Story Behind ASAP Pathway
It seems like every dental course, every dental magazine, and every dental podcast is talking about sleep and airway.
Big-time, historically famous, post-graduate dental CE programs, particularly those focused on restorative dentistry, didn’t even have sleep apnea on their radar 10 years ago, blaming bruxism on 2nd molar interferences and insufficient canine guidance. Now evaluation of the airway is a primary focus and of greatest concern when management planning worn dentition cases and complex care.
Ten years ago there was 1 University-based mini-residency in Dental Sleep Medicine. Now there are 5.
Sleep and airway information is EVERYWHERE!
And now with all of us and our staff concerned about creating aerosols, unknown new standards, and costly infection control, and some patients being scared to return to the dentist, helping people with sleep apnea seems more appealing than ever!
You may feel like you’re drowning in a sea of information, and you’re searching for a lifeboat labeled WHAT TO DO! In adults, implementation isn’t easy, but at least there is a fairly clear pathway.
- Screen the patient for a possible airway issue
- Refer for objective testing
- If the patient is found to have sleep apnea, then they are referred for management (CPAP, oral appliance therapy, or surgery).
Of course, the devil is in the details… but overall, the adult pathway is pretty well defined, and very similar from state to state and country to country.
But what about with kids?
With children, the pathway is far less distinct.
The steps are pretty much the same… screening, referring/working with medical colleagues, objective testing, and management when indicated.
But HOW to do all these things is VERY different in children and can be SUPER FRUSTRATING for all involved!
Before the covid crisis hit I was attending “grand rounds” for our local sleep community. The presentation was given by a pediatric sleep doctor and was super interesting (regarding the use of a high-flow nasal cannula, without supplemental oxygen, for children with OSA… cool stuff!). At one point in the presentation, the doctor was reviewing various options for the management of children with OSA and he mentioned palatal expansion. He then said, “I wish we had more communication and collaboration with our dental colleagues with regard to this management option.”
So I marched right up after he finished and introduced myself as a dentist that was very interested in “more communication and collaboration.”
I then said, “Doctor, could you perhaps send me a list of pediatricians that I could refer patients to who will understand the need for further evaluation and won’t just blow off the patient/parent by saying ‘those tonsils don’t look that big to me.’”
His eyes looked up and away as he thought about my question. And then he said, “I really can’t think of anyone in particular.” So I followed up with, “so would I be able to refer patients directly to you?” And he said that would be great.
The problem is that he’s at a children’s hospital, the sleep lab capacity is limited, and getting a patient in takes a long time.
A VERY LONG TIME.
The BIG POINT that I want to make by sharing this story is that the pediatric sleep doctor couldn’t think of A SINGLE NAME of a pediatrician to whom he thought I could refer patients.
So that means, in my area, if any dentist was to screen a child in their practice for being at risk for sleep apnea, and encourage the mom to get the child into their pediatrician to bring it up, MOST LIKELY the pediatrician will say that it’s nothing to worry about! Unless the child is “lucky enough” to have golf ball-sized tonsils kissing at the back of their throat.
This is one of the most frustrating aspects of trying to help these kids! You know they need help, but how do you get them to the next step?
And there’s a BIG difference between children and adults…
Time is of the essence!
The 40-year-old fat guy who has been snoring since he was 18 also needs help, and the sooner the better.
But the 6-year-old who is still wearing a pull-up to bed, struggling with reading, and starting to feel like there is something wrong with him NEEDS YOUR HELP NOW!
I once heard a well-known speaker on sleep apnea ask the audience “how many nights without proper oxygenation of the developing brain would be too many nights for your child?”
Of course, the answer is “1 night would be too many.”
BUT YOU KNOW ALL THIS!
You know how important it is! You know how critical growth and development are to the long-term health and happiness of a child.
But where do you start?
This is, unfortunately, where the frustration level gets turned up to level 1000+!!!!
It seems like everyone talks about sleep and airway in children, but very few provide any guidance on what to do and how to do it.
The only people who seem to be providing any guidance at all happen to also be selling some device, functional appliance, advanced education course, special exercises, laser, etc., etc., etc.
These things are all great, and we’re lucky to have them, but when a program is industry-driven it always makes me question if I’m getting the whole story or just the story that supports whatever is being sold as the solution.
I went to a multi-day course once on a specific type of therapy that could be used in anyone but was more focused on children (because, due to growth and development, the results were often quite dramatic in children).
For 2 days they told me how awesome the therapy was.
Lots of time looking at research articles and case studies. I was sold… or I wouldn’t have been there in the first place… but they kept selling me and the others in the room.
Finally, on day 3, we spent about half the day going over the actual WHAT TO DO.
The SUPER DISAPPOINTING part of it though was that the “what to do” was gone over so fast that there was no way anyone in the room would have felt comfortable actually DOING what they just learned.
So more courses and instruction were offered. Seriously?
Probably most of the people in the room signed up for more because THEY KNEW HOW IMPORTANT IT WAS! The practical aspects of this 4-day program could have EASILY been presented in a single-day course.
And don’t get me wrong please… the course was VERY well done, but I just left wishing that I felt better equipped to help the kiddos in my practice.
NOW, one of the problems with a lot of these industry-supported courses is they often have to teach to “the lowest common denominator” in the room… which is often dental assistants or hygienists (or people from other healthcare-related fields, like physical therapists, speech pathologists, etc.).
It’s tough to be succinct in your education when your students don’t all have the same level of experience, education, and background.
So I kept looking.
I kept taking more courses.
I tried things as I became comfortable.
I spent tens of thousands of dollars, and many, many, many weekends away from my family.
And I started to put together the hundreds of puzzle pieces. After many years of struggle, frustration, and sometimes even heartache, a clear image was finally formed.
Here’s the deal…
This isn’t just my story.
This is OUR story.
Tracey, Stacy, and Michelle.
And, we are willing to bet that this is your story too.
You WANT to help the many children in your practice who need you.
You WANT to help your own children or grandchildren or nieces and nephews.
You WANT to be an advocate for healthy growth and development and expand your practice from “just managing” to possibly preventing!
But you don’t know how. You don’t know where to begin. The consequences are too great to do this in a half-hearted way.
So you’re stuck.
You don’t know how to move forward, but your heart and mind won’t allow you to move back. You can’t just ignore what you see in your practice every day. The stories from the parents. The stories from your friends about their children or grandchildren.
It’s too important.
That’s what we thought too. So we fought, struggled, practiced, and made just about every mistake that can be made while spending more money than we ever thought possible, and dedicating countless hours of our lives to the pursuit of excellence in the field of pediatric airway and sleep.
We had to bushwhack through the brush and weeds for a long, long time. But now there is a clear pathway for others to follow.
All of us spend a good portion of our time teaching our colleagues about pediatric sleep and airway and how we can help these wonderful children. How we can have an incalculable impact on their current well-being and their entire future.
How can you measure the impact of a child being able to get off their ADHD meds?
Can you measure the impact of a child finally being able to read at their grade level instead of avoiding reading out loud and feeling like they’re stupid?
What’s the impact of a child being able to participate in a sleep-over instead of having to get picked up early because they must wear a pull-up to bed and they’d die of embarrassment if their friends ever found out?
We can’t measure these impacts or their long-term effects either, but the tears of joy from the parents of the children we’ve helped tell at least a small part of the story.
And it’s this passion that historically made us take our time to be out on the road teaching others. But there is only so much that we can do in a few hours or even a few days of courses—AND NOW THOSE COURSES HAVE BEEN CANCELLED DUE TO COVID.
But people are getting back to work, and once again, EVERY DAY each of us has colleagues reach out to ask us questions.
“How do I do this? How do I do that? When do I do this? What should I do when this happens?”
While we’re happy to answer these questions, we realized that this is a VERY inefficient way to do things. SO WE PUT TOGETHER AN ALL-INCLUSIVE PROGRAM, AND YOU ARE INVITED TO BE ONE OF OUR 2020 FOUNDING MEMBERS!
We are members of Spencer Study Club.
If you aren’t yet, and you manage adults for sleep and TMD, you should be too. Spencer Study Club does have a little bit of information on pediatric sleep and airway, but not much—that’s not Jamison’s focus and he tends to teach what he knows works. We have been guest speakers at Spencer Study Club hands-on courses, teaching about myofunctional therapy and other topics… but there is never time to DIG DEEP.
The pediatric airway and sleep pathway is VERY different from the pathway in adults and a whole system is needed. A system that we’ve developed and actually use in our own practices.
We put our heads together and came up with an On-Demand Program, with all of the Mentoring, Helps, Forms, and Feedback necessary for you to FINALLY make Pediatric Airway and Sleep an Enjoyable and Profitable Part of Your Practice.