Recognizing Sleep Apnea and The Role of Myofunctional Therapy with Dental Hygienist Jennifer Lyman

I've had the opportunity to sit down and have a deep and enlightening conversation with Jennifer Lyman, a devoted dental hygienist with a heart for recognizing signs of sleep apnea in children. It was fascinating to hear about her journey and how her experiences have shaped her practice and fueled her passion for educating others about sleep apnea, a potentially fatal condition that we should all be aware of. 

We also got to talk about the beneficial effects of myofunctional therapy in dealing with sleep apnea and other oral health issues. Jennifer shed light on the signs and symptoms we should look out for in both children and adults, along with the connections between sleep apnea and conditions like ADHD. She emphasized the criticality of referral to sleep centers and the potential hazards of ignoring what may seem as trivial as snoring. 

Towards the end, we tackled the complexities surrounding medical billing in dental sleep medicine and explored the essentials needed to successfully implement oral appliance therapy or myofunctional therapy. Jennifer underlined the importance of a dedicated team and the value of continual coaching and training. We also discussed how to navigate insurance coverage and ensure a smooth billing process for patients. For those eager to learn more, Jennifer shared her contact information. After listening to this enriching conversation, I'm sure you'll appreciate the crucial role oral health plays in our overall well-being.

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Transcript

Speaker 1: 0:25

Hi friends, welcome back to another episode of the dental billing podcast. I have a question that I want to ask you before we dive into this very interesting topic Do you know someone that snores? According to Harvard Medical School, snoring can kill you. They go on to say that sleep allows your body and brain to rest and recover from today's activities, and it's not just the quantity but the quality of your sleep that's important. The sleep can lead to a wide range of problems and the consequences can be deadly if persistent sleep trouble isn't addressed. Sporadic snoring can be a sign of sleep apnea, which can be serious. Sleep apnea is literally when a person stops breathing during sleep. As a result, the brain undergoes repeated moments of suffocating. In popular culture, snoring is viewed as funny and people often laugh when a snoring person lets out a sudden explosive snort. I know that we've all done that. The reality is, this loud snort is often the person gasping for air, as the brain is not getting enough oxygen.

Speaker 1: 1:39

Today's episode is dedicated to someone very special to me, my beloved auntie Isabel. She's, in fact, the reason we're here talking about this today. Sleep apnea has touched her life and countless others and, like myself, we have lost family members, because sleep apnea in adults is often untreated, and also with children. In this episode, I am joined by the amazing Jennifer Lyman, a passionate dental hygienist who is dedicated to identifying the signs of sleep apnea in children and early intervention. In this episode, we're going to talk about the connections between sleep apnea, oral health and overall well-being. Our goal with this episode is to educate and inspire. We want to inspire you to advocate and implement dental sleep into your practice and create awareness. So join us on this journey, as we remember my auntie, isabel, and we share our mission to raise awareness about sleep apnea. Jennifer Lyman, welcome to the Dental Billing Podcast.

Speaker 1: 2:53

We had a conversation not too long ago I would say less than a week ago, I think. We talked just kind of on the fly about billing and just to give the audience a little background as to how you and I were introduced, you and I worked together not necessarily work together. We talk about your business, your billing business that you have. That was about six months ago, I believe, so from there we just kind of kept in touch and then we got reconnected with recently regarding billing, and I think it was in that conversation we started talking about sleep and then dental sleep medicine, myofunctional therapy and we're both super passionate about you with early prevention with children infant, and me with my experience in losing my aunt to congestive heart failure as a result of having sleep apnea.

Speaker 1: 3:44

It just that conversation went on a little bit longer than we anticipated, but it was a great conversation and that's what led to this podcast episode, because I really do want to create more awareness around myofunctional therapy, early prevention and sleep apnea and how we in the dental field, as front office, back office hygienist, dentist, we can all be a part of the solution. So, with that being said, I love your story, I love your journey as a hygienist and you also made a transition over to the front. So, before we dive into all that, can you talk to the audience, let them know, talk to us about your journey as a hygienist and then talk to us about where this passion came from. That kicked all of this off.

Speaker 2: 4:33

Yeah, so I grew up from dental in 2012. So a while ago at the time I was pregnant with my son. I had just graduated college. I had my son about a month later from there waited for my license to kind of come in the mail and then I began practicing and what I noticed right off the bat being a hygienist is that we are kind of the frontline providers for preventative medicine. That was one thing that I really loved being a hygienist and do still love doing on different tips and tricks that they can use to improve their oral health care. Now, as we're seeing, a lot more systemic diseases are linked to oral and us as hygienists able to kind of combat that firsthand. And I was a hygienist for about 10 years before I transitioned to the front. I still am a hygienist one day a week because I love the profession and I love talking to people and I love just being that frontline person and just having connections with people.

Speaker 2: 5:31

So about three years ago I had some issues with my back. Being a hygienist is a very physically demanding job and I was having some issues with my back. I was unable to sit for long periods of time. I had to get a cortisone shot in my back, actually in my lumbar, and that was kind of the wake up call for me that I don't think I can do this long term. As much as I loved being a hygienist, it just was not conducive to picking up my toddlers and running around with them and doing all of those things that I love doing as a mom and also just a person running things like that. So I had to get that cortisone shot and that kind of pivoted my entire career. At that time I transitioned to helping start up a practice from ground zero so zero patients, remodeling, starting from zero patients and now growing that business as a bill or now and as a hygienist initially with that practice, that same practice for the last three years. In that timeframe I learned a lot from credentialing.

Speaker 2: 6:30

I said, yeah, so much credentialing to pre-authorizations and posting payments and I just kind of fell in love with it and talking to patients and I didn't have kind of that barrier of asking for payment or anything because I knew the value of it from being a hygienist. It was a very interesting transition. A lot of hygienists won't go to the front office because of course it's less pay, it's you're not interacting with patients quite as often. But I ended up just really loving it and just ran with that. From there I had multiple people asking me could you help me with speech therapy, billing, or could you help me with OT? Then I had a friend that was an eye doctor that wanted some help with billing and it just cascaded into now my business that I work today on a day-to-day basis.

Speaker 1: 7:17

Let me ask you, then, what has been some of the biggest aha moments. From clinician to biller that's quite a transition. What were some of your aha moments? Because I'm sure, as a biller, if I went back to school to become a hygienist, I'd be back there going, oh wow, that's why we are supposed to do that. I mean, there has to be some aha moments that you had. So talk to us a little bit about what that transition looked like.

Speaker 2: 7:44

Yeah, I mean, your verbiage changes a lot when you're a hygienist, when you know what the front desk has to deal with on a day-to-day basis. So even something as simple as fluoride, instead of saying something like I don't know if your insurance covers it, it's $49 or whatever it is, you just say this is why I think you'd really benefit from fluoride and this is why Then, when the patient goes up front, they don't have that disconnect between the front or the back of the money. They know that it was a value for them and they don't have to think, oh, what feed do I need to charge for this, or this is not worth it, or whatever, because you already added that value in the back.

Speaker 2: 8:19

So the front desk doesn't have to fight them on that, as well as pre-authorizations for crowns or bridges or different things. If the patient was really concerned about that, I just would reassure them in the back so that the front had cohesiveness with our conversations as well. It was so much more beneficial to know how the billing process worked when you're in a clinician as well, because you know what you need to document. They'll come back. Now. My notes are like pristine because I know exactly what diagnosis they need. A filler's dream. Yes, I know there are chief complaint that we have to put in there the verbiage for fractures that we need to put in the notes as far as exam goes, and different things like that were definitely aha moments for me. Oh wow, that's interesting.

Speaker 1: 9:32

Okay. So let's dive into what kicked off your passion, because I want to say it's a passion. I think the audience is going to hear that come through as we dive into what we want to create more awareness around, which is, for you, myofunctional therapy and sleep apnea. So talk to me a little bit about what kicked all of that off and where you are today as the clinician, because you are still a practicing hygienist. As a clinician, where are you and how do you help your patients with this passion you have?

Speaker 2: 10:07

Yeah, that's a loaded question. So about seven years ago or so I went to a continued education class and honestly, some of the continued education classes you're just going to check off the box, right, you need your credit to get your real licensure. This one was very different for me. This one kind of opened my eyes to a lot of personal things that I was going through as well as clinical. So it was a continued education course with a lactation consultant and a speech pathologist and at this course they spoke about myofunctional therapy and the benefits of it. I had never heard about myofunctional therapy prior to this continued education course and at the time I had a baby and I guess it was about nine years.

Speaker 2: 10:50

At the time I had a baby that had colic reflux, milk allergy, I mean, she was just she wouldn't latch when breastfeeding. And at the time posterior tongue ties anterior tongue ties, I mean anterior was definitely more prevalent than posterior. But they didn't really diagnose posterior tongue ties or give it the time of day. They just kind of laughed it off and they're like no, your baby just needs to latch better. But now, looking back, they really missed the mark on that one, because I think a lot of babies could have avoided reflux, could have avoided having lactation consultants with them every day Seems like the frustration, the postpartum depression that comes with all of that.

Speaker 2: 11:28

So that really kicked off my passion for myofunctional therapy. And then, moving that into clinical practice, I was able to learn all of those things. And then, you know, educate moms as they're sitting there with their baby and their you know stroller, whatever right next to me saying, hey, you should look for this. And then when they start talking, look for different things as well, and you can refer them to these people and really prevent any further issues from happening. So it really cascaded into clinical practice. And now I bill for myofunctional therapists as well as speech therapists, and I use myofunctional therapy. I'm not certified in myofunctional therapy I have friends that are but I'm able to educate patients on prevention and different things in practice.

Speaker 1: 12:08

So what are some of the things that you look for? Actually, let me back up, because there might be a few listeners that don't know what myofunctional therapy is, so can you go into what that is for those of our members in the audience that don't know what that is?

Speaker 2: 12:22

Yeah, so myofunctional therapy essentially retrains your brain where to properly rest your tongue, how to properly swallow and how to properly speak. So it's mostly involves training the tongue and takes a lot of repetition and different things to prevent that.

Speaker 1: 12:38

Okay, so now, what are some of the things that you look for? Is it just in children that you're looking at it, or is it in the adult patients that you have? What all are you looking at?

Speaker 2: 12:49

Yeah, so In pediatrics I pretty much look for a tethered tongue, whether anterior or posterior, a large tongue. Also, when I lay them back, if I can't see their uvula or their tonsils, that's a great indicator too that they could have like sleep apnea or something like that, and a lot of this stuff goes hand in hand. So if you, if most likely if a child, has sleep apnea, they need myofunctional therapy and they need a like a tongue click. Basically they need that lasered. So what I'm looking for in children is speech impediments really tired, honestly, sometimes some ADHD diagnosis, really like wired during the day and then can't fall asleep at night. Also, when I lean them back, if I can kind of hear that nasally breathing, I will also talk about myofunctional therapy and possibly refer them to someone as well.

Speaker 2: 13:39

In adults it looks very different but it definitely puts them in a high risk for sleep apnea if they have similar things. But in adults it shows up more as bruxism. So where on their teeth, if they already wear a night guard, that's kind of an indicator too. So, generalized, where I look for like large masseter muscles, those large cheek muscles that are constantly working at night If they're snoring, or even I have some patients that fall asleep during appointments. It's like an hour appointment and you're I mean it's not comfortable to get your teeth cleaned necessarily. So that's a big indicator Any daytime sleepiness.

Speaker 2: 14:14

Really high blood pressure when I initially sit them back and take high blood pressure. If they're snoring while they're sleeping in my chair, that's a huge indicator. If they're overweight and then also, as you know, the wear and an enlarged tongue and scalloping on the sides of their tongue will also indicate that they could have sleep apnea. Dentists and hygienists can't diagnose sleep apnea, but we can see those first signs and then refer them to like a sleep center from there where they can get tested. The scalloping is from their tongue is just so large trying to push against those teeth to try to find that airway at night. So they're grinding their teeth, their tongue's moving and they're trying to find that open airway that they just can't access.

Speaker 1: 14:54

Friends, what I want to emphasize here is that snoring is a huge indication of lack of oxygen while that individual is sleeping, and it's no joke. We really want to pay attention to the family members that are displaying those types of symptoms.

Speaker 1: 15:12

I know, sometimes you're talking to patients and they'll say you know, I feel tired. I had a full night sleep and I'm still tired. And that could also be an indication of them not getting oxygen or proper oxygen to the brain, which is causing them to feel tired. And there's so much more that I could say about that. So let's talk about early awareness or early detection. So what are your next steps? Well, who do you refer them to and how can we help other hygienists who are seeing similar symptoms in their pediatric patients? What should they do next?

Speaker 2: 15:47

Yeah, so if you have any indication of any risk factors, any of those things that we listed off for kiddos, I would refer just to cover your basis, to make sure that you're giving them the standard of care. I would find a myofunctional therapist in your area there are some hygienists that are myofunctional therapy certified, but primarily at speech therapists and find one in your area that you can connect with and that you can have a referral network with and just send them over there. A lot of them will just do like a tongue tie screening to see if that tongue is tethered. If it is, then they'll send them to like a dentist pediatric dentist that has that laser that can actually clip that and then from there they can do more speech therapy and myofunctional therapy for feeding and swallowing At those, those appointments too. They can help with some exercise to start thinning that attachment so it's easier for the patient after the tether is clipped to be able to use that in the proper way.

Speaker 1: 16:47

So this is a world, in terms of billing, that I have not been exposed to myself, so I'm going to ask you a question that I think a lot of listeners are thinking Does dental insurance cover any of these services?

Speaker 2: 17:00

No, it does not cover myofunctional therapy, yet Got it.

Speaker 1: 17:04

I didn't think so, because I have never heard of myofunctional therapy being a covered benefit, though I don't think I've ever really looked for that as a benefit, because I don't think it's very prevalent in dentistry right now. So, jennifer, can you explain to us what a tongue tether is?

Speaker 2: 17:21

Yeah, so everyone. If they lift their tongue up to the roof of their mouth they have a tether, basically a frenulum is what we call it in the dental world, and it's a skin attachment that attaches your tongue to the bottom of your mouth. And some people the posterior tether will basically be tied so your tongue cannot go all the way up to the roof of your mouth. So if you open your mouth as wide as you can and you try to put your tongue to the top of your mouth, a lot of people can. If you don't have a tether, that's not an issue.

Speaker 2: 17:50

A posterior tongue tie will be tied kind of on both sides of the tongue so it restricts access from the tongue to going all the way to the roof of the mouth, which expands that roof free, free mouth, which is where the proper development of child dentition should go. If you're unable to reach that, it can't expand your palate naturally, and so a lot of kiddos will end up having a really narrow palate which makes it difficult to speak, difficult to chew, difficult to swallow. An anterior tongue tie is even easier to catch. So if you have and this is kind of fun for kiddos in the dental chair if you have them stick their tongue out straight, like they're sticking their tongue out at you. I'm always like this is the one time I give you permission, stick your tongue out at me and the kiddos love doing that.

Speaker 2: 18:33

Yeah, and if they have kind of a heart-shaped tongue, they have an anterior tongue tie so that means that it's tied to the tip of their tongue so they really can't hardly move that tongue at all and we would not notice. Yeah, it's really hard to move around like pieces of food to swallow correctly. They can't push the tongue back to swallow the right way and they can't speak because they can't put their tongue through with your mouth to make certain sounds.

Speaker 1: 18:57

So how does this tie into preventive care for the children? Is this preventive in the sense of preventing sleep apnea in later years? But how does this prevent so many?

Speaker 2: 19:09

things. Yeah, so many things. And I'll give a disclaimer here. I'm not a doctor or anything like that, but I have seen and I've heard this by other speech and myofunctional therapist is that it can prevent ADHD diagnosis. A lot of kids are incorrectly diagnosed with ADHD because they're not getting that oxygen to the brain so their brain is just in high function all day long If they have sleep apnea.

Speaker 2: 19:31

Myofunctional therapy can prevent ADHD. It can give them a better night's sleep. It can prevent sleep apnea, bring more awareness to that. It is mostly preventative for orthodontra problems down the road. So if their palate is able to expand, they won't have crossfights as often, they won't have as much crowding, They'll have proper spacing for their adult teeth to come in. And with all of that comes the speech. If you're able to clip it early, they can speak properly at an early age and not have. I think there's a lot of middle schoolers, high schoolers now that this is becoming more prevalent that have speech impediments, that now they don't really want to get their tongue clipped when they're 13, 15 years old and then go down that route of speech therapy so early on. If we're able to kind of nip this in the bud early, then it's much, much easier for them to have a normal quote, unquote life as far as oral health goes.

Speaker 1: 20:25

Oh, absolutely, and I think that for me, my exposure to myofunctional therapy was with a colleague of mine, irene, and she was very passionate, or is very passionate, about myofunctional therapy, and I remember her talking about some of the symptoms of pediatrics sleep apnea and how myofunctional therapy can help improve the muscles around the jawline to help position the tongue while they sleep so that their airway can remain open. And one of the symptoms that she mentioned that for me, because it was new to me, was bedwetting, and you hear about children who are wetting the bed and this is a symptom of sleep apnea, from what I understand. So can you talk to us a little bit more about how, the type of symptoms, pediatric sleep apnea?

Speaker 2: 21:18

looks like Hyperactivity is a big one. Bedwetting lists Kitto has a list. They will also have difficulty speaking, choking while eating. We're foster parents too, and we had one Kitto that came into care that we were caring for, that just could not swallow. I mean, water was difficult for him to swallow, and so that was a big indicator that, okay, something's going on here and that was something that we needed to pursue. Those are the main ones. Snoring is a big one, and then grinding their teeth at night as well.

Speaker 1: 21:49

Oh, wow, and we don't think about stuff like that for pediatrics. We just think this is going to happen when we're adults, because we think kids are developing, so they shouldn't be displaying things like snoring and other areas where they're in their developmental stages, and so we just don't think about a child having sleep apnea. I really appreciate that you're sharing all the things that you look at as a clinician and how this is impacting their entire life. I mean ADHD. I think everybody here has heard about the over diagnosis of ADHD at some point. Again, I'm not a doctor, I'm just going based on my own experience with my son being diagnosed with ADHD. Turns out it wasn't ADHD, it was something else, but it was just very quickly.

Speaker 1: 22:39

He has ADHD. We're going to put him on stratera and I was used to put him on medication. I went with the biofeedback the route so that he could recognize what was going on with his body While he was either at peak or sometimes. Their brain cells are moving really slow. It doesn't necessarily mean that they're going 100 miles an hour, but we learned a lot and then, four years later, the medication that was given to him was taken off the market because it was causing suicidal. A lot of these people were committing suicide, so one of the side effects was the possibility of suicide and I was like there's no way I'm putting my son on these types of medications. It was many, many years ago. We're talking 20 plus years ago.

Speaker 2: 23:25

Yeah, no awareness.

Speaker 1: 23:27

Again, no awareness, and I wish that somebody had at least taken those things into consideration so that we could rule out certain things. One of the other things that I wanted to bring up is the oral appliance therapy for adult with sleep apnea, because we have a lot of patients who are non-compliant with their CPAP.

Speaker 1: 23:50

And the last study, that statistic that I heard was non-compliance and correct me if I'm wrong, jennifer, but the last study that I heard was a patient who has a CPAP who does not wear their CPAP four or more days per week is non-compliant. So we have a lot of those patients. As I mentioned earlier in the episode, my aunt passed away as a result of having sleep apnea. She died of congestive heart failure and she refused to wear her CPAP because she was claustrophobic and that's a real thing for a lot of patients who wear a CPAP. So talking to the patients about airway, talking to them about their alternatives with an oral appliance to help keep that airway open at night, literally could have had my aunt. You know, we could have had a few more years with her. I would have loved to have had that extra time with her, but awareness was just not there back then because we're talking only about 15 years ago and oral appliance therapy was I don't even know if it was a thing yet or if it was just emerging, but I know that I was not aware of it and working for I was working for did not talk to the patients about dental sleep medicine or airway or snoring or, you know, necks or comforts, I mean there are. None of that was going into the exam. So, you know, I really do think that and I'm happy to know that we are getting this new category of service in 2024. And we're getting a bunch of new codes related to dental sleep medicine, which is also going to increase awareness, and hopefully we're going to see a lot more providers incorporating things related to airway into their comprehensive exams.

Speaker 1: 25:33

Whether you get paid for it or not, I think it's. It should be, because it will save lives. She would have worn the oral appliance because it's like a night guard. Right, like it's. It's not. It's not like a night guard, but it's very similar to a night guard in the sense it's just something you put in. It brings your lower jaw forward ever so slightly and, voila, you're able to sleep at night and get a full night sleep. What are your thoughts around airway and incorporating that into an exam? Or, you know, just in general, in dentistry?

Speaker 2: 26:06

Yeah. So I think, first off, it's really important to think about like a new patient, somebody you've never seen in your practice before. You have no idea their history, and I think it's really important to get a full medical history to see if there's any risk factors like high blood pressure, if they already take medication for that. That's that should kind of pique your curiosity. As far as sleep apnea, I also think that every office should have a sleep questionnaire. You know, on a scale of one to 10, how tired are you during the day? Do you fall asleep? You know in the middle of the day Are you snoring? You know different things that we can already get a score for, so that we know how to document, you know, their risk factors and really give them comprehensive care. When I think about a comprehensive evaluation, the word comprehensive in and of itself should mean that you're evaluating everything that you possibly can for this patient and putting them first in their whole systemic health and just their oral health care. So one thing is documentation, getting the full medical history, including their medications. I think a lot, of, a lot of patients don't want to give you their medications because they don't think it's relevant, and it is so important for us as dental professionals to have that full list, and not only the list, but ideally the script too. You know how much are you taking, because that will indicate blood pressure, how high is your blood pressure that your doctor is monitoring for you. And also asking if they have had a sleep apnea test in the past. You know, have they been tested for that? And not in that too, not just a home test.

Speaker 2: 27:37

I've had patients that I've referred to. You know, go get a sleep study. And they were like, well, I'll just do the home test. And a year later you know, I kept talking with them they kept gaining weight, they kept having higher and higher blood pressure and I was like hey, did you ever get that sleep test? And he goes yeah, it was. It was negative though. And I was like I really want you to go into the center and get a sleep study because you can get inaccurate results with the home test. And sure enough, he had moderate sleep apnea and so moderate into yeah, moderate, and like how did that not get caught? But it's just so difficult to like manage all the wires and everything that you have at home. And yeah, it was. It was really eye opening for him, and he was actually a physician and he was a surgeon a pediatric surgeon.

Speaker 2: 28:18

Yeah, so he was really on diagnosed sleep apnea.

Speaker 1: 28:21

Wow, okay. So friends, just so, just for those of you that are new to the world of dental sleep medicine and sleep apnea, so when we're, when a patient is being tested for having sleep apnea, the they are mess, they are measuring the apnea, the hypopneas, and then it's like an index. So it's the AHI that they're measuring. And mild A H, mild sleep apnea zero to 15,. Moderate is 15 to 30. And then if the AHI is over 30, the patient has severe. And I have seen patients we we have in the offices I've worked at have always. I've always incorporated sleep because I'm passionate about it. In general, it saves lives. You can also bill it to medical, which we'll talk about in a second. But I've seen patients with AHI as high as 104. And that's terrifying. This is terrifying. And I remember I'll never forget, we saw a patient that had an AHI of 104. And I remember thinking this guy can die tonight. He had to be placed on a CPAP initially and then we gave him he was a truck driver and we gave him the alternative of an oral appliance for the nights that he didn't feel like you know, going through the trouble of the sleep, the CPAP. But within 60 days. This was the best part. Within 60 days we retested him I think it was a 60 day mark or somewhere around there and his AHI had dropped over 50% and he had lost 40 pounds. He reported so much energy like he was. Like. I've never had this much energy in my life. It was life changing and it was just one of those things where you know we took the.

Speaker 1: 30:06

My doctor took the time to examine airway. You can just see when he walked in. You knew he had, you knew he had sleep. You can see it. Yeah, you can feel free there. You know, just just thinking about you know what you think about some. When you picture someone who can't really breathe, you know they've got the dark circles under their eyes because they're not getting oxygen at night when they sleep. They're tired, their mouth breathing. You know there's just so many symptoms that you can just see as you get more of a skilled set of eyeballs, as I call it, and you just you know now you're looking at people in the grocery store and you're like that person definitely has, I know.

Speaker 2: 30:43

I do that all the time and with kiddos I'm like have you had them tested?

Speaker 1: 30:47

I know, I know and so you know like it's just. It's one of those things where it's such a rewarding thing to have in the practice because you're literally saving lives and for your extending lives, right? Let's be honest, had we given my aunt an oral appliance 15 years ago, I don't know that it would have saved her life, but it would have had a use to her life. You know, somebody's daughter, somebody's mother, somebody's sister, like if you have family members that are snoring, that's a really big indication that they may want to speak to somebody about getting tested for sleep apnea. Because it's not a joke, harvard wrote a brief paragraph and I what I like to do is lamb it. Patients are seated. I like to hand that to the patient so that they can read it.

Speaker 1: 31:31

And the study says snoring can kill you. And it's just a blurb, it's nothing crazy. So it's just in between the time that you know the patient is seated and the doctor is going to come and talk to the patient. It's just a quick read and it's amazing to see the interest that is the patient's express when they read that quick little article. You know what does this mean?

Speaker 1: 31:55

Snoring can kill, and it's a perfect way to open up the conversation to well, do you snore? And that just kind of. Well, no, not me, but my husband, oh my God. He sleeps in another room. And sometimes I've seen some humor added to that conversation like, hey, you know, you came to the right place because we saved marriages, right, because you know, a lot of times you've got this once spouse who snores and they end up in another room. I know this because I've had the conversations with the patients who are sleeping in separate bedrooms, you know. But it's so fascinating and I think, going all the way back to myofunctional therapy, prevention, for in children, looking at those, those risk factors that you mentioned, and then all the way into adulthood, what we're looking at and it's all related to, ultimately, airway, right, like it's the, like you said, the grinding, the shifting of the tongue, trying to find that open space, a place where we can get some oxygen while we're sleeping, our, you know as a hygienist.

Speaker 2: 33:01

You open up that conversation with something as simple as your Harvard study, or do you snore and then you have them for an hour Like you're about how precious.

Speaker 2: 33:11

That time is for an hour and they can't talk. So try to use that hour as education and even if it's not them, it gets their mind thinking about maybe their grandson or their neighbor or their friend or their brother or sister or whatever. You get their mind thinking about these things and then you know, as dental professionals, we can create awareness around all of this. I mean your friend, that was 140, you know his age, I was 140, that's 140 episodes per hour. So that means eight hours. You know he has a thousand episodes at night. And that's something to consider and really think about is they're not getting that REM sleep that they need. They're not getting the oxygen that is life for us as human beings.

Speaker 1: 33:55

And your body. Your body is not able to recover, the muscles can't recover, your memory isn't restored. I mean there's so much that sleep does for us. I mean it essentially just restores our entire body when we get proper sleep and when we have patients who can't even get past stage one, stage two, because the snoring just is constantly waking them up and bringing them back to stage one, moving from the clinical standpoint into the billing arena, it is also rewarding for our dentist to be a part of this. You know, revolution, if you want to call it, because it's still so new in dentistry.

Speaker 1: 34:34

I think if we can talk a little bit about why offices start and then stop right, because I have a lot of offices, a lot of dentists, who want to implement something like oral appliance therapy into their practice. However, they will also say I tried it but it doesn't work. I think because it is such a team effort and team-driven effort to ultimately help the patient understand, or motivate the patient to A understand. How do I, what am I filling out this sleepiness scale questionnaire for? Why do you need my medical insurance? It's just training the team to help them understand what their role is when we implement something like this? I mean it's something as simple as implementing a new service like implants. This is a new service. The team has to understand how to explain it to the patient. Have you heard of offices that implemented and then say it doesn't work, or success with that? What has been your experience?

Speaker 2: 35:35

Yeah, I would say most that I spoke with about doing implementing dental sleep medicine into their practices really do start out like gung ho. They're like we're going to do this. Everyone's on board Then. In the last three years especially, there's been a lot of turnover. It's retraining staff from everywhere, from the front office to the assistance, the hygienists, and then back up to the front office. Yeah, everyone has just shifted. There's a big shift happening, I feel like in dentistry clinical practice right now in general, trying to keep your staff up to date on all of the new research coming up, all of the new billing services coming up.

Speaker 2: 36:13

It's exhausting and I think it's a lot when you already have problems with staff and you have patients, and you have patients that you're trying to take care of already. It's just one more thing to add. It gets overwhelming and medical insurance in dentistry is an anomaly. I don't feel like everyone's like this big scary mantra that they just don't even want to touch when really it's not easy. But it's simple. It's very similar to what you're doing in a day-to-day basis. Anyways, it's just adding a diagnosis code and knowing which codes to bill out. I think it all comes down to training and knowledge and that ultimately is up to the dentist to really train their staff up.

Speaker 1: 36:52

Right, having the right resources to do the training. I believe that when an office decides to implement something like oral appliance therapy, myofunctional therapy, incorporating a speech therapist into the referral sources that we have, I think that that's going to require ongoing coaching for that office. It is not going to be worth the investment to just say, hey, I'm going to send you to a course and you're going to come back and we're going to magically have this smooth implementation of oral appliance therapy or myofunctional therapy. It is going to require ongoing coaching and how long that's going to take Is anybody's guest to be honest with you, because every office functions differently. Every team member learns differently.

Speaker 1: 37:40

I think that also investing in the ongoing coaching is going to help send the message to the team that this isn't just about our office. This is about we're investing in you and your knowledge and we're also ultimately going to be creating a better experience for our patients and helping to save lives. That's like, I think, for me when I used to go and train teams on implementing medical billing for sleep app for dental sleep medicine, one of the biggest things for the offices that we had massive success with, and then the offices that kind of just fizzled out. The difference that I saw was the buy-in from the team believing that we do, in fact, save lives with oral appliance therapy, with the prevention, with myofunctional therapy, helping kids get better sleep and helping them have better development. When the team buys into that, when they believe in the mission, there's massive success.

Speaker 2: 38:42

But when it can't just be about money?

Speaker 1: 38:45

it cannot be about money. It can't be about the money at all. No, I think sharing the same passion about helping people is going to be that common thread. And when you want to implement something like this, when we're all focused on saving lives and improving airway, improving better sleep, promoting better sleep, I think that the money becomes a byproduct of saving the lives. Right Like I can't imagine how much money can you pay me to save lives? You can't pay me enough, but because I'm passionate about saving people like my aunt, or maybe extending lives, I will do that all day long. And yes, I'm in. Tell me what it is.

Speaker 1: 39:24

My part is with this whole process. So I think, as we have offices that listen to this episode and now they're thinking should I implement myofunctional risk assessment or, you know, in children if this is a PEDA office listening, you know, should I do it in my general practice? First, make sure that you have the right team and you have a team that's going to buy into the idea of doing this, because it's not hard. The implementation is not hard.

Speaker 2: 39:52

The medical billing aspect.

Speaker 1: 39:54

It's not scary. You are using the same codes over and over and over again, just like we do in dentistry. It's the same crown code. You know, if you're doing a PFC, it's 2740. If you're doing a buildup, it's 2950. We know it's the same code over and over again.

Speaker 1: 40:11

It's just a small shift into the medical arena where we do have to provide a diagnosis code. We're starting to see that in dentistry anyways. So in dental billing there's going to be no difference with the diagnosis code being added to our dental claim form versus adding a diagnosis code to the medical claim form. So it's something that we're shifting over to anyways. And you know, as I was mentioning it for the medical billing aspect of it, I said you know we might as well just get ahead of the curve anyways, because this is coming down the pipe, like it's coming down the pipeline it is.

Speaker 1: 40:45

You're going to start to see an uptick in denials because there is no diagnosis code on the claim form and I'm talking about a dental claim form. So we might as well do it. And there's no difference when we're doing it for oral appliance therapy, myofunctional therapy, there's no difference. We are going to going to build medical for those surfaces. Process is now going to be universal right, like diagnosis code, procedure code. That's it. So you know, I don't think that one course is going to do it, but I do think a good, strong, base foundational course with ongoing coaching would be ideal for these offices to see success with this type, with this implementation for myofunctional therapy and for oral appliance therapy.

Speaker 2: 41:29

Yeah, they're going to need that support because everything is, you know, every year change, codes change and requirements change for payers and you have to be on top of that. If you don't have the proper documentation, they will automatically deny those claims and you will end up appealing everything and it's just a nightmare. So if you're able to submit those clean claims initially and have that coaching to really be confident in that your staff will be empowered, that way they will know that you know each person in that office, like you said, is saving lives.

Speaker 1: 42:02

If the team does not believe in the vision and what we're doing, then they're either going to stay and give this artificial harmony and low-product productivity or they're going to stay and buy in and give you a very high return on that investment. Coaching, ongoing coaching only works, I believe, when the team buys into what we're trying to accomplish.

Speaker 2: 42:25

Yeah, and you notice each other's strengths and weaknesses and can really like amplify those for people. If you have a really strong staff member that really loves doing the billing, give them the billing.

Speaker 2: 42:36

Yes, hand it over, You're going to get an advertisement yeah, Absolutely, People that love what they're doing and that really comes down to like that culture of those dental practices and how the dentist can, you know, manage that and if they have their team that's behind their mission of their practice, 100% they will. You know, you take care of your staff, they'll take care of you, and I firmly believe that.

Speaker 1: 42:57

Oh, I've seen it. I've seen it all. You and I have both seen a lot Dentistry.

Speaker 2: 43:02

you give all of yourself right. I mean every day, day in and day out. You are giving everything to that patient and all of your knowledge, all of your skills, everything. And so at the end of dentistry, at the end of a clinical day, for me, I am exhausted.

Speaker 1: 43:19

It's like a mental exhaustion, because you give everything and I, If there, was one thing, jennifer, that you could, one piece of advice that you could give to your fellow hygienist or a dentist who is thinking about Now they're thinking about myofunctional therapy and oral appliance therapy. What was that one piece of?

Speaker 2: 43:40

advice I would say take a continued education course. Just get the awareness you don't have to implement medical billing and sleep apnea appliance and myofunctional therapy in your practice tomorrow, but just start thinking about these things. Start looking for signs after you take that course, in your patients and continuing your education in this realm, because it is becoming so much more prevalent and I think it can really change the trajectory of a lot of people's lives.

Speaker 1: 44:10

I agree with that. That couldn't have been better said. So, wow, we have given our listeners a lot to think about here, and this has been a very deep topic. I'm really happy that you were able to come on and talk to us about your clinical background and the things that you look for the risk factors and if anybody has any questions, they want to take this conversation further with you. How can the listeners get in contact with you?

Speaker 2: 44:41

At the moment. Probably texting is the best, honestly. I'll put your number in the show notes. Okay, that would be great. Yeah, my email and my phone number is probably the best way to reach me at the moment. I am definitely happy to answer any questions. If they want to give me a phone call or whatever, Just set that up through text.

Speaker 1: 45:00

Yeah, absolutely so. Friends, you can look at the show notes. We're going to have a little bio about Jennifer in there and if you want to get to know her a little bit better, just go to the show notes. Information will be there so that you can continue this conversation outside of this podcast episode. Jennifer, it has been such a pleasure having this conversation with you. I cannot wait to get this episode out, because I do want to create that awareness and I'm pretty sure that we will end up doing a part two at some point, because you and I have a new project that we're going to be working on here and you guys, this is not the last you're going to hear of Jennifer, so you know I cannot wait to have you back.

Speaker 2: 45:38

Yeah, well, thank you for having me. It was a pleasure speaking to today and I really hope that this just takes off and more people become more aware of all of this.

Speaker 1: 45:46

I agree with you.