Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises...
Transcript of Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises...
![Page 1: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/1.jpg)
CoordinatingProfessionsResolvingaBrokenModel
NorthAmericanSleepSymposiumFebruary15-16
HiltonClearwaterBeachResort
![Page 2: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/2.jpg)
DentalSleepMedicinePromises
• Sleepgurusandindustryhaveclearbiasintheirattemptstorecruitmoregeneraldentistsintothefieldofdentalsleepmedicine
• Onthesurfacethereareseeminglyobviousadvantagestolearningtopracticesleepmedicine– Savinglivesasopposedtorestoringteeth– Economic– EaseofPractice,physicallyandmentally– IncreasedPatientAppreciationandLove
![Page 3: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/3.jpg)
DentalSleepMedicinePromises
• YETmanystruggle–andmanyfailovertimeintermsofsuccessfulimplementation
• HIDDENCHALLENGES
![Page 4: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/4.jpg)
ChallengesofDentalSleepMedicine1. Dentist/Physician Bias
2. Competitive Arena 3. Issues of Diagnosis
4. Economic 5. Communication with Physicians and Dentists
6. Referral patterns 7. Learning Curve of Sleep Medicine
Oral appliance Selection and Therapy and Testing 8. Bruxing : Dealing with Dental Myths of Occlusion and Parafunction
9. Other Untoward Effects
10. DENTAL MODEL VS. MEDICAL MODEL
Glassman, B. H. (2011). "The Hidden Challenges of Dental Sleep Medicine." DentalTown Magazine
12(5): 20-24.
![Page 5: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/5.jpg)
ChallengesofDentalSleepMedicine1. Dentist/Physician Bias
2. Competitive Arena 3. Issues of Diagnosis
4. Economic 5. Communication with Physicians and Dentists
6. Referral patterns 7. Learning Curve of Sleep Medicine
Oral appliance Selection and Therapy and Testing 8. Bruxing : Dealing with Dental Myths of Occlusion and Parafunction
9. Other Untoward Effects
10. DENTAL MODEL VS. MEDICAL MODEL
Glassman, B. H. (2011). "The Hidden Challenges of Dental Sleep Medicine." DentalTown Magazine
12(5): 20-24.
![Page 6: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/6.jpg)
ChallengesFacingtheDentist• FollowupCare&ManagementofComplications– TheimportantRisk/BenefitDecisionConcept– OcclusalConceptsandMyths
MODELCHANGINGandDEFININGSUCCESSEDUCATINGPHYSICANSANDPATIENTSNote:PhysiciansOftenuse“TMJComplications”asacontraindicationforOAT.
TREATINGATRUEMEDICALDISORDERWHICHINVOLVESMANAGEMENTRATHERTHAN“CURE”
![Page 7: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/7.jpg)
TheBrokenModelWeakestLinkintheChain
![Page 8: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/8.jpg)
TheBrokenModelUnderstandingtheHistory
Medical Dental
![Page 9: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/9.jpg)
HistoryofSleepMedicineAYoungScience
• CatondemonstratesactiveEEGinanimalsin1875,butnotidentifiedinhumansuntil1929(Berger)–formanyyearsthesleepingbodysleepingbrainconceptcontinued
• CatonR.Theelectriccurrentsofthebrain.BrMedJ.1875;2:278.• BergerH.Überdaselektroenkephalogrammdesmenschen.Arch
PsychiatrNervenkr.1929;97:6–26.
• KleitmanidentifiesREMin1953• AserinskyE,KleitmanN.Regularlyoccurringepisodesofeyemobilityand
concomitantphenomenaduringsleep.Science.1953;118:273–4.[PubMed]
![Page 10: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/10.jpg)
HistoryofSleepMedicine• 1956-Burwellpublishestheirclassicdefinitionofobesityhypoventilation
• 1966-DiscoveryofOSAwithPSG’sbyGastaut• 1978– RemmersrelationshipbetweengenioglossusEEGandintraluminalairwaypressure
BurwellC,RobinE,WhaleyR,etal.Extremeobesityassociatedwithalveolarhypoventilation:APickwickiansyndrome.AmJMed.1956;21:811–8.[PubMed]GastautH,TassinariCA,DuronB.Polygraphicstudyoftheepisodicdiurnalandnocturnal(hypnicandrespiratory)manifestationsofthePickwickiansyndrome.BrainRes.1965;2:167–86.[PubMed]RemmersJE,deGrootWJ,SauerlandEK,etal.Pathogenesisofupperairwayocclusionduringsleep.JApplPhysiol.1978;44:931–8.[PubMed]
![Page 11: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/11.jpg)
HistoryofSleepMedicine
• 1978CertificationinSleepCreated
• TheAcademyofDentalSleepMedicine(ADSM)wasfoundedastheSleepDisordersDentalSocietyin1991byeightdentistswithaninterestintreatingpatientswithsleep-disorderedbreathing.
• 1991AmericanBoardofSleepMedicine
![Page 12: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/12.jpg)
HistoryofSleepMedicine
• 1979ColinSullivan/CPAPIntroduction
• PSGbecomestheGoldStandardforDiagnosis
• FinancialCommitmentsbyHospitalswithSleepLabs–The“GoldenAge”ofsleep
• Resistancetochange:– “Aspecialtywithonediagnosisandonetreatment”– HSTvsPSG– Decreasedreimbursementsovertime– Oralappliancetherapy– RoleofESSindiagnosis– CurrentStateofResidencyPrograms
![Page 13: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/13.jpg)
ORALAPPLIANCEHISTORY
• In1923,PierreRobindescribedglossoptosis(tongueobstruction)andusedamonoblocfunctionalappliancetomovethemandibleforward.
• LATE70’sCartwrightintroducestongueretainingdevice
• Thetitratableappliancethatallowedlateralmovementfollowe
![Page 14: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/14.jpg)
AlternativeTherapyHistory
• MedicineenamoredwithCPAPduetoitspredictablesuccessrate
• Compliancenowbeingmeasuredbyquestionnaires
• SurgicaleffortsgradedbysuccesswithoutposttreatmentPSG’s
• OralappliancesdeemedunsuccessfulbasedonpatientreportsandposttreatmentEpworthresults
![Page 15: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/15.jpg)
Landmark1995Study• LiteraturereviewinSleep– Firsttoestablishboththeefficacyoforalappliancesandestablishsuggestedpracticeparameters
– Reviewed21publications/320patientsexamined– IndicatedOA’seffectiveinsimplesnoringandmildOSA– AppropriateformoreseverecaseswithnoncomplianceofCPAP
– Schmidt-Nowara,W.,A.Lowe,L.Wiegand,R.Cartwright,F.Perez-GuerraandS.Menn(1995)."Oralappliancesforthetreatmentofsnoringandobstructivesleepapnea:areview."Sleep18(6):501-510.
![Page 16: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/16.jpg)
1999Schmidt-NowaraStudy• DemonstratesOATTherapysuccesswithsevereOSA• Unfortunately,theinitialstudyremainsimbedded
1999 Schmidt-Nowara Study Sleep and Breathing Vol 3 #3
n Reviewedpublicationsn ImagingofopenedairwaywithOAT
n 3controlledtrialsshowpatientsconsistentlypreferOATtoCPAP
n Laboratorycustomappliancesmorecomfortableanddurable
n FollowupisessentialduetoocclusalchangesandTMJcomplications
![Page 17: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/17.jpg)
Meanwhile……BackintheMedicalandCPAPWorld
• NSFnowgettingfunding• PrivateinsuranceandMedicareinvolvedinreimbursements
• “GoldenAge”offeesforPSG’sdropping• InsurancecompaniesbegintoexploreactualuseofCPAP—
• SMARTCARDSREQUIRED…COMPLIANCEDISCUSSION
![Page 18: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/18.jpg)
OATPotentialRecognized
• JohnRemmers• ColinSullivan• GrowthofSDStotheAADSM• Industrysupport– FDAAPPROVEDAPPLIANCECHOICES– ADVANCEMENTOFHSTFROMREMMERSTOWATCHPAT
![Page 19: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/19.jpg)
ThePhysicianBiasTheDentalKneeJerkReactionTheResultingCompetitive
Environment
![Page 20: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/20.jpg)
BiasContinuesDespiteMDAStudies
• Anandam,A.,M.Patil,M.Akinnusi,P.JaoudeandA.A.El-Solh(2013)."Cardiovascularmortalityinobstructivesleepapnoeatreatedwithcontinuouspositiveairwaypressureororalappliance:Anobservationalstudy."Respirology18(8):1184-1190.
• Vanderveken,O.M.(2013)."Perspectivesonthereductionincardiovascularmortalitywithoralappliancetherapyforpatientswithsevereobstructivesleepapnoeaintoleranttocontinuouspositiveairwaypressure."Respirology18(8):1161-1162.
![Page 21: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/21.jpg)
WhytheBias?• TMDQUALIFIEDEXPERTVSRESTORATIVEGURUSANDMYTHS/CHIROPRACTORS
• WEEKENDCOURSESCREATEDENTALEXPERTS– TRUESPECIALTYORTHEFALLINTOTHETRAPOFOSAORNOOSA
– ISDIAGNOSISREALLYANUMBER?– SHOULDDENTISTSBEMORETHAN“TECHNICIANS”CARRYINGOUTTHERX
• FRUSTRATIONHASLEDTOSIMPLIFICATIONANDATTEMPTSATENDRUNSAROUNDTHEMEDICALPROFESSION
• NONEOFTHISCREATESAUNIFIED“PATIENTCENTRIC”MODEL
![Page 22: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/22.jpg)
CLEARINDICATIONOFBROKENMODEL
![Page 23: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/23.jpg)
CLEARINDICATIONOFABROKENMODEL
• LOOKINGATREFERRALRATESTOSLEEPCENTERSFROMCARDIOLOGYOFFICESINHOSPITALNETWORKPLANS
• INABILITYOFSLEEPCENTERSTOENCOURAGEINCREASEDREFERRALS
• EPIDEMILOGYOFSLEEP• SLEEPSPECIALTYRESISTENCETOCHANGE– CPAPVSORALAPPLIANCE– HSTVSPSG– ROLEOFAHI– POLITICAL:EXECUTIVEDIRECTOROFAASMREMAINEDTHESAMEFOR21YEARS
![Page 24: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/24.jpg)
ResolutionoftheBrokenModel
• Medicinehastochange– HSTresistance– ReturntomorethanOSAconcernsandgivemorethanlipservicetoimprovequalityofsleepacceptingtheimportantroleofsleep
– DiagnosisandTreatmentneedstobecome“patientcentric”acceptingthescienceofalternativecaretoCPAP
– Needstopoliticallysupportevidencedbasedgrowth
![Page 25: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/25.jpg)
ResolutionoftheBrokenModel
• Dentistryhastochange– Educationalrequirementsneedstobelesspoliticalandmorecompleteandlessindustrydriven
– Thefactisthatsleepmedicineisdifferentthandentalspecialtiesandrequiresanalteredmodelforsuccessfulimplementationofapatientcentricmodel
– Thirdpartypaymentsneedtoberevamped–insurancecompaniesarenotwelleducatedintermsoforalappliancetherapy.
![Page 26: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/26.jpg)
TheDentalModelChangesRequired
• Needtobewelleducatedinanareatotallyforeignfromdentistry
• Needtobeabletoeducateourselves,ourpatients,ourstaffs,andphysicians
• Patienthistoriesandrelationships• Communicationwithphysicians,insurancecompanies,
![Page 27: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/27.jpg)
CommunicationIssuesWhoseDiseaseIsItAnyway?
1. BLACKBOXConcept2. Diagnosis3. TreatmentDecisionMaking
1. TechnicianworkingonPhysician’sRX?2. ORvaluable,respectedmemberofthe“team?”
4. SOAPNotes?TreatmentUpdates5. Ultimateresponsibility
![Page 28: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/28.jpg)
“EDUCATION: THE PATH FROM COCKY IGNORANCE TO
MISERABLE UNCERTAINTY.”
MARK TWAIN
![Page 29: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/29.jpg)
TheDentalModelChangeRequired
• Diagnosis– Morecomplex– Historydependent
• Treatmentdecisionmaking– NotsimplybasedonAHI– Coordinatedwithphysician
• ManagementvsResolution• Definitionof“successfultreatment”• PredictingSuccess:FearofFailure• RecordKeeping• Thirdpartypaymentrequirements• DealingwithdentalmythsincludingocclusalchangesandTMD
![Page 30: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/30.jpg)
CoordinatingProfessions
• TheGOAListocreateapatientcentricmodelthatappropriatelyscreens,diagnosesandintelligentlytreatspatientstodecreasethelikelihoodormorbidityandmortalitywhenappropriateandimprovethequalityoflifewhenappropriate
![Page 31: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/31.jpg)
CoordinatingProfessions
• GOALSMUSTBEIDENTIFITIEDANDAGREEDUPON
• AMODELTHATISWIN-WIN-WINMUSTBEESTABLISHED
• GREEDAND/OREGOWILLDESTROYANYCHANCEOFSUCCESS
MODELCHANGESAREREQUREDBYBOTHTHEPHYSICIANANDTHEDENTIST
![Page 32: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/32.jpg)
CoordinatingProfessions
![Page 33: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/33.jpg)
CoordinatingProfessionsPossibleSolutions
• Acceptingtheappropriategoals• Mutualrespectwithlackofego• Developingamodelthatiscoordinatedwithcurrenthealthcaredistributionrequirements
• Providingeasetothepatientastheymovethroughthescreeningallthewaythroughthetreatmentandmaintenancephases
![Page 34: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/34.jpg)
CoordinatingProfessions
• Howdowefindtherightphysician?• Howdoweeducatetherightphysician?
• Possiblemodelsincludingtelemedicine
![Page 35: Coordinating Professions Resolving a Broken Model · 2019-01-14 · Dental Sleep Medicine Promises ... F. Perez-Guerra and S. Menn (1995). "Oral appliances for the treatment of snoring](https://reader033.fdocuments.us/reader033/viewer/2022050122/5f51f24a169c9f32a05f22db/html5/thumbnails/35.jpg)
OPTIMISMFROMDR.REMMERS
• Currentandanticipatedtechnologicaladvancessuggestthatwearenowembarkingonanewphaseofthisrelationship,onewherethesleepdentistandphysicianwillcollaborateefficientlyinwidespreaduseoforalappliancestomanageOSA.Inotherwords,wemaybeenteringaneweraofsleepmedicine,onewheredentalsleepmedicineplaysacentralrole.