Long Island Dental Sleep Medicine: Leading the Way in Oral Appliance Therapy to Treat Obstructive Sleep Apnea

By Trevor Willingham
Monday, December 12, 2016

Equipped with an array of the industry’s most state-of-the-art equipment and latest procedures, the experienced team at Long Island Dental Sleep Medicine (LIDSM) is at the vanguard of dental offices combating the dangers associated with obstructive sleep apnea.

L–R: Jeffrey S. Rein, DDS, FAGD, D.ABDSM, D.ACSDD, D.ASBA, and Neal Seltzer, DMD, FAGD, D.ABDSM, D.ACSDD, D.ASBA, of Long Island Dental Sleep Medicine

LIDSM has been treating patients successfully with oral appliance therapy for more than 25 years. Led by Neal Seltzer, DMD, FAGD, and Jeffrey S. Rein, DDS, FAGD — both Diplomates of the American Board of Dental Sleep Medicine, Academy of Clinical Sleep Disorder Disciplines, and the American Sleep and Breathing Academy — LIDSM is the first office in the state of New York to attain a Dental Sleep Medicine Accreditation from the Academy of Dental Sleep Medicine.

Earning the title of “Dental Sleep Medicine Accredited Facility” places LIDSM amid an elite group of practices around the country recognized for their excellence in care and professionalism in treating patients with obstructive sleep apnea (OSA). To become accredited by the Academy of Dental Sleep Medicine, facilities must meet stringent standards for their dentists, staff, policies, procedures, care, treatment, billing, follow-up and safety.

“The goal is rather simple: to provide our patients with the best care we possibly can,” Dr. Seltzer says. “Although it took many years of hard work to achieve, this accreditation will put us in a position to provide better outcomes for those suffering from the very serious condition of sleep apnea.”

Recognizing the Problem

Often dismissed by patients as a harmless annoyance, OSA has become more of a concern over the past few years due to its growing presence within the population and clearer evidence linking it to severe health complications. The American Academy of Dental Sleep Medicine estimates that around 25 million adults in the United States now have OSA.

Gina Pepitone-Mattiello, Registered Dental Hygienist, prepares a patient for 3-D cone beam CT using Sirona Galileos CBCT.

L–R: Jeffrey S. Rein, DDS, FAGD, D.ABDSM, D.ACSDD, D.ASBA; Gina Pepitone-Mattiello, Registered Dental Hygienist; Neal Seltzer, DMD, FAGD, D.ABDSM, D.ACSDD, D.ASBA

OSA occurs when tissue in the back of the throat collapses, blocking the airway and reducing the amount of oxygen delivered to the heart and brain. People living with this condition may actually stop breathing for short periods of time — as frequently as 60 times an hour.

If left untreated, OSA will not only cause excessive daytime drowsiness or fatigue that can greatly increase the chances of experiencing driving or workplace accidents, but it can also boost the risk of serious health problems such as cardiovascular disease, heart attack, high blood pressure, stroke, diabetes, chronic acid reflux, erectile dysfunction and depression.

“Evidence has made it very clear that sleep apnea has major effects on the health and well-being of those who suffer from it,” Dr. Seltzer says. “By helping people get a good night’s rest, we are not only making an enormous difference in people’s quality of life, but we’re also saving lives. Knowing this drives us to rely on the greatest equipment to reach even more optimal outcomes.”

Driving Toward Improvement

For many years, when weight loss and nighttime sedatives failed to address sleep issues, patients had to choose between surgery and using continuous positive airway pressure (CPAP) therapy. As the gold standard in treatment for sleep apnea, CPAP involves breathing in forced air that is administered through a mask. While worn, this mask provides a steady stream of air that keeps the individual’s airway open so he or she can breathe consistently through the night.

“The CPAP is a wonderful tool that can make a huge difference for people suffering from sleep apnea,” Dr. Seltzer says. “The problem is it’s very difficult to be compliant with. The device is bulky and unappealing. Many patients will choose to go to bed without it — rendering the CPAP ineffective.”

Offering similar relief in a far more discreet package, oral appliance therapies have become extremely popular over the last decade. A study published in the European Respiratory Journal found that dental appliances were equally effective as CPAP in treating mild and moderate sleep apnea.

“In our experience, we’ve seen that dentists who utilize oral appliance therapy can offer significant insight and support for patients who have breathing problems related to sleep apnea,” Dr. Rein says. “However, with around 160 appliances to choose from, it’s more important than ever for patients to find an experienced dentist armed with the latest equipment and technology to provide the patients with the best option for them.”

Next Generation of Care

From the moment a patient is first referred by their physician, LIDSM harnesses the latest technology to ensure each aspect of the treatment plan is optimized for superior results.

“A lot of facilities and practices are timid when it comes to spending money on new technology and having to donate the time required for proper training,” Dr. Rein says. “However, we embrace the opportunity to use the latest equipment so our patients know they have every option available to them.”

LIDSM leads the way in offering patients the most advanced oral appliance therapy to treat sleep apnea — an achievement made possible by its impressive lineup of the latest tools.

The MATRx Diagnostic System

Trying to predict if a patient will benefit from oral appliance therapy has been a challenge for dentists over the years. Without the latest technology, dentists have had to rely on careful clinical observations, analysis of anatomy, sleep studies and detailed medical histories to choose a particular appliance and ensure its careful placement and fitting.

The MATRx remote-controlled oral appliance titration device by Zephyr for in-lab use

While there is still no single measuring device capable of absolutely predicting if a patient will respond favorably to oral appliance therapy, technology has given rise to a new tool that can improve the chances of a successful prediction: the MATRx.

Developed by Zephyr, the MATRx system is used for in-lab titration prior to actually fabricating a final custom oral appliance for patients. Once a patient is diagnosed with OSA, a MATRx test will enable a physician to confidently prescribe oral appliance therapy that will be effective.

“We are proud to be one of the few dental offices in the country trained in the use of the MATRx system,” says Dr. Seltzer. “So far, Long Island Dental Sleep Medicine has helped institute the MATRx into several area hospital-based sleep centers. Together, we are breaking new ground in our ability to predict success early.”

Latest in Oral Appliances

As continuous open airway therapy (COAT) using oral appliances has grown in popularity, so have the specific mouthpieces used to treat OSA. LIDSM has access to the latest brands and designs to match a patient’s individual needs.

Sirona GALILEOS CBCT scans using Sirona SICAT AIR software to analyze airway

Access to quality products is one thing, but LIDSM also prides itself in having the experienced team necessary to select which option will be best. Choosing the correct appliance for an individual requires years of experience to consider factors such as anatomy, dental prosthetics, gag reflex, periodontal condition and temporomandibular joint dysfunction.

Averaging several oral appliances a day, the team at LIDSM is in a good position to accurately choose the best device available.

“It’s not uncommon for us to change an appliance for a patient during treatment due to limitations or intolerance,” Dr. Seltzer says. “When we feel we can do better, we aren’t afraid to change things up. Our goal is to get the patient back to a good night’s rest, no matter what it takes.”

3-D Cone Beam CT Technology

Obtaining as much information as possible about the teeth and their supporting structures along with the upper airway and sinuses is imperative when treating patients. To best accomplish this, LIDSM invested in the Sirona GALILEOS 3-D cone beam CT (CBCT) — technology designed to assist in state-of-the-art diagnostics.

Sirona GALILEOS CBCT scan using Sirona SICAT AIR software to analyze airwa and fabricate Sirona OPTISLEEP digitally manufactured oral appliance

“With this technology, we can see things now that we were never able to see in the past and are better able to understand the anatomy of the airway,” Dr. Rein says. “The 3-D CBCT has been a game changer in our ability to find pathologies of and complications with the airway and properly refer a patient to the appropriate specialist. The CBCT even helped us find a malignant bone tumor in a patient’s mandible, saving his life.”

In addition to helping better understand the anatomy of an individual’s teeth, bone structure and upper airway, the GALILEOS CBCT can now offer so much more thanks to its ability to sync with the latest SICAT AIR software by Sirona. This technological pairing allows the doctors at LIDSM to not only view the airway in 3-D, but also analyze the airway before, during and after treatment.

“Digital technology is revolutionizing our field, and nowhere else is this more evident than in the ability to now have an oral appliance made digitally using the 3-D CBCT, Sirona’s CEREC scanning technology and SICAT AIR software to virtually design and then digitally build a Sirona OPTISLEEP oral appliance,” Dr. Rein explains.

With this technology, no rubber impressions of a patient’s mouth are needed to create an accurate model. Rather, digital photos of a patient’s teeth are taken using the CEREC camera. That information, along with the GALILEOS scan, is then superimposed using the SICAT AIR analysis to create predictable, perfectly fitting appliances faster and easier than ever before.

“We’re proud to be one of the first offices in the Northeast to use a combination of all this technology to boost efficiency and outcomes when treating our patients,” says Dr. Seltzer. “The very first patient we treated using this equipment went from having an Apnea Hypopnea Index of 35 events per hour to only three events per hour — an astonishing improvement.”

Hybrid Therapy

Sometimes a detailed analysis of the patient may not point toward oral appliance therapy as the best and only solution. Patients with severe sleep apnea may not respond to any of the standard, time-tested treatment modalities such as surgery, CPAP or oral appliance therapy, needing instead a combination of all three.

Patient wearing a TAP/PAP HYBRID oral appliance-supported PAP mask manufactured by Airway Management

The latest solution, dubbed “hybrid” therapy, eliminates the two most common reasons for CPAP failure: ill-fitting masks and excessive air pressure. The hybrid design TAP/PAP interface blends the best of CPAP and oral appliance therapy. By fusing a specially designed nasal CPAP mask with an oral appliance, doctors can help eliminate the issues that lead to so much CPAP failure for those who require CPAP.

“What we see with hybrid therapy is, in essence, the sum of two devices is better than the individual tools,” Dr. Seltzer says. “The oral appliance component splints the mandible to open the airway, allowing the CPAP portion to use far less air pressure to splay open the remainder of the collapsed airway.”

By mounting the CPAP mask to the upper portion of the oral appliance, the device is securely fit and doesn’t move. This detail gives patients the ability to sleep in a wide variety of positions, including on the stomach, without headgear or straps and without the fear of dislodging the CPAP mask. The result is a more comfortable, more tolerable and more successful treatment for patients who have had no answer for their sleep complications.

Monitoring Compliance

One of the great obstacles in treating OSA has been finding a treatment that works and is easily tolerated by patients. Historically, surgery was the first treatment option offered, and due to poor success rates, complications and side effects, insurance carriers reduced payment for these procedures and physicians have shied away from performing them.

Braebon DentiTrac microrecorder embedded in Somnodent Flex oral appliance used for compliance monitoring

CPAP, while an excellent treatment, tends to be less tolerated due to the difficulties of being strapped to a machine. To track their usage, CPAP devices have been equipped with recording devices that allow doctors to see whether or not they are being used frequently enough to make a difference.

“Studies have shown that, over time, less than 30 percent of patients prescribed CPAP continue treatment,” Dr. Rein says. “Moreover, the compliance requirement for CPAP is a minimum of four hours per night. So the bar has been set very low for CPAP, and it leaves many people improperly treated.”

While oral appliances have been shown to be much more tolerable, for years there was no way to track their usage so that insurance companies and doctors could monitor the patient’s progress. LIDSM has adopted the Braebon DentiTrac compliance recorder to fix this concern.

Braebon data reader used to download information from the DentiTrac microrecorder

“This micro recorder allows us to level the playing field when it comes to tracking usage,” Dr. Seltzer says. “It’s a small device, the size of a finger nail, approved by the FDA, that can be embedded in the oral appliance and can accurately keep track of a patient’s usage. They are also tamper-proof, which means it will be hard for patients to trick the system — something we see often with many CPAP recording devices.”

Results so far show that 87 percent of patients are using their oral appliance long-term and sleep nearly eight hours a night with it.

Looking to the Future

LIDSM has grand plans moving forward. While remaining a frontrunner in the latest technology and equipment remains essential to the practice, raising awareness about sleep apnea is the next big step.

Dr. Neal Seltzer, Dr. Jeffrey S. Rein and the staff of Long Island Dental Sleep Medicine

“We need to begin educating parents, teachers and pediatricians on looking for the signs and symptoms of sleep apnea in children,” says Dr. Rein. “With the increase in childhood obesity, more and more children are developing sleep apnea.”

While oral appliances are not yet approved for children, interventions can take place through diet, exercise and orthodontic dental treatment to correct the anatomy of the airway before the problem becomes severe.

“What we are doing is saving lives,” says Dr. Seltzer. “Twenty-five years ago, we never would have thought this would become a major part of our dental practice. Once you experience that feeling, it’s hard to let go of it. That feeling has fueled the passion and drive we have had to continually build our dental sleep practice.”

To learn more, visit www.lidentalsleepmedicine.com.