Dental Sleep Medicine Insider January DSM Insider 2018 | Page 28
RICK VAN GURP
WHAT DO YOU DO FOR A LIVING?
A it’s important for patients to know
where we are coming from and
what is involved in what we do.
Look closely, these are two very dif-
ferent answers. For example, when I consult with
patients, certainly I will show pro-
spective patients examples of dental
devices, how they work and even
the pluses and minuses of therapy,
but the consult primarily centers
around how I can potentially di-
rectly help or facilitate helping the
patient improve their quality of life
and breathe better while sleeping.
Oral Appliance Therapy happens to
be one aspect of how I will do it.
s dentists involved in Dental
Sleep Medicine, are we providing
a commodity or a service? Put an-
other way, on the occasion that you
happen to find yourself engaged in
small talk with a stranger and he/
she asks you what you do for a liv-
ing, how do you reply? 1) “I’m a den-
tist and I make dental devices for
sleep apnea.” or 2) “I’m a dentist and
I treat/help patients who have sleep
apnea”.
Partially, I bring this up as a con-
cern. Having practiced dentistry for
30 years, I’ve seen our profession
in some respects being reduced to
a commodity. A filling is a filling is
a filling, whether it gets done at Dr.
Smith’s, Dr. Jones’ or Dr. Wilson’s of-
fice. It’s still a filling. In my opinion,
certain outside influences want this
because if it’s all the same no matter
where you go, then it comes down
to the price. If there is no perceived
difference in the item, there is no
difference in the value. Answer 1
reduces dental sleep medicine to a
commodity.
But patients don’t belly up to a den-
tal device vending machine and on
a whim, select A4 for a Dorsal de-
vice, and C2 for a Herbst, and D1 for
a Dream TAP. Instead, in essence, we
provide therapy; we’re treating pa-
tients as in Answer 2 above. I think
It is extremely important for the pa-
tient to know that it’s oral appliance
therapy and not a piece of plastic. I
cannot emphasize this enough. I’m
not going to order their device on
Amazon Prime, get it in 2 days, stick
it in their mouths and be done with
it. With that in mind, it’s important
to make sure patients understand
the process – the importance of the
comprehensive examination, de-
vice selection, the initial protrusive
position, the acclimation period, ti-
tration to find what I call the “sweet
spot” that maximizes the positive
effects and minimizes side effects
and finally facilitate a titration sleep
test to make sure we are hitting the
mark. As Dr. Yatros and Dr. Drake
say, “I want to first help you to feel
better and then I want to make sure
you are breathing better.”
When I explain this to patients, usu-
ally a light bulb goes off. It’s not a
widget (commodity), and it is espe-
cially not an item that can be picked
up online; there’s much more to it
than that. It’s a therapy….
But oral appliance therapy may only
be part of the process. Is position-
al therapy necessary? Nose cones?
Perhaps, a referral to an ENT is war-
ranted to address issues with nasal
patency. If a patient comes to us
for help, we have to have a mind-
set of helping a patient who has a
serious, potentially life-threatening
disorder, and not as one who sim-
ply needs a dental device. Be the
patient’s advocate. We may even be
part of a team of healthcare profes-
sionals who help the patient and I
dare say, on occasion, we may find
ourselves as the leader of that team.
Dental Sleep Medicine is a service
and includes a therapy that can
change lives and save lives. It’s much
more than a piece of plastic. Make
sure your patients are aware of this.
So doctor, if I may ask, what do you
do for a living?
RICK VAN GURP,
DDS, FACD
Dr. Rick Van Gurp is a general den-
tist in Charlotte, North Carolina.
He has a solo general dental prac-
tice and a separate solo dental sleep
medicine practice. He has over 150
hours of continuing education in
dental sleep medicine including
having recently completed the Tufts
University mini-residency.
Dr. Van Gurp can be reached at
[email protected] and
704-220-1930.