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Dental Sleep Medicine Blog

Changing this Blog to once a month

7/14/2017

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Due to being so busy I have decided to do this blog once a month on the first Thursday.  I still answer questions via my email at dentist2@yahoo.com

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My book Dental Sleep Medicine Basics the clinical guide to treating obstructive sleep apnea is now available.

7/12/2017

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The publisher has made the book abailable to order now at https://secure.mybookorders.com/Orderpage/2012

It should be available on Amazon in a month or two.  This is a great place to order right now.

Everything you want to know about getting started with treating obstructive sleep apnea. Read the book and see if this is something you want to start before taking a course.

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Another Sleep appliance repair

7/6/2017

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Watch on You tube


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Repairing a sleep appliance

6/29/2017

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On Vacation

6/22/2017

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So I am on Vacation and enjoying being in Cancun Mexico.  

As I look at all the Americans in my all inclusive hotel I notice most are obese, they drink and eat too much and probably have sleep disorders.

I feel sad because most people know for their health they should eat better and lower the alcohol consumption. It is just so hard for people including myself.  I have increased 4 pounds in just 4 days while on this vacation.

Also this week I learned the actress that played Princess Lea in the original Star Wars movie "Carrie Fisher" just died from sleep apnea.  This is why we treat obstructive sleep apnea.  Hopefully we can help prevent these deaths.

Even if all we do is get patients to use their CPAP then we have helped.  Our oral appliances do work and they have a higher compliance than the CPAP.  We need to get the word out to everyone.

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What do you do if you have a new crown on a tooth and your appliance no longer fits? What if that tooth is the most posterior one?

6/14/2017

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There are many different ways to dealing with this.  Here are the ways you can deal with this:      

1. Grind it out to fit.  Downside is this may allow for slight tooth movement.
    
2.Grind it out then take an alginate mold pour it up in stone. Place the appliance on the stone and make sure it fits on and off easy.  Next super sep the cast and then mix acrylic and monomer into putty and place in the appliance and sit it back onto the stone model.  Soak in hot water for 20 minutes then remove from stone and trim and polish.     

3.You can grind it out and then using a chair side denture reline acrylic add to it in the patients mouth. Tokyama rebase.     

4. Send to the lab with an impression for a correction.

5. If it is accufit from Dynaflex then just boil it to heat the thermoplastic and re-fit it in the mouth.  
  
6. Make a new appliance. If over 5 years old I do this.

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Using a Type III Home Sleep Tester in dental sleep medicine

6/1/2017

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Every day I am asked about using a home sleep tester to diagnose patients and how do you bill for that.

This is a very grey area and there are many different answers and opinions about this.

Medical doctors do not wish us to use an HST for diagnosis even if we send it to a board certified sleep physician.  In several states the medical board has influenced the dental boards to disallow the use of an HST for anything other than titration.

Many medical insurances and Medicare will not pay you for the diagnosis use of the HST. They require a face to face visit with a sleep physician and administration of the testing by him/her.  

If you treat a Medicare patient as a Medicare provider you can't refer the patient to do an HST online or use your tester and expect to be allowed to provide services. You have broken their rules and can be denied any future claims, even potential charges against you.

The only people we recommend an HST online is cash patients. Some patients with insurance and high deductibles become a cash patient due to their insurance not paying for treatment. These patients get the HST and they can try to submit the bill themselves, but the reality is the insurance will not pay and won't apply it towards their outpatient deductible. So you must let the patient know this before they order one.

To avoid any grey areas and angering the medical community and insurances we just reserve our HST for titration studies only.  You can bill the patient's medical insurance 90 days after delivery for the HST used in titration.  

I do believe every dental office treating sleep apnea needs to have and use an HST in the titration.  You can never know if you are titrated correct until you do the test.  For payment it is best to wait 90 days and then do the test.

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No Blog post today due to Memorial Day weekend

5/25/2017

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I took time of from the website today to get started on my holiday weekend. I promise to write next week.  I hope everyone has a great holiday weekend.

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How do you disinfect oral appliances?

5/17/2017

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Most of my sleep patients, denture patients, or any other type of patient that wears some removable appliance ask me how do I disinfect my appliance.

For years I have been asking them to soak their appliance in chlorhexadine for about 30 minutes once a week.  That kills all the fungus and bacteria.

Now I have discovered something better.  Dr. B Dental Solutions Cleanadent Crystals.  These work great for killing off the bad things on removables and keeping the appliances clean.  You can purchase these and give them to patients or you can sell them to patients or even tell them where to order them.

I have listed a few key points for the product to help highlight the main benefits.

Cleanadent Crystals
Kills Pathogens like Candida and Strep
and Removes Heavy Plaque, Stains and
Calculus
Most Oral Appliances Become Infected
with Candida Over Time, yet Many
People Don’t Know
Economical – Individually Packaged
and Provides up to 180 Deep Cleanings
per box
Others Only Kill Odor-Causing Bacteria
Sonic Cleaners
Uses Sonic Waves to Mechanically
Remove Heavy Plaque, Stains and
Calculus
No Matter What Cleanser You Use,
Doctors Recommend Sonic Cleaners
as Essential for Oral Hygiene
Sonic Cleaners Ensure More
Complete Elimination of Pathogens
and Prevent Recolonization
Works on All Removable Appliance
 To learn more go to:
http://www.drbdentalsolutions.com or email them at info@drbdentalsolutions.com  I am not being paid or compensated for this endorsement.

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Medical Billing Companies

5/10/2017

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Why use a Medical billing company verses billing medical insurance and Medicare yourself? This is a common question that I am asked. 

The answer is difficult because you need to look at the individual office.

If the office is very busy and low on staff than adding in extra work like calling medical insurances and following up on claims or rejections can be hard. Often times a phone call to the medical insurance can take several hours. Also making sure all the papers needed for submittal and follow-up can be difficult.

If the office is slow and there is an extra person then that person can afford to spend the extra time needed to deal with the medical insurance.

Switching back and forth from dental to medical insurance can be confusing and can lead to many mistakes. Many dentists do not want their staff to do both.

Medicare, and most medical insurance now require offices to file electronically. This can be done with some low cost software for under $100 a month, but still you need to learn how to do this.

In my office we use a billing service. This allows us to hire less staff and lower our overhead. It also allows us to focus on dentistry and not the medical billing.  The billing company does pre-verifications and pre-authorizations for us, and tells us what we need to do if we want to be paid. The billing company also keeps following up with claims that have not been paid or dealing with rejections.  It has made treating sleep apnea so much better.

Which billing company should you use? There are many to chose from. What you need to ask is do the handle Medicare if your a provider. How many sleep cases have they billed and how many dentists do they represent? What procedures do they have success billing for in your region. What insurances are they used to dealing with?  Not all billing companies live up to their promises and most charge to set up an account so firing them can be costly.  The one I recommend the most is GOGO Billing in AZ.  there are other good ones, but I have experience with GoGo.

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    Mark Collins DDS
    ,DABDSM

    Author, international and national lecturer, inventor, software designer, and mentor on dental sleep medicine

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