Dental Sleep Medicine Blog

Repairing a sleep appliance

6/29/2017

On Vacation

6/22/2017

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.

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

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.

Using a Type III Home Sleep Tester in dental sleep medicine

6/1/2017

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.