Alpher Washington D.C.

“OSA is a prevalent disorder among workers, which increases the risk of occupational accidents and has a significant impact on public safety. Fortunately, many of these accidents could be prevented by screening and treating sleep-disordered breathing with the resources and technology available…we are grateful to have Congresswoman Eshoo’s support on this matter,” says Dr. Alpher.

Dr. Alpher, one of the District’s most experienced specialists for sleep and jaw disorders, on staff at George Washington University Hospital and Georgetown University Hospital, has been known as a leader in the treatment of sleep disorders and jaw pain for 25 years. Dr. Alpher has pioneered a conservative, non-invasive approach utilizing computerized and verifiable diagnostic methods to treat TMD, snoring and sleep apnea. This method of treatment has proven to be greatly successful and is highly regarded as the first method of choice by physicians and patients.

Dr. Alpher was also responsible for heading a delegation to the Medical Advisory Board (MAB) to introduce the new technology of compliance chips in oral appliances to treat and monitor sleep apnea and snoring of truckers and other transportation personnel. In addition, he earned the status of Diplomate of the American Board of Craniofacial Pain & Dental Sleep Medicine in October 2013 and serves as a board member. Dr. Alpher is a Diplomate of the American Academy of Pain Management, Life Member of both the American Dental Association and the District of Columbia Dental Society. Dr. Elliott Alpher says, “The ASBA is the only academy fighting for the dentists’ rights in the sleep apnea arena and the efforts will become stronger as the American Sleep and Breathing Academy grows. The more members we have the more firepower we’ll have. I am so pleased that I have joined this academy because this is the only academy making a huge difference in my humble opinion. We are so blessed to have former Congressman Marty Russo as our ally.” Dr. Elliott Alpher was elected to the ASBA Hall of Fame for his lifetime achievements in the field of dental sleep medicine. If you are a concerned dentist about your rights, join the American Sleep and Breathing Academy at americansleepandbreathingacademy.com.

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

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

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

First Amendment Action Time!

Marty Russo, a retired Congressman, addressed the American Sleep and Breathing Association annual meeting last weekend with a strong call to action.

The commissions that oversee Railroad Operators and the Trucking industry have opened a public comment time for critical  rule making associated with treating Obstructive Sleep Apnea.  Marty talked about searching the current public comments and finding only one mentioning dentists at all, so he put together  an action sheet.  If we want the regulators to hear about oral appliances, it’s completely up to us to ‘petition our government,’ a right enshrined in our Constitution just for this very purpose.
Here’s what he advises us to do:
Dental Sleep Medicine Has A Big Opportunity
Speak Up To Federal Policy Makers – Let’s Be Heard In Washington
The Opportunity: 
The U.S. Department of Transportation has requested public comments on proposed rulemaking about screening, diagnosing, treating and tracking compliance for OSA in individuals occupying safety sensitive positions in highway and rail transportation.  These agencies need input from experts on the science of dental sleep medicine.
 Federal Motor Carrier Safety Administration (FMCSA)
Federal Railway Administration (FRA)
 How You Can Prepare:
Read the announcement outlining the proposed rulemaking. There are twenty specific questions about OSA that cover the areas of most interest to federal policy makers.  Address the questions that most closely align with your expertise.  The announcement can be located by going to your Internet browser and searching for these two docket numbers:
 What You Can Do:
Online:  Go to www.regulations.gov.  Search separately for each docket number listed above. Follow instructions to make comments on each docket number.
  • Present your credentials and relevant experience.
  • Be concise and support your claims.
  • Use scientific evidence from dental sleep medicine. Include scientific studies on oral appliance therapy and your own experience as an expert.  There is the ability to upload documents that support your position.
  • Address trade-offs and opposing views.
  • Include the costs and benefits to patients of your approach. It is especially important for oral appliance therapy to address costs and compliance.
  • Do not attempt any perceived commercialization for your product of services
  • Comments are not votes, but one well supported comment is more influential than a thousand form letters.
DO NOT let this opportunity pass us by.  If we don’t impress our views on the rule-makers, years will  pass before we can have this chance again.
David Gergen CDT

David Gergen CDT

David Gergen, CDT and President of Pro Player Health Alliance, has been a nationally respected dental lab technician for over 25 years. He received the award for “The Finest Orthodontic Technician in the Country” given by Columbus Dental in 1986. He also has been appointed Executive Director of the American Sleep and Breathing Academy Dental Division, a national interdisciplinary academy dedicated to sleep training and education with over 60,000 members. David rolled out of bed on December 4, 1982 and had his career “ah ha” moment. He knew he was going to be an orthodontic technician and he knew he was going to help people all over the country to help treat their sleep disorders in partnership with their dentists. He has worked for some of the pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for the likes of Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Harold Gelb, Dr. Joseph R. Cohen, Dr. Rodney Willey, Dr. Allan Bernstein, and Dr. Thien Pham. One of his proudest achievements is receiving The National Leadership award for Arizona Small Businessman of the Year in 2004.

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