When the folks at Henry Schein Dental set their sights on dental sleep medicine training, they focused on filling the educational gaps within this market segment.

Marketers love the one-stop-shop concept, but do customers like it? Ultimately, it all depends on the experts on staff. All too often, the “under-one-roof” locations are long on products and short on answers.

In the competitive world of dental sleep medicine training, it’s difficult to cover all the bases of economics, hardware, software, clinical considerations, and equipment. Al Simon, Director of Marketing, New and Exclusive Products, Henry Schein Dental, thinks his Melville, NY-based company has solved that problem with a new program called Sleep Complete.

“There was no one place where dentists could go to get all the education and products they needed to implement a successful dental sleep medicine program,” says Simon, who lives in Delaware. “They would have to go here to get education and there to get the product. Then they would have to figure out how to incorporate it into their dental practice.”

Integrating these elements into a busy restorative dentistry practice is the goal of Sleep Complete. One of the keys to making the vision a reality is Henry Schein’s partnership with veteran dentist and educator John H. Tucker, DMD, DICOI, DABDSM, the Erie, Pa-based owner of Erie Dental Sleep Therapy LLC. As the organization’s primary speaker, Tucker knows the challenges of rank-and-file dentists.

The Time is Right

Almost a decade ago, Henry Schein officials seriously examined the prospect of getting into dental sleep medicine training, but Simon says the timing was not right. An immature market made the venture impractical, but the idea didn’t stray far from the surface.

By 2012, insurance coverage had improved, and the market noticeably ripened. Simon pursued the training idea with gusto, taking a number of sleep courses himself and talking with key opinion leaders at the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM). He found a “fragmented” patchwork of educational opportunities, and immediately thought the considerable resources of Henry Schein could change the landscape.

Other luminaries inevitably felt the same way, and Sleep Complete eventually joined the educational stage with other respected entities. Despite the considerable competition, Simon believes that Henry Schein’s umbrella approach to incorporating all products and financing to the doctor will make it easier for dentists to access and develop a successful sleep practice program. “Even more important is that we are a company that so many dentists trust,” enthuses Simon. “We focused on our education right from the start, because the education needed to be on a level that I had not seen out there during all my visits.”

After 18 months in the educational planning stage, Sleep Complete emerged as a 2-day program. Schein encourages dentists to bring team members to the training venues. During the program, these team members are separated into different workshop areas to learn about the medical billing aspects and the proprietary Dental Writer software. Meanwhile, the dentists continue to learn about the clinical aspects of sleep.

Ultimately, the whole team gets the appropriate education, and all have access to multiple industry experts for each facet of dental sleep medicine. “Representatives from Itamar Medical [makers of the WatchPAT] usually bring about 20 of their home sleep tests,” explains Simon. “Because it’s a 2-day course, we can send 20 people back to their hotel room or home that night to take a home sleep test and bring it back. We can get the results for them and show them what the report would look like. It really helps to get people to understand the process of implementation.”

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Simon wants each clinician to be ready to go back to the office the next week and implement the program. He credits John H. Tucker, DMD, with making this a reality. “John was selected as one of the top 100 dentists in the country doing sleep medicine for 2012, and his practice was also selected as one of the top 100 dental practices doing sleep medicine,” says Simon. “He has been accredited by the AADSM, and John’s passion is apparent to the audience. He identifies with this audience. He’s not your typical key opinion leader. He’s been doing this for almost 10 years, and he’s been through what these guys are going to go through. They relate to him.

“If you look at many of the people on the circuit, they’ll have their own product or appliance, and John does not,” continues Simon. “He has no axe to grind. He tells everybody what they really want to know. Yes, we have the products they need, but more importantly we have the education and training to get them to the finish line.”

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Moses Oral Appliance

Partnership with The Moses

More than 100 oral appliances are currently on the market, and most do essentially the same thing—move the lower jaw forward to tighten up soft tissues in the back of the throat that block the airway. “I had several of these products made for me,” muses Simon. “I don’t have sleep apnea, but I just wanted to find out what the patient would be going through. The Moses™ appliance was the most comfortable—not that it’s the only product a dentist would use.”

According to Simon, the Dental Product Shopper and the Clinician’s Report have favorably evaluated the Moses appliance. “If there’s a reason to incorporate other products, I’m sure we will,” he says. “Maybe there are four or five appliances to satisfy every patient. We like the Moses because it activates muscles in the back of the tongue that actually move the tongue forward. And if you don’t get the tongue out of the way, you’re missing a big opportunity to correct the condition.”

Awareness High, Understanding Low

Over the last few years, Simon has spoken with a lot of people in the field of dentistry. After so many conversations, he characterizes sleep apnea awareness as high, but he thinks many dentists are so buried in traditional work that deep understanding of their opportunity to participate is lacking.

The mainstream media has actively promoted remedies for sleep disorders, and in some ways this phenomenon is forcing the hand of the dental profession. Patients will be demanding answers, and dentists increasingly need to acquire the knowledge that was only glossed over in most dental school curriculums.

“It’s true that dentists have been very cautious about getting involved with dental sleep medicine,” says Simon. “ Many feel the treatment of sleep disorders is outside the scope of their practice. It is part of our educational process to let them know that it is not.”

Physicians don’t fabricate oral appliances, because it is out of their scope of practice, and dental/medical insurance distinctions complicate matters. Dealing with these complications is the job of Sleep Completes partner, Dental Writer.

Dental Writer is a software package that makes it easier for the dental team to provide the documentation, referrals, letters, and claim forms for medical insurance that can be baffling. “Dental Writer is considered the gold standard in this area,” enthuses Simon. “It’s one of the reasons that our course breaks out the team members because they have to learn about medical insurance and how Dental Writer can help them.

“Again, education is really the key to this whole program,” adds Simon. “For example, we must constantly remind dentists that this is a medical condition with a dental solution, and they can’t diagnose it. Dentists must refer out to physicians to make this work. Anyone interested in learning more should go to http://sleepcomplete.com/ for more details.”

SIDEBAR: A Conversation with John H. Tucker, DMD, DICOI, DABDSM, owner of Erie Dental Sleep Therapy LLC, Erie, Pa.

Sleep Diagnosis & Therapy (SDT): What do fellow dentists appreciate most about your approach?

John H. Tucker, DMD: In our programs, I talk about how it can look like someone has taken a shotgun to our hygiene schedule that was completely full the day before. Most of us have seen many changes in our practices over the last five years. I was tired of going to programs and listening to people lie to me. I remember one of our attendees started to cry. She said, “This is so refreshing, because you’re telling me the truth. For years I’ve felt like such a failure in my practice because I can’t do what these speakers are telling me they do.”

SDT: How did you first get involved with sleep medicine?

Tucker: I was attending a post-graduate program at the University of Buffalo to obtain a Proficiency Certificate in Esthetic Dentistry in the late 1990s. Part of the program dealt with orthodontics. I met an ortho resident that was involved in analyzing the child’s airway prior to treatment. He explained to me why our son snored. From that point on, I was hooked on learning more about the importance of sleep for our overall health.

SDT: What did you like about Dental Writer?

Tucker: Rose’s software was the only thing available that would enable dentists to document all the information needed from a medical/legal standpoint for sleep, as well as the documentation that is critical for medical insurance.

SDT: In general, how equipped are dentists to handle the extra billing duties?

Tucker: We have entered the medical world. Most dentists have never been trained on how to bill medical, so Rose and her team at Dental Writer are pros at assisting dentists in being able to bill medical, as well as provide the needed medical documentation. Rose and I teamed up with the goal of me educating the doctors on oral appliance therapy, physiology, comorbidities associated with OSA, and she could educate the team on what is needed from a medical/legal standpoint for proper documentation and be able to bill medical insurance.”

That’s how we started. Initially, everyone wanted to expose the dental profession to the world of sleep and oral appliance therapy. But no one wanted to help us institute and bill insurance to get paid for it. That’s what Rose and I started on the quest about 3 years ago.

SDT: What attracted you to training and education?

Tucker: I found that the existing continuing education was good, but when I left the programs I felt that I had no traction. I could not implement what I’d learned because nobody was focusing on that. This is a medical disease with a dental solution.

SDT: How did you get involved with Henry Schein?

Tucker: It happened about 2 years ago. I have a personal/business relationship with some of the senior management team at Henry Schein. I have been encouraging them for the last 5 years that they should get into the dental sleep medicine market. Al Simon [Director of Marketing, New and Exclusive Products, Henry Schein Dental] is in charge of new products. They sent him to one of our programs, and Henry Schein decided to partner with Dental Writer from Nierman Practice Management, the Moses Appliance and Itamar Medical, because they have the WatchPAT, which is the home sleep testing unit.

SDT: How is the Itamar used in practice?

Tucker: We use the home sleep-testing unit like an apex locator in the clinical practice of dentistry. As dentists, we are not allowed to diagnose OSA. It must come from a physician. The use of the home sleep testing units such as the Watch PAT 200 is our apex locator. The patient takes the unit home and does a home sleep study to verify that we have efficacy of treatment with our oral appliances.

SDT: What has Henry Schein brought to the table in this process?

Tucker: Henry Schein, via Sleep Complete, has made it a complete turnkey process, because there was nothing like that out there. If you wanted an appliance, and there are over 100 FDA appliances approved for treatment of OSA, you’d have to go do your research. Then there is a multitude of home sleep testing units available. You had to figure that out. Then figure out billing medical insurance and documentation. When Schein completed Sleep Complete, they made it a one-stop shop by incorporating everything needed to adequately treat and manage the CPAP intolerant sleep patient.

SDT: What are some additional advantages that you offer?

Tucker: We help dentists to implement, institute, and most importantly bill insurance so you can get paid for it. That was my vision and why I wanted to work with Rose. Nobody was doing that. So let’s help these practices that want to get involved in dental sleep medicine get traction.

SDT: How important is the documentation aspect these days?

Tucker: Without the proper medical documentation, and being able to bill medical, practices won’t get traction. A lot of them tried to do fee for service. It’s a medical disease and here’s part of the problem. If a physician refers a patient to another health care professional, he expects the patient to be treated and managed.

SDT: Are people willing to pay cash?

Tucker: I found that people did not want to pay out of pocket. They expected their medical insurance to work. It became very apparent that we were not getting more referrals from the physicians.

SDT: What specifically did the physicians say?

Tucker: I talked to them personally, and they said, “You have failed to deliver the needed care to my patients because you want everyone to pay cash and that doesn’t work.” That was a huge step to have our peers [dentists] learn to work within the medical model. Medical insurance is far different than dental.

SDT: Do you focus solely on sleep in your practice?

Tucker: No. That’s one of the reasons I’ve been so successful in speaking to many of our peers in the profession. I’m a wet finger dentist. I still do restorative, crown and bridge, implant prosthetics and about 30% to 35% of my practice is dental sleep medicine. I’ve incorporated it, and I’m not limited to just treating OSA patients that are CPAP intolerant.

SDT: What is the level of awareness among dentists these days about sleep disordered breathing?

Tucker: From a dental standpoint, awareness is growing rapidly. However, I spoke to 300 physicians last February. Most of them had no clue that there was an alternative for the CPAP intolerant patient. My best friend is an ER doc. His son just graduated from medical school. I asked how many hours he had regarding sleep. The answer was 4 hours.

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Moses Oral Appliance
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